Search

The purpose of this study was to examine whether vehicle type based on size (car vs. other = truck/van/SUV) had an impact on the speeding, acceleration, and braking patterns of older male and female drivers (70 years and older) from a Canadian longitudinal study. The primary hypothesis was that older adults driving larger vehicles (e.g., trucks, SUVs, or vans) would be more likely to speed than those driving cars. Participants (n = 493) had a device installed in their vehicles that recorded their everyday driving. The findings suggest that the type of vehicle driven had little or no impact on per cent of time speeding or on the braking and accelerating patterns of older drivers. Given that the propensity for exceeding the speed limit was high among these older drivers, regardless of vehicle type, future research should examine what effect this behaviour has on older-driver road safety.

Technology Evaluation in the Elderly Network (TVN) was funded in July 2012 under the Canadian Networks of Centres of Excellence (NCE) program, to develop, rigorously evaluate, and ethically disseminate information about the use of technologies for the care of seriously ill elderly patients and their families. TVN’s vision is to position Canada as a global leader in providing the highest quality of care for its aging population. The focus is on the frail elderly with multiple chronic conditions, across all settings of care. As part of the NCE’s mandate and TVN’s strategic priorities and mission, we have developed a unique Interdisciplinary Training Program designed to promote and facilitate interdisciplinary learning by providing experiential and entrepreneurial opportunities. The goal is to develop Highly Qualified Personnel (HQP) with disciplinary, interdisciplinary, and transdisciplinary skills, experiences, and attitudes necessary to provide creative solutions to the complex and multi-faceted issues confronting the seriously ill, frail elderly. The TVN Interdisciplinary Training Program is based on an experiential learning approach that crosses health sciences, law, social sciences, and ethical aspects of working with the frail elderly. The program provides trainees with unique educational experiences that deepen appreciation for holistic care, increase exposure to interdisciplinary research through knowledge creation and translation projects, and advance intellectual and professional development. The goals for the TVN Interdisciplinary Training Program align with the NCE training mandate, which is to: 1) create a collaborative, multidisciplinary training program to develop HQP, 2) improve trainee’s viability for future employment, and 3) provide support to trainees to facilitate their success. The training program was launched in Summer 2013. We currently have over 120 HQP in approximately 23 different disciplines—including law, ethics, public policy, social work, engineering, and other disciplines— with an interest in improving care for the frail elderly participating in our training program. These individuals may be undergraduates, graduates, postdoctoral fellows, or working professionals. The program emphasizes the acquisition and application of knowledge and skills across all of its components. HQPs work in teams of four to identify and develop an online collaborative project. Online collaborative projects facilitate interprofessional collaboration through multi-sectoral and multidisciplinary learning by enabling interactions. They also participate in at least one, and up to two, external placements in a sector and/or discipline in which they have not been previously engaged, with reports or projects required at completion. Under the direction of their supervisors and mentors, students complete at least two academic products involving knowledge mobilization efforts. Mentorship is another component of the training program whereby HQPs meet with interdisciplinary mentors, patients and their families and support system (PFSS), and peers. After each meeting, they write a reflection on what they discovered through dialogue with their mentors, and how this discussion will influence their future studies and practice. HQPs collaborate online through a learning management system that provides opportunities to interact with colleagues, access disciplinary and interdisciplinary data, and diagnostic tools. There are three main ways an HQP can enter into the program: the Interdisciplinary Fellowship Program;as HQP within TVN-funded research programs; orin the Summer Student Award Program. One of the components of the TVN Interdisciplinary Training Program is to strongly encourage HQPs to disseminate their work through publication and meetings. The main dissemination event of TVN is the annual conference; the 2nd TVN Annual Conference on Improving Care for the Frail Elderly was held in Toronto, September 21–23, 2014. The goal was to bring together key researchers, practitioners, educators, policymakers, advocates, and organizations devoted to improving health care for the seriously ill, frail elderly, and to highlight HQP research. All HQPs in the Summer Student Award Program, the Interdisciplinary Fellowship Project, and 1 HQP in each TVN-funded project submitted an abstract for this conference. The abstracts were reviewed for quality and the authors presented them as posters during the conference. Herein we present the compilation of research abstracts that were presented by TVN HQP at our annual conference. The annual conference will continue to expand in coming years, and next year we will accept abstracts from all researchers who are engaged with the seriously ill, frail elderly., Introduction: Engagement in shared health-care decision-making has been recognized as an important, and often lacking, aspect of person-centred care. We aimed to draw on available theory, evidence, and experience to develop guidelines for engaging older adults and their families in decisions around their own health care. Aims: To share results from the CHOICE (Choosing Healthcare Options by Involving Canada’s Elderly) knowledge synthesis project. Guidelines for engaging older adults and their families in health-care decision-making will be presented. Methods: We conducted a realist synthesis (Greenhalgh et al., 2011; Pawson et al., 2005) of available knowledge on strategies for engagement of older patients and their caregivers in health care decision-making. The search methodology was informed by a framework for realist syntheses (Wong et al., 2013), as well as Arksey and O’Malley’s (2005) design considerations for scoping reviews. Our synthesis encompassed theoretical frameworks and both peer-reviewed and grey literature. Search terms included: health care, decision making, public, health care decision making, engagement, and public engagement. Expert consultation included interviews with academics (n=5), two focus group interviews with seniors and families, and two half-day workshops organized with our partner Patients Canada. Results: The initial search generated over 15,000 articles; of these, 2921 were pertinent to health-care decision-making and were retained for further review. Theoretical and empirical work identifies a range of strategies and levels of engagement of older patients, but offers most support for approaches in which older patients and families are informed and active partners in decision-making and equal members of health-care teams. Conclusions: We have developed guidelines and recommendations for creating productive partnerships between older adults, their families, and health-care providers. These partnerships can result in more informed clinical decisions, and more effective health care., Context: Effective literature searches are imperative to systematic review (SR) conduct. Failure to design comprehensive searches compromises the validity of results and conclusions. Unfortunately, the quality, comprehensiveness, and transparency of published search strategies are variable. Novice researchers may lack guidance to tackle such issues. We recently conducted a SR of trials comparing antipsychotics for delirium treatment to alternatives (pharmacological or nonpharmacological strategies) for adults in acute care settings. Purposes: To describe the methodology used to design the search strategy and study screening forms using the aforementioned SR for illustration purposes. Methods: With the assistance of a professional librarian, we queried the following databases for primary sources: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health, and the Latin American and Caribbean Health Sciences Literature. Concepts encompassed in our search strategy included: 1) the population (i.e., patients in acute care settings experiencing delirium), and 2) the intervention (antipsychotics) and comparison interventions (non-antipsychotic). For each concept, we identified controlled vocabulary provided by the selected databases (e.g., MeSH for MEDLINE, EMTREE for EMBASE), by navigating index trees and examining definitions provided in scope notes. We scanned relevant publications for additional controlled vocabulary, text words, and their synonyms. Appropriate truncations and wildcards were used to control for spelling variations; all possible drug names were included. Bolean operators were used to combine controlled vocabulary and text words using “OR” within each concept and “AND” between concepts. We applied the Cochrane filter for randomized controlled trials and a filter to limit to humans. No language restriction was imposed. Test searches were performed at various steps (before and after combination of terms) to ascertain the number of hits and to verify studies known to meet the inclusion criteria were present. The final search strategy was written for MEDLINE and thereafter customized to the other databases by a professional librarian. We searched for secondary sources in the Database of Abstracts of Reviews of Effects and the Health Technology Assessment Database. To identify other potentially relevant studies, we searched the Web of Science Citation Index, Conference Proceedings Citation Index and trial registration websites for ongoing trials, reference citations of selected publications, and contacted principal investigators of eligible trials and content experts. Pre-specified study inclusion and exclusion criteria developed in consultation with content experts informed the design of the study selection form. This form was piloted on 5 papers by 2 study team members and then applied after removal of duplicates and obviously irrelevant studies. Results: The search strategy yielded 16,925 publications following duplicate removal. After abstract and title review, 127 full text references were assessed; seven met inclusion criteria. Conclusion: Designing an effective search strategy that identifies all eligible indexed studies without high numbers of irrelevant studies requires careful planning and involvement of professional librarians. Despite a rigorous search strategy, we identified a large number of irrelevant studies with significant resources required to identify eligible studies., Traumatic Brain Injury (TBI) can be a devastating injury for an older adult. The elderly are more likely than younger adults to suffer emotional, physical and behavioural consequences and may require a longer period of time for recovery following a TBI. Much of what is currently known about recovery for older adults is based on information provided by family or clinician ratings. More recently, researchers and clinicians working in the field of rehabilitation acknowledge that a patient’s subjective perspective of their problems and the degree to which they are bothered by them is a critical indicator of outcome following TBI. Gathering information on the breadth and scope of the patient’s Quality of Life (QoL) is crucial information for clinicians caring for the elder, as well as researchers seeking to quantify the true burden of TBI, and may help to determine/predict outcome after a TBI. There is no current synthesis of the evidence on QoL measures used with TBI patients. As such, clinicians and researchers may be unclear as to which QoL tools are best suited for this vulnerable population. Implementing standardized QoL measurements will help facilitate comparison within a clinical practice and care for a single TBI survivor, as well as facilitate comparison across multiple survivors in research studies. Objective: This review assesses the scope, characteristics, methods of administration, dimensions of measurement and use in different types of TBI severity of QoL instruments used with older adults surviving TBI. Participants: Studies reviewed must have evidence of including patients at least 65 years or older with a TBI. Methods: We systematically reviewed six databases and extracted QoL instruments that were used to assess elderly survivors of TBI. Results: The initial search yielded 3145 abstracts. After removal of duplicates, title and abstract review, and full text screening, 73 articles were included for review. We uncovered a total of 27 multidimensional Qol tools that have been used with elder TBI survivors. Conclusions: We found five promising measures (based on frequency and currency of use) to consider for a measurement tool to evaluate of an elder’s perspective on QoL after TBI. The tools include the generic measure of SF-36, (also the short version SF-12), the EQ-5D, the WHO-QoL (also the short version WHO-QoL BREF), the Sickness Impact Profile, as well as the TBI-specific measure of QOLIBRI. There is limited literature that assesses QoL specifically for elderly survivors of TBI. As elderly individuals may have unique needs as compared to younger populations with regards to QoL following TBI, future research should be conducted to evaluate current measures and/or develop future measures that may be specifically targeted to the aged., Introduction: Engaging the community in health-care research and planning has been recognized as an important component of system improvement. The input and involvement of older persons is particularly critical, given that older adults are high users of the health-care system, but are often excluded from health research studies. Unfortunately, guidelines for how to engage older adults in these initiatives are not readily available in the literature. Aim: Guidelines for engaging older adults and their families in health-care research and policy will be presented, based on the CHOICE (Choosing Healthcare Options by Involving Canada’s Elderly) knowledge synthesis project. Methods: In the CHOICE project, we conducted a realist synthesis of available knowledge on strategies for engagement of older adults and their families (including other informal caregivers) in health care. The search methodology was informed by a framework for realist syntheses, as well as Arksey and O’Malley’s (2005) design considerations for scoping reviews. Our synthesis encompassed theoretical frameworks and peer-reviewed and grey literature. Expert consultation included interviews with academics (n=5), two focus group interviews with seniors and families, and two half-day workshops organized with our partner Patients Canada. Results: The initial search generated over 15,000 articles; of these, 1,624 identified as relevant to health-care research and planning were retained for further review. Theoretical and empirical work identifies a range of strategies and levels of engagement of older adults and their families in health-care research and policy. This project reveals that level of involvement should be authentic; appropriate for both the desired level of engagement of older adults and matched by the ability of the system to realize this involvement. Conclusions: Guidelines and recommendations for the engagement of older adults, their families and caregivers in health-care research and policy have been developed. Limitations: Due to the limited available information specifically focused on engagement of older adults (65+), our search strategy included papers focusing on engagement of all adults over 18 years of age, which may have limited the applicability of some of the findings. To overcome this, we held focus group interviews with older adults to review and interpret the study findings and develop recommendations specific to this population. Suggestions for future research: We plan to test the guidelines and recommendations from the CHOICE project, in collaboration with members of our SHARP (Seniors Helping as Research Partners) network., Background/Rationale: Older critically ill patients represent approximately half of all patients who receive life support with acute dialysis therapy while in ICU. However, we currently have very limited information on the optimal circumstances for starting renal replacement therapy (RRT) in older patients with acute kidney injury (AKI) and no specific data on older critically ill Canadians. This contributes to large variations in practice between providers and hospitals, and across jurisdictions, and undermines the optimal selection and delivery of high-quality care to older critically ill patients with AKI. Objective: The primary objective of this project is to evaluate whether in older critically ill patients with AKI there are clinically important differences in survival, receipt of life-sustaining therapies, commitment to ongoing support, and changes in goals of care amongst those who do receive or those who do not receive RRT while in ICU. Methods: This is a multi-centre prospective observational cohort study with a target accrual of 500 patients from 15 to 20 centers across Canada. Eligible patients will be 65 years of age or older, admitted to an intensive care unit (ICU), and exhibit evidence of AKI as defined by protocol. Both the presence of a drug overdose/toxicity that necessitates RRT initiation and/or the receipt of any form of RRT in the past 4 weeks will be cause for study exclusion. Upon fulfilling eligibility and obtaining informed consent (or deferred consent where permitted), participants will have baseline data captured and will be followed daily during their stay in ICU. In addition, participants and/or surrogates will be approached and interviewed to provide additional pre-morbid and baseline data specifically captured for OPTIMAL-AKI. Each participant will be contacted at 6 months and 12 months from time of enrollment to ascertain long-term outcomes. Progress: As of August 2014, recruitment is under way at 8 centers and greater than 10% of the target accrual has been achieved. We anticipate that seven more centers will become active before the end of the year and that recruitment will continue until autumn 2015., Objective: The objective of this preliminary review to scope the research literature was to identify the essential data elements to be included in a standardized transition form. Background: This project builds on the OPTIC Program (Older Person’s Transitions in Care) examining transitions experienced by NH residents, when they require urgent or emergent care and are transferred from their nursing home (NH) via emergency medical services (EMS) to an emergency department (ED). The OPTIC study conducted by our team found a substantial lack of information communicated consistently between providers and settings during transitions of care. Results identified significant gaps in medical information, documentation of care needs and inclusion of pertinent resident information and personal assistive devices (hearing aids, dentures and glasses). The latter were recorded as accompanying the resident less than 5% of the time. This is astonishing, considering the significant complexity and vulnerability of these older adults. As a result, the OPTIC team developed a communication form to pilot-test in a sample of transitions from 15 NHs to one ED and back. The data elements included in this form were informed by the OPTIC study results and a literature review that revealed the essential medical information and documents required for residents during transitions of care. Methods: This preliminary review focused on the transitions of care that older adults experience. Searches for scientific articles were conducted using Medline, Psycinfo and EMBASE, and Google Scholar for grey literature. To be considered for inclusion in the review, articles had to meet the following criteria: 1) published in English, 2) between the years of 1995 and 2013, 3) address transitions of care between NH and ED, and 4) address questions relevant to the nature of communication, documentation, and information shared between providers. Studies were excluded if they addressed the handoff process in one care setting. Following title, abstract and manuscript review, 16 articles were included and essential data elements used for documentation were extracted and tallied once for each article in which they were listed. Results: Over 75 data elements were found and grouped into the following categories: transfer information, resident history, medication, basic vital information, mental status information, physical status information, precautions, resident focused information, information from sending facility, information from receiving facility, and information from more than one setting. The top scoring data elements from each category, respectively, included reason for transfer, past medical history, current medications, recent vital signs, baseline mental function, baseline physical function, allergies, DNR/code status, provider facility contact information, treatment provided, and recent lab work results. Implications: Based on pilot-testing of these essential data elements, we hope to confirm that a standardized evidence-based communication form used by all health-care providers across settings during transitions of care improves communication, provides evidence for best practice, and ultimately results in better care for NH residents. Furthermore, this preliminary scoping of the literature informs the protocol required for a full systematic review of the literature on essential communication data elements during transitions of care., Long-term care homes provide aging adults with assistance with activities of daily living, scheduled leisure activities, and medical services. Our work focuses on designing a socially assistive robot named Tangy, which will help residents in long-term care facilities with maintaining social connections and cognitive ability. Tangy is designed to autonomously schedule, facilitate, and promote engagement using the group recreational activity Bingo and telepresence sessions for residents. Focus group sessions were conducted with elderly residents, family members, and health-care professionals from a long-term care facility to obtain feedback about the design considerations, attitudes, expectations, and acceptance of Tangy. Participants were shown demonstrations of Tangy’s capabilities and then guided through an open discussion. The focus group sessions were transcribed and organized to identify recurring themes throughout the participants’ responses. The results show that the participants indicated that Tangy could be beneficial for long-term care residents and health-care staff. They believed that Tangy could help alleviate the recreational staff’s work load by facilitating Bingo, and they were enthusiastic about the ability of the telepresence activity to help residents connect with their families. Moreover, health-care staff and family members suggested a wide variety of additional assistive capabilities to promote engagement and acceptance of the robot, such as multiple-language support, reminders and prompts, and modifications to the robot’s appearance. Furthermore, they were generally positive about the introduction of socially assistive robots in the residential care homes, although some concerns about various barriers to the adoption of the technology were brought up., Intensive Care Unit (ICU) patients are the sickest patients in a hospital and receive constant, one-on-one, specialized care in an environment utilizing life support technologies and significant resources (Field, Prinja, & Rowan, 2008). When their condition improves, they are usually transferred to a regular hospital ward, an environment with fewer resources and staff. Patients and their families often find the transition from ICU to a hospital ward very challenging. Here they become ‘one patient amongst many’ (Field et al., 2008), and the nurse to patient ratio switches from one-to-one to one-to-many. Moving these vulnerable patients to an environment with limited resources is a risky medical transition and, due to the demand for ICU beds, patients may be given little advance notice of their move (Forsberg, Lindgren, & Engström, 2011). In Canada, over 250,000 patients will be transferred from ICUs this year; however, many patients will suffer adverse consequences during the transition (Forsberg et al., 2011), and 18,000 patients will be re-admitted to the ICU (Leeb, Jokovic, Sandhu, & Zinck, 2006). These data indicate both the risk associated with ICU to hospital transfers and the inadequacies of the transition process. (Field et al., 2008). Relocation stress and transfer anxiety are terms frequently used in the medical community to describe the transition experience (Chaboyer, 2010; Suen, Lee, & Wong, 2010). Previous research describes patients who are transferred from ICU to hospital ward as exhibiting both physiological stress (altered heart rate, blood pressure, respiration, and sleep patterns) and psychological stress (insecurity, fear, anger, and tension) (Suen et al, 2010). Data suggests that family members exhibit similar emotions such as fear, mistrust, and vulnerability (McKinney & Deeny, 2002; Odell, 2000). We are conducting a study to better understand patient and family experiences during patient transfer from ICU to hospital ward. The goal of the study is to improve ICU to ward transition experiences by listening to the lived experiences of patients and families. The research question guiding the study is: What are the experiences of patients and family members when a patient is moved from the ICU to a regular hospital ward? Data will be collected using the PACER (Pacer and Community Engagement Research) method of peer-to-peer research to engage patients and families. (Marlett & Emes, 2010). PACER is a collaborative inquiry and research framework consisting of three phases: SET (initial phase, which involves a focus group of representative participants who share relevant experiences and become advisors to help set the study’s direction and goals), COLLECT (data collection and analysis phase, which involves up to 12 semi-structured interviews with patients and family members), and REFLECT (final phase, which involves a focus group with the original SET participants to review the findings, analyse data and identify recommendations). By listening to and analyzing the lived experiences of patients and families, we will gain a deeper understanding of the transfer experience. By engaging patients and families throughout the entire process, our research will be distinguished from more traditional investigations., Background and Objectives: Older adults with chronic life-limiting illnesses present unique challenges within acute care hospital settings. The use of quality of life (QOL) assessments may enable clinicians to more efficiently attend to fluctuations in patient and family caregiver’s QOL. The aim of this integrated knowledge translation (KT) research project is to adapt and integrate an electronic tablet/mobile practice support system for clinicians in a tertiary palliative care setting. This system will facilitate routine assessment of concerns and needs relevant to the QOL of older people with chronic life-limiting illnesses and their family caregivers. We refer to this as a Quality of Life Assessment and Practice Support System (QPSS). This project involves three phases: 1) Preliminary development—using focus groups with clinical team members to inform the selection of appropriate tools and to tailor the system; 2) Usability testing—a small subset of clinicians, patients, and family caregivers will be invited to try the system and provide feedback; and 3) Implementation—making the system available for routine use by any clinician on the unit. The purpose of this abstract is to present the results of Phase I of the project. Methods: Phase 1 included a diverse sample of eleven clinicians who participated in 3 audio-taped facilitated focus groups (FG). The initial FG asked participants to consider: 1) ideal characteristics of QOL assessment instruments; 2) feedback system features to report assessment information to clinicians; and 3) linkage with site-specific practice recommendations. Findings from the first FG were presented to participants in the 2nd FG, including four potential QOL instruments comprising both patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs). Participants were encouraged to express concerns and identify potential barriers related to these instruments. FG3 included an initial demonstration of the QPSS and discussion about the incorporation of existing practices/protocols. Results: Clinicians revealed that they wanted instruments that assessed various social, physical, psychological, and existential aspects of QOL, satisfaction with the care team, and communication with family regarding advance care planning. Desired features of the feedback system included: the capability of amalgamating and presenting data visually (e.g., graphs); visualizing changes over time; ranking areas of greatest concern/needs; accessing assessment results in “real time” at the point of care; printing reports that can be used in rounds and filed in paper charts; preventing duplication in documentation; and simplifying documentation where possible. Desired features of the device itself included: be lightweight; be easy to use; and have the ability to be cleaned/ sanitized between uses. Additionally, recommendations were that automated prompts address areas of concern/need, interventions could be tracked and existing available practice recommendations be easily accessed. Conclusion: Clinicians’ perspectives helped determine which QOL assessments may be most applicable to their practice setting, how these might best be integrated into their practice, and what reporting and feedback features are desired. Next steps include using clinician, patient, and caregiver feedback to evaluate and further adapt the QPSS., This work focuses on designing the functions and behaviours of the robot Tangy in order for the robot to provide assistive activities to residents of long-term care facilities. The assistive activities include facilitating both a Bingo game with a group of users and a one-on-one telepresence session with a user and his/her family members/friends, as well as also providing reminders. The Tangy robot is designed to: 1) navigate through the environment using a combination of different sensors, 2) detect users of interest within the environment, and 3) interact with these users using speech, gestures, and a touch screen tablet. Each activity requires certain assistive behaviours to be executed. The Reminder activity performs two distinct behaviours, which consist of navigating to where the user is located and providing a reminder to the specific user regarding an upcoming activity. The main behaviours for Tangy when facilitating the Bingo activity are separated into three categories during the game: 1) calling out Bingo numbers, 2) providing assistance, and 3) providing social utterances and gestures. The behaviours for the Telepresence activity are to navigate to where the user is located, prompt the user for the video call, and track and follow the user during the video session. We describe some initial performance results of Tangy (e.g., sensing & behaviour selection accuracy) from a preliminary study., The purpose of this poster is to describe how collaboration with knowledge users shaped the direction of a knowledge synthesis research study. The aim of the knowledge synthesis project was to produce evidence-based recommendations for the selection and utilization of patient- and family-reported outcomes (PROMs) and patient- and family-reported experiences (PREMs) for seriously ill elderly patients and their families in acute care settings. The knowledge synthesis was informed by the initial stages of the Knowledge-to-Action framework and included close collaboration with an intentionally selected and diverse team. Team members were invited from local and national communities of researchers, content experts, well-connected knowledge users, decision makers, and trainees. These team members represent a variety of areas including government, local health authority, medicine, nursing, psychometrics, and library sciences. Knowledge users partnered in developing the aims and objectives of the project, and collaborated in shaping the knowledge synthesis processes along the way. The team members were engaged on an ongoing basis to identify gaps, refine synthesis questions, discuss emerging results, and prepare for knowledge translation. The strength of having a diverse team approach is that research is shaped so that research outcomes become relevant to multiple populations, including various user communities. One example of multiple perspectives within the research team is that clinician team members valued the clinical usability, while researcher team members emphasized the importance of ensuring reliability and validity of the instruments. A flow chart illustrates the collective team’s contributions throughout the research study. Overall, the poster demonstrates how knowledge synthesis processes may need to be adapted on an ongoing basis to ensure that the results are meaningful to researchers and knowledge users who have different disciplinary and professional backgrounds., Background: Patients surviving critical care experience residual disabilities, with long-term consequences, challenging their return to pre-injury/illness roles. Occupational therapists (OTs) are experts in facilitating recovery from disabling conditions. However, the OT role is inconsistent and infrequent in many critical care settings and not clearly defined. To establish an OT niche on the critical care team and support best outcomes for patients, these shortfalls require in-depth, interdisciplinary exploration. To begin addressing this need, we designed this scoping review to systematically identify and explore reports describing the current and potential OT role in critical care. Methods: We searched MEDLINE, CINAHL, Web of Science, Scopus, Cochrane Library, ERIC, Social Science Citation Index, and SSRN from inception to November 2013 for all documents discussing the role of OT in critical care. We sought documents (original research (quantitative and qualitative), review articles, practice guidelines, editorials, commentaries) mentioning current or potential OT role(s) of activities involving the care of patients, their families and support of critical care staff, with no language restrictions. An interdisciplinary review team (three OTs, one physiotherapist (PT), one critical care methodologist) examined the citations to select relevant reports. Independently, in duplicate, pairs of review team members screened study titles, abstracts, and full text for eligibility. Similarly, an interdisciplinary team (three OTs and one PT) abstracted data independently in duplicate from included studies. Discrepancies at all review stages were resolved by consensus. Results: The initial search identified 32,711 citations; thus, practical considerations for managing our yield necessitated modification of our inclusion/exclusion criteria. To focus on the most pressing critical care needs, the review team collaborated to narrow our selection criteria to include citations that suggested a possible OT role only in direct patient care within the critical care setting focusing on interventions. Title screening by four reviewers (90 hrs) identified 3,628 abstracts for further review. Abstract review (37 hrs) identified 1,217 reports for full-text review. To date, 709 full-text documents have been retrieved, and 216 met the revised inclusion criteria. Four reviewers have abstracted data from 173 reports (57 hrs). Preliminary results suggest that reports on OT in critical care are limited in number; varied in document publication type, study design, and methodological quality; and, widely span traditional and emerging OT roles. Conclusions: The interdisciplinarity of the review and data abstraction teams have been instrumental in distilling the large volume of citations, defining key concepts, and collegially resolving conflicts to capture the current state and potential contributions of OT in critical care. Preliminary analysis suggests a need for further research into the effectiveness of existing OT roles in critical care (e.g., mobilization) and role expansion to support recovery from disability for patients during and following critical care, emphasizing cognitive and psychosocial services. This dynamic, iterative interdisciplinary process may serve as an exemplar of how other disciplines can describe their role in emerging aspects of health care., Rational: Lesbian, gay, bisexual, and transgender (LGBT) older adults are often described as a doubly invisible population – invisible as LGBT older persons in the heteronormative environment of social services and health, and invisible as elders within the LGBT community (Brotman, Ryan, & Cormier, 2003; de Vries & Blando, 2004). More likely to be without partners and without children, the primary caregivers of older adults, LGBT older adults look to friends and chosen family for care and support in later life — those same persons who are less likely to be socially groomed for such care and less likely to have participated in such care discussions (Adelman et al., 2006; MetLife, 2010; Wallace et al., 2011). When this network is unavailable, unrecognized, or unaccepted, higher rates of loneliness and isolation result leading to further exacerbation of serious and life-limiting conditions (Kuyper & Fokkema, 2010). Objectives: This project has three primary goals: (1) to understand and describe the issues involved in and the preparedness for aging and end-of-life planning among LGBT adults aged 60 and over; (2) to share knowledge and resources that will foster and encourage individual action and develop a greater sense of community; and (3) to provide a safe and supportive environment in which information about planning for aging and end-of-life can be accessed and lead to action. Method: The first component, currently in progress, entails four focus groups in five major cities across Canada. Three groups comprise LGBT older adults: (1) gay and bisexual men; (2) lesbians and bisexual women; and (3) transgender persons. The fourth group consists of local service providers and agencies that provide services to LGBT older adults. Following the focus groups, a town hall meeting will be held in each city at which themes from the focus groups, state-of-the-field research findings, and information about services for LGBT older adults will be presented. The final component of the project is the development of a pilot Web-based resource that will allow further knowledge transfer to the community. Discussion: By initiating and facilitating discussions about aging and end-of-life planning within the LGBT community, and by making knowledge available and easily accessible through a Web-based platform, LGBT older adults will be empowered and motivated to use the resource as a community building tool, enabling individual and communal planning and support in later life., Background: With the aging of the population and concomitant increases in the number of individuals with acute and chronic illnesses, understanding the patterns of health services use among the elderly at the end-of-life is increasingly important to Canada’s health-care system. Accordingly, our objective was to examine health services utilization at the end-of-life, with a focus on sex-based differences in health-care use. Methods: This population-based retrospective cohort study included elderly (≥ 65 years) residents of Ontario who died between April 1, 2004 and March 31, 2013. Vital status data was obtained from the Ontario Registered Person Database and this information was linked to several population-based administrative datasets to describe health-care use. Indicators of use included hospital and intensive care unit (ICU) admissions, emergency department visits, and physician visits. Descriptive statistics are reported to describe the study population. Results: The cohort included 764,081 decedents, 50.6% of whom were women and 46.1% died in hospital, with 22.5% of in-hospital deaths occurring in the ICU. Compared to men, women were older (mean 78.6 (14.6) vs. 73.2 (15.3) years), had fewer deaths occurring in hospital (43.8% vs. 48.5%), and fewer ICU admissions in the terminal hospital episode (29% vs. 34.2%). In the 6 months prior to death, 51.8% of decedents saw 10 or more physicians, with a lower proportion of women (48.7%) than men (55%) seeing 10 or more physicians. Women also had fewer emergency department visits (mean 1.7 (1.9) vs. 1.9 (2.2)), admissions to ICU (mean 0.2 (0.6) vs. 0.3 (0.7)), hospitalizations (1.1 (1.2) vs. 1.3 (1.3)), and fewer hospital days 13.8 (20.9) vs. 14.7 (21.5) days). Conclusion: This study highlights differences in health-care utilization between men and women at the end-of-life. Understanding the determinants of these differences will be informative to efforts aimed at improving the quality of end-of-life care for elderly Canadians., This study is part of a larger research project whose aim is to develop a Canadian nutrition care algorithm for hospitalized older adults; currently nutrition care is ad hoc, resulting in malnourished patients being undetected and untreated. The need for monitoring and communication tools that support algorithm implementation were identified in an environmental scan. This poster will present the process of developing and testing three tools including: a self-assessment of patient food intake; an audit of mealtime practices; and a standardized discharge communication for follow-up nutrition care. Development included review of literature for extant tools and key issues, modification of extant tools where possible or development of new tools with key user input. Tools will be tested in five diverse Canadian hospitals with 150 patients. Feasibility assessment will focus on ease of use and completion rate of tools. Interdisciplinary focus group at each hospital will be conducted for input on content validity and feasibility of implementation of tools. Criterion validity will be tested where possible. A detailed example of the development of one tool will be described., Background: Determining location of care is a difficult decision faced by many frail elderly persons. Moreover, it is challenging to establish the impact of location of care on frail elderly and caregivers’ health. Objective: To systematically review and critically appraise the evidence concerning health outcomes of location of care for elderly people and their caregivers. Methods: We conducted an umbrella review of systematic reviews guided by the Cochrane Handbook. We searched the Cochrane Effective Practice and Organisation of Care Group (EPOC), the Cochrane Rehabilitation and Related Therapies Field Database, EMBASE, CINAHL, PsycINFO, and MEDLINE. We determined eligible systematic reviews using the following PICO question: P: elderly people (65 and over) and/or their caregivers; I: location of their care; C: any comparison; and O: any health outcomes in clients and/or caregivers. Reviews in French, English, Spanish or Portuguese were eligible. Independent reviewers used the PICO question to screen citation eligibility in 5 stages: titles, abstracts, full texts, study quality (minimum score 5/11 on the AMSTAR quality measurement tool), and relevance to the review objectives. A third reviewer resolved discrepancies. We used descriptive analysis to synthesize the results. Results: Of 988 titles screened, 21 full texts were reviewed and four reviews were included. Systematic reviews were English publications from 2002 to 2010 conducted in Canada (n=1), United Kingdom (n=1), Belgium (n=1) and Sweden (n=1). One review was a Cochrane systematic review which did not comprise a meta-analysis. Two reviews comprised a meta-analysis. Sixty-seven studies were included across the four systematic reviews (range = 1–30). The locations of care included: home, community care program, and nursing home/institutional setting. Three studies examined the frail elderly and found no differences in health outcomes based on the elder’s dwelling location. One study showed that caregivers of elderly with dementia were more likely to be depressed compared to caregivers of elderly with other chronic diseases. The risk of depression increased with burden of care. Study quality was moderate, with two studies scoring 5/11 and two scoring 7/11 on the AMSTAR quality measurement tool. Conclusions: There is insufficient evidence to predict frail elderly health outcomes based on location of care. Therefore, the decision to stay at home or move to another location requires weighing personal importance of reasons for and against each option., Introduction: The emerging concept of frailty has been shown to predict postoperative risk in patients undergoing cardiac surgery. Therefore, it is critically important for the health-care team to identify strategies that will “de-frail” patients prior to surgery and optimize preoperative risk factors. Study 1: The purpose of this study was to prospectively examine the prevalence of frailty in patients undergoing cardiac surgery. In a cohort of 133 patients, 54% were classified as frail, according to the Modified Fried Criteria. Frailty was correlated with increased postoperative hospital length of stay (LOS), where frail patients had a median hospital LOS of 8 days compared to 6 days in non-frail patients (p 7 days compared to just 37% in non-frail, cardiac surgery patients (p, One component of our study consists of a clustered randomized control trial (RCT) to determine whether the use of the Carer Support Needs Assessment Tool (CSNAT) by home care nurses with the family caregivers of their patients improves the quality of life of said family caregivers. We will be testing the following 2 hypotheses in our RCT: The use of the CSNAT as a practice support tool intervention will 1) lead to improved family caregiver quality of life during the time prior to patients’ death and in bereavement, and 2) contribute to the following secondary outcomes in family caregivers during the time prior to patients’ death—enhanced perceived social support, improved preparedness to provide care, and reduced caregiver burden. We have adapted a model of caregiver burden to hypothesize the various concepts by which addressing support needs may contribute to family caregivers’ quality of life. Due to the complex nature of quantifying quality of life and the factors that contribute to quality of life for family caregivers, we needed to create a questionnaire that would address each concept in our hypothesized model—for example, burden, preparedness, overall quality of life, patient functionality. and symptoms. Developing an appropriate questionnaire for our outcomes measurement took considerable foresight and required that we address the following concerns: Constructs: We had to define the constructs within our model as they relate to family caregiver support needs and the quality of life of family caregivers.Measurement Tools: We had to investigate and select a number of appropriate, validated measures to use in order to measure our constructs (e.g., to address general quality of life we selected the Quality of Life in Life Threatening Illness—Family Carer Version (QOLLTI-F)). Appropriate authorization was obtained to utilize each of the measurement scales we had deemed most appropriate.Order of Tools: Considering the length of the final questionnaire, we needed to determine the most appropriate order for the measurement tools so as to ensure that we would obtain our primary outcome measures near the beginning, while still maintaining a natural flow between topics.Mode of Administration: As is the case with longitudinal outcome measures, we needed to assess what would be the best course of action to ensure that our data collection was as complete as possible over the entire data collection period. Our final measurement tool consists of various established family caregiver tools incorporated into one questionnaire. As this questionnaire will be longitudinal, we will be using an in-person interviewer administration mode with response cards to help with retention and data integrity. In some cases, we have adapted the family caregiver tools slightly to accommodate a change from the original self-administration mode to an interview administration., The overall objective of this research is to determine whether the learning resources promoted by the General Practice Services Committee (GPSC) Practice Support Program (PSP) End-of-Life (EOL) learning module can be incorporated into the electronic medical record (EMR) of primary care providers to improve the quality of palliative/EOL care delivered. This research intends to explore whether the palliative approach that is integrated into the EMR of primary care physicians as a set of electronic tools based on the GPSC EOL PSP module can enhance EOL care in ways that can be measurable, scalable, and sustainable. The GPSC EOL PSP learning module is considered the best practice approach to managing EOL patients: those enrolled in the BC Palliative Care Benefits Program or are currently at risk of dying due to a serious, life threatening illness within the next 12 months; and family members who have a relative who passed away within the last 12 months. This research has 4 stages over a 2-year period. Stage 1 is complete, where a small group of general practitioners (GPs) and medical office assistants (MOAs) were recruited to determine current EOL care practices. Stage 2 is complete, where EMR-supported tools based on the EOL PSP learning module were developed, based on feedback from GPs and MOAs. Stage 3 is in progress, to disseminate the EMR EOL Care Module widely to physicians across BC through live learning sessions and the project website. Stage 4 is in progress concurrently with Stage 3, with the evaluation and impact of the EMR EOL Care Module provided by means of time-series evaluation. By focusing on identification, assessment, and pro-active care planning of technology supports for EOL processes in primary care practices, more efficient use of health-care resources and improvements to EOL care are being addressed., The MOH&LTC’s report Living Longer, Living Well highlights a rapidly increasing need to care for seniors requiring complex care in nursing home (NH) settings. As the number of seniors rises, pressure increases on the care capacity in these organizations. The majority of these workers will be registered nursing and unregulated health-care staff. However, insufficient geriatric content in Canadian health-care education persists, leading to serious concerns that staff do not have adequate knowledge to assess, plan, provide, and document care. This deficit is especially acute in NH settings, with negative consequences for seniors. The Applied Simulated and Integrated Learning Approach (ASILA) Program is aimed to improve targeted clinical outcomes for seniors through the use of evidence-informed case simulations in the areas of frail seniors with cognitive and physical challenges. The ASILA Program is based on the use of Minimum Data Set (MDS) as a comprehensive assessment and quality improvement framework. This presentation will highlight the efforts made by the multi-disciplinary research team to develop, implement, and evaluate the ASILA Program on clinical care outcomes for frail seniors. Three evidence-informed simulated case scenarios addressing current deficits in the care of frail seniors will be discussed. These scenarios include the use of assessment scales to conduct a CGA and Clinical Action Protocols (CAPs) to facilitate care planning. In addition, a “train the trainer program” and a training and evaluation plan to integrate these scenarios for impactful learning will also be discussed. The implementation and research plan will be presented, focusing on select measures which will be used to collect health-care staff, resident, and organizational data. This work builds on leading practices in simulation education to develop inter-disciplinary and evidence informed training scenarios for health-care students and staff. This research will inform subsequent expansion of the ASILA Program for health-care education and training in NH settings across Canada. The ASILA Program has the potential to enhance care for frail seniors in NH settings, emphasizing quality of life and promoting best practices, all while working within a financial framework of accountability., Background: Advances in medical technologies are allowing patients with complex and terminal diseases to live longer, but this does not necessarily mean that treatment will restore health or improve quality of life. Advance care planning (ACP) is a method used for patients to express in advance their preferences, beliefs, and values for life-sustaining treatments at the end-of-life. With growing ethnocultural diversity in Canada, health-care providers are managing an increasing number of diverse beliefs/values that have significant impacts on the patient and family’s reaction to the dying process and the medical decisions they make. Medical decisions that are informed by cultural or religious beliefs are commonly associated with preferences for aggressive treatments, such as mechanical ventilation (MV) and hospitalization, at the end-of-life. How we manage ethnocultural beliefs/values in ACP is a significant indicator for the quality of care and quality of death that patients and families experience. Methods: The objectives for this study are: 1) understand methods used in ACP to manage ethnocultural beliefs/values for MV; 2) highlight challenges in ACP (organizational, material, systematic) that may hinder physicians’ or nurses’ ability to provide cross-cultural care; and 3) explore methods used to overcome perceived challenges. This qualitative study uses a semi-structured interview to explore methods used by physicians and nurses to set care plans for MV with patients and families from different ethnocultural backgrounds. Eight (8) participants (four physicians and four nurses) who engage in ACP were recruited from the following acute-care hospitals within the Ottawa region: l’Hôpital Montfort, Ottawa General Hospital, Saint-Vincent’s Hospital, Civic Hospital, Riverside Hospital. Interviews were audio-recorded and transcribed for content data analysis. Results: Three major themes emerged from the coded dataset of transcribed interviews: 1) goals of care across illness trajectories, 2) respecting beliefs, values, and wishes for care, and 3) cross-cultural support in ACP. Using a value-based approach in ACP is seen as an effective method for managing and interpreting diverse beliefs/values that impact decisions for MV. Physicians and nurses should be supported with more cross-cultural education and culturally competent skills for communicating and adjusting to different ethnocultural contexts. Knowledge from this study can be translated into evidence-based practice guidelines that facilitate meaningful ACP discussions, regardless of race or ethnicity. An ACP framework that is effective across cultures may have positive social, economic, and ethical implications that may serve as a promising tool for reducing burden at the end-of-life., Background: A palliative approach centres on improving the quality of life of persons with serious life-limiting illnesses and their families. Such an approach to care encompasses multidimensional aspects of health, with an upstream orientation on the needs of ill persons and their families. Objectives: This presentation addresses the complexities and highlights several key considerations in conducting research about a palliative approach to care for culturally diverse elderly persons with serious illness and their families. We report on lessons learnt during the early phase of our study regarding the challenge of conceptualizing a palliative approach in a way that is congruent with the cultural understandings of life-limiting illness of Chinese-speaking people who live in Canada. Methods: Multiple research methods, including literature synthesis, interviews, and focus groups, were employed to explore understandings of a palliative approach to care and quality of life outcomes for Chinese-speaking elderly people with life-limiting illness and their families. The literature synthesis is based on the search database of a comprehensive knowledge synthesis on a palliative approach by the iPANEL team (Initiative for a Palliative Approach in Nursing: Evidence and Leadership; www.ipanel.ca). Screening of this database revealed 14 documents that specifically focused on the care experience of the culturally diverse populations in the context of a palliative approach. An additional 22 articles were identified through subsequent backward and forward citation searches and are currently being screened for relevance. Participants for the interviews include seriously ill Chinese-speaking elderly persons and family support persons in British Columbia. The study is in the early phase of literature screening and interview participant recruitment. To date, 5 participants have been enrolled: 1 ill person and 4 family support persons have completed the interviews. The goal is to recruit a minimum of 5 ill persons and 5 family support persons for the interviews. Results and Discussion: Key issues that have emerged thus far include the conceptual clarification of a palliative approach and the contextualization of language in the culturally diverse populations. The preliminary review of the literature on the cultural dimension of a palliative approach reveals a challenge in defining a palliative approach in the cultural context of the diverse populations. The difficulty in recruiting Chinese-speaking dyads may be reflective of the cultural attitude towards death and dying, and the role of the family in coping with life-limiting illness. In recruiting Chinese-speaking participants for the study, the preference for hope instilling language may further distant participants from providing their views on a palliative approach to care for the dying. Notably, the culturally appropriate framing of a palliative approach will need to consider the tension between hope of living and acceptance of dying. Conclusions: This study seeks to contribute to the improvement of quality of care for the frail elderly persons and their families of culturally diverse backgrounds. With an increasing diverse population in Canada, the challenges in research on a palliative approach to care must be addressed in order to achieve the goals of culturally competent care for the frail elderly and their families., Objective: Informal caregivers of persons with dementia experience significant difficulties or “caregiver burden”, which has been associated with the quality of the caregiver and care-recipient relationship. Reminiscence Therapy (RT) is an intervention that may help improve the quality of this relationship and mitigate caregiver difficulties. In rural and remote communities, the high proportion of older adults with limited access to health services makes dementia care a challenge. This project will evaluate the effectiveness of an RT intervention for informal caregivers and assess the use of video conferencing as an accessible method of service delivery. The first objective of the project is to investigate the benefits of an RT intervention for caregivers of persons with dementia. A second objective is to contribute to the delivery of health services to older adults living in rural and remote areas by assessing RT delivered via video conferencing. Methods: Sixty-four informal caregivers of persons with dementia will be recruited to participate from the University of Saskatchewan Rural and Remote Memory Clinic. Participants will be randomly assigned to one of four groups: in-person RT, in-person active control, RT over Telehealth video conferencing, or active control over Telehealth. The RT intervention will be based on an empirically supported autobiographical memory activity involving the facilitated recall of positive memories involving the care-recipient. Measures of relationship quality, caregiver burden, and other outcome measures will be administered at pre, post, and follow-up. Hypothesis: It is expected that caregivers in the RT groups will demonstrate an increase in perceived quality of their relationship with the care-recipient, and a decrease in their perceived burden of caring. It is further anticipated that there will not be a significant difference in group outcomes between the in-person and Telehealth video conferencing delivery mediums. Relevance: This project will provide evidence of RT efficacy for improving caregiver/care-recipient relationships and reducing perceived burden of caring for persons with dementia. Further, it will add support for the use of video conferencing technology in the development of accessible services for those with limited access, especially in rural and remote areas., Almost 75% of residents die in their long-term care (LTC) home (Palliative Care Alliance, 2010). The Ontario Long-Term Care Homes Act (2010) states that all staff providing direct care to residents must receive training and re-training in the area of palliative care; however, little training is available and evaluation of education strategies is lacking. The need for high-quality, standardized, on-the-job training will increase over the next decade as LTC increasingly assumes a hospice-like function for frail seniors (Palliative Care Alliance, 2010). Effective and innovative educational strategies tailored for LTC staff that improve provision of palliative care and enhance team work are urgently needed. The objective of this educational research is to implement and evaluate simulation as an immersive experiential approach to teach palliative care to teams of LTC staff. Research questions: Can use of simulation improve the palliative care knowledge and skills of interdisciplinary LTC providers?Can use of simulation improve the self-perceived palliative care competence of interdisciplinary LTC providers?Can use of simulation promote interdisciplinary team-work in LTC homes?How does the using simulation positively and negatively impact the palliative care education experiences of interdisciplinary LTC providers? This research will evaluate the process and outcomes of a simulation palliative care training program with interdisciplinary LTC providers. Staff from 2 different LTC homes will participate in education using HFS as a pedagogical approach to gain skills in providing palliative care, caring communication, and teamwork. Four simulation training modules with accompanying resources will be developed and implemented: advanced care planning, teamwork, holistic care planning, and caring end-of-life communication. The process of learning and the qualitative experience of the participants will be evaluated through debriefing focus groups held at the end of each of the four simulation sessions. Outcomes will be evaluated by having participants complete pre and post surveys. Enhancing knowledge mobilization, the reach of this research will be expanded by inviting educators from Baycrest Long term Care Home and Elisabeth-Bruyere Residence to Thunder Bay to learn to replicate the simulation educational intervention in their LTC settings in Toronto and Ottawa. Through these collaborations, the findings of this research will benefit LTC homes throughout Ontario. This research is aligned with TVN’s mission to improve the care of the seriously ill elderly, while evaluating simulation as an educational strategy to address the palliative care training gap for health-care providers working in LTC. It will generate knowledge that can be used to: 1) advance the use of HFS in continuing interdisciplinary health-care education for LTC staff, 2) promote interdisciplinary teamwork in LTC, 3) advance educational research in LTC, and 4) improve the knowledge, skills, self-perceived competence, and teamwork of LTC home staff so they are better prepared to care for people who are dying and their families. This pilot project will generate evidence that will begin to determine the effectiveness of HFS to teach palliative and end-of-life care to interdisciplinary health-care providers and promote palliative care teamwork., Patient-reported outcome (PRO) measures are designed to provide important information to ensure that the needs and concerns relevant to the quality of life of patients are systematically assessed. Assessment of health and quality of life is critical to the provision of high-quality care that addresses the full range of and often complicated needs relevant to seriously ill elderly patients. This project is a review of research and other sources of information to establish consensus-based best practice guidelines using the Delphi Method for the selection and utilization of PRO instruments to assess the quality of life and inform the care of the seriously ill elderly patients. The purpose of this poster is to present the study protocol that describes the plan for this study. The present study consists of two stages. Stage I is a review of research and other sources of information to develop a large set of initial guidelines germane to the selection and use of PRO instruments for elderly patients. The standard approach to knowledge synthesis will be used. Evidence from various forms of knowledge from different sources will be synthesized. The recommendations of the Evidence for Policy and Practice Information and Coordinating Centre (EPPI-Centre) for knowledge synthesis will be followed. The EPPI-Reviewer software will be used to combine all documents into a common database, apply selection criteria corresponding to each of the review questions, conduct critical appraisals of relevant documents, establish and apply a code book to extract relevant information from each document, and facilitate the synthesis of findings. Stage II involves using the Delphi Method to generate consensus-based best practice guidelines. (The Delphi method is widely used for gathering data from participants within their area of expertise. The method is designed as a group communication process with an eye towards building consensus by conducting multiple rounds of surveys to collect information from a panel of experts.) Stakeholders, experts, and various health-care consumers, and advocacy and patient network group members will be invited to participate in the Delphi survey. A set of guidelines developed based on the knowledge synthesis from Stage I will be sent to the participants. Participants will be asked to rate the importance of each guideline for inclusion in the final set, provide feedback or a rationale for giving a guideline a high rating, and suggest possible additions to the list of guidelines. The list will be narrowed to include only the most highly rated guidelines, new ones will be added based on participant recommendations, and written comments about the guidelines will be summarized. The process will be repeated until consensus is reached. Having consensus-based best practice guidelines available will help ensure that the best PRO instruments are selected and utilized to assess and improve the quality of life of seriously ill elderly patients., The main objective of this study is to implement a mindfulness-based intervention (MI) to improve mood and quality of life for frail elderly and caregivers in long-term care (LTC). Depression is the most prevalent mood disorder among elderly in LTC and is also common in family caregivers. In addition, LTC staff working with elderly clients experience stress and burnout more than other personnel. We plan to implement a modification of Mindfulness-Based Cognitive Therapy (MBCT)—a group intervention that combines techniques from Mindfulness-Based Stress Reduction (MBSR) with Cognitive Behavioral Therapy (CBT). MBSR is a group program in which participants learn mindfulness mediation to decrease stress, anxiety, and suffering associated with various problems. CBT is a one-on-one approach for depression, in which patients learn to restructure irrational thought processes. MBCT has shown to be effective at preventing relapse in recurrently depressed individuals, as well as reducing symptoms of depression and anxiety. We hypothesize that our MI will: 1) improve depression and quality of life for frail elders and may also have a positive effect of daily functioning and physical health; 2) improve mood, stress, burden, and quality of life for caregivers and may also have a positive effect on physical health; and 3) improve mindfulness, self-compassion, and satisfaction with life in both groups. We plan to use a Randomized Controlled Trial consisting of two interventions: one MBCT intervention for frail elderly and one MBCT intervention for caregivers. The intervention will be 1.5 hours once per week for eight weeks. Questionnaires will be administered both before and after the MBCT interventions and waitlist period for all participants. The following scales will be completed by frail elders: Geriatric Depression Scale, Geriatric Quality of Life Questionnaire, and Frail Elderly Functional Assessment Questionnaire. The following scales will only be completed by caregiver participants: Beck Depression Inventory-II, Caregiver Strain Index, Zarit Burden Interview, and Quality of Life scale. All participants will complete the Depression, Anxiety and Stress Scale; Health Survey (SF-36) for physical and emotional health symptoms (a visual analogue to assess intensity and frequency of pain), Five Facet Scale for mindfulness; Self-Compassion Scale; and Satisfaction with Life Scale. Analyses will be conducted using Analysis of Covariance (ANCOVA) models with group (intervention or control) as the independent variable, the post-intervention score as the dependent variable and the pre-intervention score as the covariate. We predict greater change in the intervention group compared to the control group for all analyses in both frail elders and carers. By supporting frail elders and their caregivers through MBCT, we anticipate improvements in mental and physical health, stress, and quality of life. Importantly, reducing work-related stressors in caregivers may improve their quality of care for frail elderly, as lower stress levels in caregivers are related to increase quality of care. Because MBCT is a time-limited structured group program, it may be a cost-effective method by which to sustain the TVN’s strategic priority of improving outcomes and quality of care for frail elderly and supporting caregivers and families., Background: Advance care planning (ACP) is a process that can assist people to think about, talk about, and document their preferences for health care. Alberta Health Services (AHS) has developed ACP information materials to facilitate discussions among patients/families and health-care professionals (HCP). Currently, Alberta’s ACP information materials have not been empirically evaluated within medical contexts that provide services to seriously ill older patients. Study Aims: (1) establish a baseline understanding of how seriously ill older patients, families, and HCP interact with existing ACP information materials in four medical contexts (kidney clinics, palliative care, cancer clinics, and institution/facility living for older adults); (2) tailor refinements and intervention strategies to improve ACP information materials, HCP education, and discussion strategies to better reflect the needs of older patients; and (3) further tailor materials and discussion strategies to meet the needs of older patients in different medical contexts. Method: Conversation analysis (CA) is used to examine and evaluate discussions among HCP (e.g., physicians/nurse practitioners/nurses/social workers) and seriously ill older patients involving AHS’ ACP information materials. CA is the fine-grained qualitative analysis of interactions between people as a means of understanding how their talk results in actions and activities without directly asking (e.g., informing, criticizing). CA assists researchers in detecting and interpreting functional/dysfunctional communication practices. Data collection/analysis is being done in three phases. Phase 1: ACP discussions among HCP and seriously ill older patients/families are audio/video recorded in the participating medical contexts (a total of 30–35 ACP discussions). I examine how the design and content of the HCP’s talk using ACP information materials influences the patients’/families’ level of interaction and displays of understanding. Phase 2: Evidenced-based interaction principles derived from CA are used to illustrate and support possible revisions to the ACP tools and develop recommendations to enhance ACP discussions. HCP from each medical site are trained on how to use the new materials and discussion strategies to increase the effectiveness of their communication (30–35 intervention discussions will be recorded). The effectiveness of the new materials is evaluated. Phase 3: Feedback on using the new ACP information materials and HCP training tools is obtained from participating HCP. The intervention materials are revised based on findings from Phase 2 & 3. Preliminary Findings from Phase 1: Based on 22 recorded consultations, it has been determined that (1) very few of the patients/family members are familiar with the term ‘Advance Care Planning’; (2) there is little use of the existing ACP information materials by HCP; (3) patients receiving the existing ACP information materials display little interest in them; and (4) most of the HCP have developed their own discussion style that generally show good effectiveness. To assist with familiarity of the terminology associated with ACP, I have developed new ACP, Goals of Care Designations, and Green Sleeve icons and slogans. The new icons/slogans will be pilot tested with patients and family members attending kidney clinics in Edmonton. The pilot study will inform the development of the intervention materials used in Phase 2. This project is in progress. Final results available September 2015., Home-based rehabilitation services are part of Ontario’s home care strategy for safe hospital discharge and to reduce (re)hospitalization through prevention and maintenance. An estimated 78% of home care clients do not receive any rehab, wait times can be as long as 3 months, and the longest waiting is experienced by elderly with chronic disorders. Data on hospital utilization among elderly receiving home-based rehab and the impact of waiting for such services are sparse. These data are extremely important in Ontario where close to 60% of home care clients are elderly, over half are admitted post-hospital discharge, and the number awaiting long-term care placement at home is growing. Our study seeks to determine: How do wait times for home-based rehabilitation affect (a) emergency room use and (b) hospital (re)admission? Methods: The proposed project uses a retrospective cohort study design. The cohort includes individuals over the age of 65 who have been newly admitted to Ontario’s 14 Community Care Access Centres (CCAC) home care programs from 2009 to 2013. Data will be abstracted from province-wide datasets held at the Institute for Clinical Evaluative Sciences (ICES). The primary outcome is hospital utilization. Demographic information, medical historym and rates of hospitalization and emergency department visits will be analyzed. Survival analysis will be used to take account of the duration of the wait time to a hospital encounter (event). The analysis looks at the total time a client is at risk for a hospital encounter and allows us to determine: 1) if returning to hospital occurs later for clients who received rehab versus did not receive rehab; and 2) the impact that wait time for rehab has on time-to-event. The analysis also permits us to control for multiple potential confounders known to impact rehospitalization. Results: This provincial study builds upon a pilot study conducted in 2012–13. Results from the pilot were based on 1029 patients, ≥65 years of age, admitted to home care following a discharge from two hospitals in southeastern Ontario. The pilot found that home-based rehab was offered to 43.8% of these home care clients. Average wait times from home care admission to first rehab visit was 28 days for clients that were re-hospitalized compared to 13 days for those who were not. Survival analysis showed that physiotherapy was effective in delaying re-hospitalization, despite wait times of slightly over 3 weeks. Wait time for occupational therapy was over 4 weeks, and was associated with a high proportion re-hospitalized (37.4%). The majority of clients returning to hospital presented with pain, fever, dehydration, dyspnoea, pneumonia, nausea, polypharmacy, delirium, angina, COPD, and renal failure. Relevance: The study is an extensive examination of wait times for Ontario home-based rehabilitation and its impact on elderly clients. The survival analysis will include all clients over the age of 65, regardless of their assessed clinical and home care needs or length of stay on home care. This analytical strategy, study design, and inclusion criteria will provide results that are meaningful to decision makers at local, regional, and provincial levels when discussing resources, clinical pathways, and processes. Results delineated by diagnosis and case mix groupings will also inform physicians and rehabilitation therapists’ triage process and practice., Background: Health policy in Canada supports healthy aging at home and in the community. Specialized geriatric assessment services are generally centralized and frequently require frail seniors to travel for assessment and follow-up visits. Technology enabled interprofessional assessments and follow-up in the home or local community will enable more frail seniors to receive timely assessment, intervention, and follow-up by overcoming barriers. Timely comprehensive geriatric assessment has been demonstrated to support the development of holistic care plans that provide the best opportunity for seniors to maintain their independence and function. At the same time, older people are becoming the subjects of applied technology solutions, but may not have had the opportunity to influence the development of these technology solutions. An understanding of the ways in which older people currently view and use technology is required to ensure the needs and values of older people inform technology development and adoption. This understanding can also support the development and selection of technology solutions that optimize the potential for self-care among frail older people. Objectives: To explore the use and limits of technology to facilitate in-home geriatric assessment and follow-up/monitoring of community-dwelling frail seniors, including: Identification of available and emerging health technology options for both self and provider-led care for frail older peopleDevelop strategies to inform the selection and use of technology in the care of frail older peopleLearn from the experience of seniors, families and health-care professionals who use technology in health-care relationships to inform the design and modification of technological solutions Methods: In 2006, Ontario’s government implemented regionalized health-care services and created 14 Local Health Integration Networks (LHINs). Each LHIN is responsible for the planning, integration, and funding of specified health services in their region, including hospitals, community care, and home care. Similar to other regions in Canada, the number of seniors experiencing frailty (e.g., multiple co-morbidities, high health service utilization) is increasing in Ontario’s Central East LHIN. Data collection in phase one includes focus groups and interviews with seniors, technology designers, and decision makers, and a survey of health-care and social services workers in the Central East LHIN, to identify and evaluate technology options and approaches for home-based care of frail seniors. Results and Implications: We will report on the first stage of the study. Working collaboratively with field experts and others we have identified technology options for health assessment and monitoring. We have then gathered input about the process of design and the inclusion of the input of seniors in the design, decision-making, and selection of technology options. Ideas to enhance the inclusion of seniors are explored, as is the tension between the opportunities and limits of technology in the care of frail seniors. The evaluation of the technology and current decision-making approaches is considered and can inform health service design for community dwelling frail seniors., Depression is the most common mental illness among older adults and is more prevalent among those living in long-term care (LTC). Depression is undertreated, underdiagnosed and misdiagnosed in this population. The Resident Assessment Instrument-Minimum Data Set (RAI-MDS) 2.0 contains a depression rating scale (DRS) originally validated nearly 15 years ago. Guidelines exist for assessing and treating depression but the extent of their uptake is unknown. However, we do know that a consistent finding in clinical and health services research is a failure to translate research into practice. Facilitation is gaining recognition as a knowledge translation intervention but little empirical research exists on its effectiveness and none in this sector. The purpose of this project is to revalidate the DRS and evaluate feasibility and effectiveness of facilitation as an intervention to enhance depression guideline uptake by healthcare aides caring for elderly residents with depression in LTC in Alberta. The research involves 3 phases: I will conduct an environmental scan to understand depression screening and management practices and assess baseline state of guideline use with respect to engaging healthcare aides in managing depression. I will then revalidate the DRS in the RAI using the same approach as in the original validation.I will use Normalization Process Theory (NPT) and intervention mapping (IM) to develop a tailored, theory-informed facilitation intervention. NPT addresses processes by which new practices are operationalized in healthcare. It taps into the actual work routines and tacit knowledge base of workers, an important consideration for the healthcare aide group. IM involves conducting a needs assessment, creating objectives for change, planning for adoption and implementation of an organized programme, evaluating change and supporting sustainability. I will also work with care aides in focus groups to tailor the intervention to their work practices and identify potential barriers to implementation.I will evaluate the acceptability and feasibility of doing the facilitation intervention with healthcare aides using process evaluation. I will select a LTC facility with at least three resident care units and 6–8 care aides from each unit and perform the intervention with these groups. In this feasibility study I will also evaluate use of flowcharts to capture guideline uptake. The process evaluation will involve examining to what extent the programme is implemented as planned, evaluating reach, participant satisfaction, implementation of activities, intervention performance, and quality assurance. Data collected will include flowchart documentation, interviews, focus groups, and surveys. The appropriate approach to quantitative analysis of flowchart data and surveys will be determined. The qualitative data will be analyzed using the inductive approach of constant comparison. This research will add to our understanding about facilitation as an intervention to enhance the use of research. This will help us know if this strategy can be used with care aides as one tool to improve depression management, an important contribution to quality of life for this vulnerable population of older adults., Rational: Nursing staff provide the majority of direct care for institutionalized older adults with dementia and thus have the biggest impact on their quality of life. Understanding how nursing staff’s attitudes and perceptions of their residents is crucial because it directly affects quality of care delivered and the culture of care in residential care homes. Objective: This paper presents a systemic review of nursing staff perception and attitudes towards residents in residential care settings. The aim of this poster is to describe where the gaps in our knowledge and what future research needs to be conducted to further our understanding of attitudes of nursing staff in residential care settings. Method: Data Sources included Ageline, Medline, Cumulative Index to Nursing and Allied Health Literature, Web of Science, PsychINFO, PubMed, and active researchers in this area from 1990 to present. Empirical studies will be included that explored perspectives or attitudes held by nursing staff of residents in long-term residential care settings. Conclusion: Preliminary findings suggest that social and cultural aspects of teamwork and staff morale have strong influences on perception of residents. Attempts to improve staff attitudes should focus on creating organizational cultures that promote high morale and collaboration of all members of the nursing staff., There is an increasing awareness and discussion of issues at the end of life, including the concept of advance care planning (ACP). ACP is a process through which older adults with capacity can plan in advance for their preference for care if they become incapable of making decisions for themselves. While ACP is important to all older adults, irrespective of age or health status, it is of particular salience for those with diagnosed cognitive impairment. The current study aims to provide the first step in understanding reasons cognitively impaired older adults choose to engage in aspects of ACP by exploring ACP as a multi-component complex process. The purpose is then to explore not only which aspects of ACP occur in families of cognitively impaired older adults, but also the reasons why these decisions are made. The specific research questions are: 1) When and how do cognitively impaired older adults and their families receive information about ACP and its relation to cognitive impairment? 2) In which aspects of the ACP process do they engage, and why? and 3)What is the role of ACP in family members’ perceptions of the deceased’s quality of death? Interpretive description (ID) will be used as the method of analysis in the current study as it addresses the limitations in traditional schools of qualitative analysis (Thorne, 2008). A key tenant of this approach involves grounding the research in both the literature as well as the practical knowledge gained from experience. The ID method focuses on practical applications, particularly the clinical utility of research to guide best practice. Family members of deceased older adults who were cognitively impaired prior to death will be recruited for one of four stages of data collection. In stage 1, 10 participants will engage in individual interviews with open-ended questions to address the research questions. Data collection and analysis will occur concurrently with the principle investigator immersing herself fully in the data and looking for broad themes as a first step in the analysis. These initial themes will be presented to two focus groups, each with 4–6 participants, who will provide feedback on these themes based on their experiences in order to illuminate aspects of this complex topic that may not have been explored through the initial individual interviews. Feedback from these focus groups will be used to create additional probes used in stage 3, which will consist of individual interviews with 10 new participants. Throughout this process, data analysis is inherently flexible, allowing for shifting of data construction and an openness to changing themes as new understandings of relationships are elicited. The final stage of data collection will involve 2 more focus groups (4–6 participants) where participants will be asked to discuss their reactions to the themes brought forward by the principle investigator to further refine these relationships. Finally, constant comparative analysis will be used to compare each identified theme with all the other themes to identify commonalities and patterns (Glaser & Strauss, 1967)., We all know an elderly friend or relative who has broken a hip or an arm after a fall on ice or snow. This winter was particularly treacherous in North America. Even the elderly who avoided a fall likely felt confined in their own homes for long stretches. Falls and the inactivity resulting from the fear of falling both lead to dramatic declines in the health of older adults each winter. At Toronto Rehab we are developing better footwear in WinterLab by testing on real ice and snow. We can tilt this lab to measure the maximum angle that someone can walk up, across, and down a wintery slope. The results show remarkable repeatability and can distinguish between the performance of footwear with much greater certainty than existing methods. Our results can be surprising. While most good winter footwear manages slopes up to about 7°, one undistinguished smooth boot enabled us to walk up and down 18° slopes on wet ice! The winter footwear slip resistance testing program at Toronto Rehabilitation Institute aims to reduce instances of slips and falls in older adults. Our objectives are to: improve winter footwear slip resistance standards;test, classify and develop an easy to understand labeling system for consumers so they can select the best performing footwear;develop new materials and designs for high performance winter footwear. Current winter footwear slip resistance standards rely on measuring the force required (coefficient of friction) to drag a fixture-mounted shoe across an ice surface. Our testing has shown that user-worn shoe testing based on real users walking up ice slopes is a more ecologically valid approach as it involves a subject’s natural gait cycle and biomechanics. This is particularly a concern when selecting winter footwear for older adults as their balance abilities and reaction times are severely impaired. We are also exploring new materials and design strategies to improve the slip resistance of winter footwear with the aim of developing universal footwear for indoor use on hard tile surfaces and outdoors on snow and ice. We have developed a new rubber compound that is a hybrid of a soft rubber and a hard fibrous phase, and which according to preliminary testing possesses a three times greater coefficient of friction on ice than other similar compounds. This material grips ice similar to metal cleats, but remains soft and flexible for use on hard tile indoor surfaces. Our work considers the design of optimal tread patterns on winter footwear, and we use 3D printing technology for fast and iterative slip resistance testing of evolving tread patterns. The knowledge generated from these activities will increase awareness regarding winter issues facing older adults and provide solutions to these issues through winter footwear testing and design. Addressing these issues is essential now more than ever due to our nation’s shifting demographics and the pressing need for older adults to remain physically active in all seasons as they age., Background: Health-care providers at Canadian long-term care (LTC) homes provide care to older adults with significant illnesses, and functional and cognitive decline. They need to be able to identify changes in residents’ health and functional statuses in order to promote comfort and provide appropriate interventions. The Palliative Performance Scale (PPS) (version 2) is a tool widely used by palliative care and other clinicians to assess and communicate the functional status of their patients, according to five key criteria. However, this tool has not been tested or evaluated in the LTC home setting. Objectives: To help determine the PPS’s suitability in the LTC home setting, the objectives of this project are to: 1) test the interrater reliability of the PPS between licensed nurses and personal support workers; 2) collect stakeholder feedback on the use of the PPS; and 3) develop and refine approaches to integrate the PPS assessment and educational components into an electronic documentation program. Methods: To learn more about the use of the PPS, a review of the academic literature was performed using five databases (PubMed, Web of Science, Cumulative Index to Nursing and Allied Health, Ageline and MEDLINE) with the key words, Palliative Performance Scale. To test the interrater reliability of the PPS, it was determined that (n = 5) personal support workers and (n = 5) licensed nurse raters will need to assess 52 residents’ PPS scores to obtain an intraclass correlation of .8. To obtain stakeholder feedback, using a qualitative descriptive approach, semi-structured interviews will be conducted with clinicians, family members, and residents. The interview questions will focus on learning about the PPS’s potential use in LTC home practice, and any facilitators and barriers to using the tool in this setting. To integrate the PPS into practice, key individuals from the LTC home setting who are responsible for overseeing the electronic charting and documentation will be invited to participate in a working group to develop and refine PPS policy and procedures. Preliminary Findings and Next Steps: A search of the literature returned 1020 articles published in English, between 1996 and August 2014. After accounting for duplicates, 633 articles were identified. Titles and abstracts were screened for an inclusion of the tool. Of the articles that included the PPS, the main themes in the literature included: using the PPS for survival or mortality prediction, evaluating psychometric properties, describing characteristics or personal factors of a study sample, and triggering palliative care interventions. Following clearance from McMaster University’s review board, the project will commence. Conclusions: The results will be important, if supported by the study, in encouraging the widespread, consistent use of the PPS in LTC homes. The use of the PPS will ultimately create opportunities to dialogue about palliative and end-of-life care interventions with dying residents and family members., WHAT: This project focuses on the creation of digital stories by older adults with mental illness and dementia and the impact of these stories on health-care providers. WHY: Ageism and stigma of growing old with mental illness continue to permeate society and the healthcare experience. Dominant (mis)conceptions about the abilities of older adults, in particular those living with mental illness and dementia, shape the experience of aging with mental illness. Digital storytelling is a person-centred process that builds on the values of maintaining personhood and preserving dignity—key tenets in the culture of person-centred care for older adults. Use of social-contact-based interventions has been identified as key ingredient in reducing stigma. Empowering older adults with serious mental illness, particularly older adults with dementia, to engage with technology and develop digital stories also challenges dominant concepts of ageism and stigma as it relates to aging with mental illness. HOW: Project Re•Vision is a mobile multi-media lab and expressive arts institute led by Dr. Carla Rice at the University of Guelph, dedicated to exploring ways that arts-informed research can work with communities to advance social inclusion and justice by challenging stereotypes. Project Re•Vision has successfully developed methodologies for accommodating people with diverse disabilities and difference including physical, mental, and intellectual difference, enabling them to tell their stories and impact others through digital media. Re•Visioning Aging builds on the success of Project Re•Vision by bringing arts-based research to seriously ill older adults and their families. This research will explore the value of digital stories developed by older adults with mental illness/dementia and understanding how they influence healthcare providers and trainees. Specifically we seek to answer the following questions: Does engagement with the digital storytelling process change older adults and provider perspectives on growing older with mental illness?Do changed perceptions influence clinical practice by enhancing the capacity of providers to communicate and share decision making with older adults?What is the potential of health providers’ engagement with digital stories to inform and enhance their attitudes, responses, and clinical competencies in interactions with those aging with mental illness? Is there a relationship between ageism and stigma?Can original arts-based digital stories be used to complement the education and training of providers and trainees working with older adults with mental illness?Can original arts-based digital change providers’ feelings towards the elderly or beliefs/attitudes about mental illness?, This research Fellowship will examine and evaluate Canada’s systems of laws governing caregiving leaves as relates to a very seriously ill elderly population. This research is important in determining the effectiveness of these laws in order to ensure that the seriously ill elderly population is provided with the option of informal family caregiving assistance where possible and appropriate. Laws associated with caregiving leaves have historically been available to family members or close relations on only a short-term and episodic basis, and are a mix of provincial and federal jurisdiction. They are often seen as confusing, and may not meet the needs of either the caregiver or care recipient. Canadian caregiving leave laws were not been developed with a Lifecourse perspective, nor an aging population in mind. Rather, what they reflect is a stop-gap support for short episodic leaves from paid work often to provide for acute care supports or to assist children, or to support a person within their last 26 weeks of life. This research will evaluate how effective, usable, and appropriate Canadian caregiving leave laws are for the modern reality of providing care to our increasingly oldest old, frailest frail, and seriously ill aging populations. It can no longer be assumed that, because an adult is very old and seriously ill, they will be at “end of life” within 26 weeks. Rather, it is the new reality that older people with significant health concerns are living longer and the current care leave laws may not fit the needs of Canadians. This interdisciplinary work will integrate research on law and policy, ethics, aging, geriatric care, home, and institutional care, as well as palliative care issues. The research will also consider issues of ethno-cultural and sociological issues associated with aging, care provision, and gender roles. Outcomes of this project will include knowledge mobilization tools and strategies for older adults, caregivers, and allied health professionals. A further key outcome will recommendations for law reform, as appropriate, to inform government and Canadian law reform commissions on possible changes to legislation and policy related to caregiving leaves., Background: Hip fractures are a common source of pain and related morbidity among the frail elderly. One technique that has been shown to adequately manage pain in this population is the femoral nerve block. However, it is not currently employed routinely in Alberta emergency departments. Objective: The first objective was to systematically review the recent literature around the use of femoral nerve blocks to manage acute pain among older adults with a hip fracture. The second objective was to survey physicians about the potential barriers to routinely performing femoral nerve blocks in the emergency department. Materials and Methods: Searches of MEDLINE, EMBASE, and the Cochrane Trials database were conducted between 2010 and 2014 to identify randomized control trials examining the use of femoral nerve blocks in the ED to manage acute hip fracture pain among older adults (65 years of age and older). The reference list of a previous systematic review published in 2011 was also searched. The results of the systematic review were used to inform the development of the barrier survey. The questions were structured using Michie’s twelve theoretical behaviour domains and the Behaviour Change Wheel. The survey was distributed to physician members of the Alberta Emergency and Bone & Joint Strategic Clinical Networks. Results: Seven randomized control trials were included in the review. Four studies employed a single femoral block, while three employed continuous (catheter placed) femoral blocks. All of the studies reported statistically significant reductions in pain. All but one study reported that patients treated with femoral nerve blocks consumed significantly less rescue analgesia. Finally, there were no significant adverse effects reported with the femoral block procedure, and multiple studies found a decreased risk of respiratory and cardiac events. Surveys are still being collected and evaluated. The results of the barrier survey will be mapped against the Behaviour Change Wheel to help determine the most effective knowledge translation strategies to employ to increase the use of femoral nerve blocks in Alberta emergency departments. Conclusions: Femoral nerve blocks appear to have benefits both in terms of decreasing pain and limiting the amount of systemic opiods administered to frail older adults experiencing a hip fracture. The results of this review and the barriers survey will help inform the development of knowledge translation strategies to increase the routine use of femoral nerve blocks., Background: Hip fractures in the elderly are a common problem associated with morbidity, mortality, and increased health-care costs. The hip fracture patients on the orthopedic service at Mount Sinai Hospital are complex and pose challenges to the surgical team to coordinate and manage their acute medical issues. The literature suggests that a co-management model with hospitalists or geriatricians may improve staff satisfaction and reduce costs. Therefore, a co-management clinical service was established to address gaps in care for the hip fracture patients. The objective of this study is to examine the effects of the hip fracture co-management service on patient outcomes, quality indicators, and appropriate resource utilization. Setting: Mount Sinai Hospital, an academic medical centre with orthopaedic inpatient units. Population: Geriatric patients admitted to MSH with hip fractures after 2011 with appropriate historical controls. Study Design: Retrospective, before-and-after cohort study. Data Collection: Covariate and outcome measures collected through electronic and paper chart reviews. Results: Preliminary data analysis demonstrates a positive impact on outcome measures of the co-management service. The average length of hospital stay for hip fracture patients decreased by 20% following the implementation of the co-management model of care. There was also a reduction in the in-hospital mortality rate and hospital acquired infection rate. The post-operative delirium rate was the same for both conditions. Preliminary analysis demonstrates a reduction in the time required for patients to get to the operating room and higher rates of osteoporosis treatment initiation post hip fracture. Important predictors of negative outcomes among elderly patients with hip fractures include advanced age, male gender, and co-morbid diseases. In this study, male patients had a longer hospital stay than female patients. Patients with increased co-morbidities and advanced age have a decreased chance of 10 year survival and a longer length of stay. A functional status score of 4 or below, which is indicative of moderate to severe functional impairment, correlates with increased length of stay. Conclusions: The preliminary results of the study are encouraging and suggest the intervention may improve patient outcomes and reduce post-operative complications. This novel model of care can has significant impact on improving healthcare efficiency and the quality of care of hip fracture patients. Implementation of this model has potential to improve coordination of care among health-care professionals and may be generalizable to other patient populations undergoing urgent procedures or surgeries., Background: Current literature provides evidence for the beneficial effects of physical and mental activities on cognitive functioning of older adults at risk of cognitive decline. In fact, according to existing epidemiologic studies, there is little dispute that type-2-diabetes (T2D) is linked to cognitive impairment. 2011 World Alzheimer report outlines the importance of providing routinely individualized cognitive stimulation programs as a part of care for older Canadians. Emerging health technologies, including mobile health (mHealth) via smartphones, have shown promise in extending the reach of preventive and management solutions for patients with cognitive impairment. Currently, however, there is a lack of consistency in the application and availability of cognitive training in geriatrics. This research group has developed the HealtheBrain smartphone application which is currently available on the Apple App store for iPod touch 4+, iPhone 3GS+, and iPad 2+. The HealtheBrain smartphone application aims to provide an easily accessible mind-motor exercise program known as Square-Stepping Exercise (SSE) developed by Shigematsu and Okura (2005). The SSE task uniquely challenges participants to utilize their memory and balancing skills as they watch, recognize, memorize, and executefollow step patterns demonstrated on a 4 by 10 square-patterned floor mat (in-person program) or diagram (smartphone application). Preliminary evidence indicates that the mind-motor exercise program leads to improvements in verbal learning and memory, as well as verbal fluency and overall global cognitive functioning, in community-dwelling older adults without dementia, diastolic blood pressure, and fitness (Gill et al., 2014). Objectives: The aim of this study is to develop, implement, and evaluate the HealtheBrain smartphone application. Methods: Two samples (7–8 participants in each) of community-dwelling T2D older adults who previously consisting of those who have completed a an previous aerobic and cognitive exercise study with our group (including both participants who are and and those who are not experienced with mind-motor exercise programs) will be recruited. Both samples of participants will be asked to use the HealtheBrain smartphone application for two weeks. Following this two-week period, participants will complete a 25-item questionnaire, intended to evaluate the feasibility, utility, value, and design of the HealtheBrain smartphone application. Bivariate zero-order Pearson correlations and independent sample t-tests will be performed on the pooled data to determine general linear relationships. Cronbach’s reliability alphas will be used to assess internal consistency of the questionnaire. Thematic analysis will be used to interpret participants’ responses to short answer questions. Anticipated Results: It is anticipated that the cognitive exercise smartphone application will receive positive feedback from the T2D patients. Additionally, the questionnaire will provide the investigators with valuable feedback about design features of the smartphone application. Significance: Findings from the questionnaire will establish grounds for a HealtheBrain smartphone application pilot study, which will determine the efficacy of mobile health technology in T2D as assessed by global cognitive functioning, specific cognitive domains (memory, reasoning, concentration and planning), mobility (balance, falls self-efficacy), and vascular outcomes. The smartphone application will extend the reach of the mind-motor exercise program to underserved populations in rural communities with limited transportation options and limited access to exercise programs. Overall, these studies will take us a step closer in building and implementing evidence-based mHealth mind-motor exercise mHealth programs to prevent life-limiting illnesses., Objectives: To determine: 1) compliance with use of validated delirium screening tools in hospitalized older patients; 2) use of non-pharmacological and pharmacological interventions for delirium management. Design: Retrospective chart review. Setting: Single tertiary care hospital. Participants: We included patients aged ≥ 65 years admitted to four medical units—Acute Care for the Elderly (ACE) unit, ICU, one general medicine unit, one orthopedic surgery unit for hip fractures— for ≥ 48 hours during seven time blocks between September 1, 2010 to October 31, 2013. Patients admitted or discharged from the unit outside of these time blocks and patients with documented palliative status were excluded. Measurements: Compliance with delirium screening was determined 1) within 24 hours of admission, or 2) at any point after the first 24 hours before discharge. This was used to calculate incidence of both delirium on admission, and hospital-acquired delirium. Further, use of nonpharmacological and pharmacological delirium practices were evaluated. Non-pharmacological practices included use of physical restraints, mobilization, and removal of devices, such as catheters. Pharmacological practices included changes in subject’s medication regimens, such as reduction of polypharmacy, initiation of medications used to manage delirium, and discontinuation of medications that are thought to contribute to delirium. Results: At the time of abstract writing, the study population (n = 315) consisted of a mean age ± standard deviation of 78 ± 8.6, 52.1% female. Delirium screening was completed for 60.6% of patients within the first 24 hours of hospital admission; 73.7% had delirium screening at any point after the first 24 hours before discharge; 82.5% of patients were screened at least once within 24 hours or after the first 24 hours. The average total screening compliance was calculated using number of days subjects were screened with a validated delirium screening tool, physician progress notes or consult notes, divided by total days admitted to the unit of interest, yielding a rate of 56.9%. Of the 315 subjects, 27.9% had a positive delirium screening at some point during their hospital stay. Of these, 69.3% developed delirium while in hospital; 30.7% were already delirious upon admission. The most common non-pharmacological practices used in patients who were screened positive for delirium were mobilization (64.8%), use of physical restraints (27.2%), and removal of urinary catheters (10.2%). Pharmacological practices most commonly initiated include use of antipsychotics (28.4%) and benzodiazepines (12.5%). Conclusions: An increase in delirium screening rates and a decrease in delirium incidence could be monitored as a quality of care indicator for hospitalized older patients. The results of this chart review indicate that there is room for improvement in terms of better optimization of screening to ensure early delirium detection and appropriate management throughout hospital stay in the older adult population., Background: Providing appropriate end of life care for all population groups requires health-care professionals to be culturally aware and have the ability to understand, appreciate, and interact with persons from cultures and/or belief systems other than their own. Unfortunately, this level of cultural safety does not occur for many indigenous peoples as they must leave their communities to receive end of life care in unfamiliar care systems. Purpose: For the purpose of this study, the results of previously completed qualitative studies were synthesized to enhance the overall depth and breadth of understanding of the diverse experiences of indigenous peoples at the end of life. Methods: This studied utilized the metasynthesis procedures outlined by Sandelowski and Barroso (2007) to synthesize the qualitative research studies on the end of life experiences of indigenous peoples. A total of 2255 articles were obtained; of those 18 articles fit the inclusion criteria. These 18 articles were appraised for quality using the Critical Appraisal Skills Program (CASP) scoring system and the classification of findings outlined by Sandelowski and Barroso (2007). SPSS was utilized to descriptively analyze the results of the CASP scores and study demographics. The reported findings from the chosen articles were entered into NVIVO 8 software for qualitative analysis. Synthesis of the findings was achieved using taxonomic analysis, constant target comparison, and reciprocal translation in conjunction with team meetings. Findings: A total of 447 individuals from Australia, Canada, Japan, New Zealand, and the United States participated in the included studies. Although diverse spiritual perspectives exist amongst indigenous peoples the relationship between the “inner being” and the body was viewed as the vital to health. As the pains of life were encountered, the “inner being” was set out of balance or fragmented. Although restoration of balance was attended to throughout life, at the end of life this became a priority. To prepare the “inner being”, three strategies were identified: healing, connecting, and protecting. It was through these preparations that individuals obtained what they viewed as important at the end of life which included: to be at peace, to be healed/renewed, to feel safe and comforted, and to feel strong for the journey ahead. Such preparations often occurred whilst receiving end of life care. This care was described to have the potential to both enable and retract from preparations at the end of life. The degree to which this care respected the indigenous person’s view of health and enabled their unique preparation for death, determined overall satisfaction and quality of life. Implications: The findings are clear for health-care providers and policy makers that end of life care must be restructured to better support indigenous peoples in their preparing of the “inner being” through healing, connecting, and protecting. These findings also contribute to closing literature gap on the end of life experiences of indigenous peoples. Future research may build on these findings by exploring the experiences other indigenous groups not represented here, such as those from the continent of Africa., Introduction: We sought to study whether muscle mass at admission to the intensive care unit (ICU) is predictive of overtaking among elderly critical care patients. Methods: 78 patients over the age of 65 admitted to the ICU at an academic hospital between April 2013 and May 2014 were included in the study. Inclusion criteria were if the patients were over the age of 65 at admission and had a computed tomography (CT) scan of the abdomen two days prior or seven days after admission. Exclusion criteria included presence neuromuscular disease or a CT scan of poor quality. Muscle area at the third lumbar vertebrae was determined by using a specialized computer program (Slice-O-Matic). This area is a validated measurement that corresponds with overall body muscle mass. Results: Muscle area is a predictor of mortality in the elderly ICU patient. The association between muscle area and mortality was significant before (p = .036) and after controlling for severity of illness (APACHE II score), age and sex (p = .033). Discussion: Low skeletal muscle mass during the early stages of critical illness is predictive of mortality in elderly critical care patients. This holds true after controlling for severity of illness, age, and sex., Introduction: Ventilator-associated pneumonia (VAP) is a lung infection that affects 10%–25% of patients in the Intensive Care Unit (ICU). PROSPECT (Probiotics: Prevention of Severe Pneumonia and Endotracheal Culture Trial: a Pilot Trial) is currently underway to assess the feasibility of a larger trial of probiotics to prevent VAP and other infections. In conjunction with the PROSPECT Pilot Trial, we conducted a survey of ICU pharmacists. Objectives: To assess Canadian ICU pharmacists’ attitudes toward the use of probiotics in critically ill patients; secondary objectives were to evaluate their knowledge and self-reported use of probiotics for critically ill patients. Methods: We surveyed pharmacists providing care to ICU patients in Canada. The survey instrument was rigorously designed according to previous guidelines. Following a literature review, a preliminary version of the survey was generated. This version was pre-tested by experts in the areas of survey development, natural health products, and/or critical care. Pilot and reliability tests of English and French versions of the survey were conducted by 5 ICU pharmacists (3 English and 2 French). Possible respondents were identified by telephoning inpatient pharmacies of all Canadian hospitals known to have ICUs. Of 356 total pharmacists identified, 9 were excluded due to participation in survey development, 12 could not be reached to obtain their email address, and 10 declined to provide one. Following an electronic announcement by the Canadian Society of Hospital Pharmacists, the final survey was distributed via email to 325 Canadian ICU pharmacists. The French version was sent to pharmacists in Quebec, and the English version to all others. Three waves of follow-up will occur via email at one, two, and three weeks after the first distribution. The survey will close after 5 weeks. Results: At the time of abstract writing (after the first follow-up email), 137 pharmacists had responded to the survey (42% response rate). Of these, 70% said probiotics were available in their institution, and another 6% indicated availability only under certain circumstances. 80% of respondents stated that they would “never” recommend probiotics for VAP prevention in critically ill patients, while 61% said they would “never” recommend them for prevention of C. difficile infection. 6% believed that probiotics are “definitely safe” for VAP prevention, while 34% were “unsure”. 56% of respondents accurately estimated the cost of a daily dose of probiotics as less than $5, and 65% indicated that they had used probiotics for at least one patient in the last year (in any formulation, for any purpose). However, 73% identified the “absence of written guidelines or protocol” as a barrier to usage of probiotics in their ICU practice. Conclusion: Preliminary survey results indicate that probiotics are available in most institutions and that the majority of Canadian ICU pharmacists have used probiotics for patients in the last year. However, most pharmacists do not recommend them routinely for prevention of VAP in critically ill patients., Background: Well-conducted clinical trials are essential for improving current standards of care and introducing new methods of therapy for critically ill patients. Previous research documented that older patients were less likely to be enrolled in critical care clinical trials (Cooke et al., 2010). The primary objective of this substudy was to determine if the consent rate for older adults (> 60 years) was different than younger adults in the TryCYCLE study (a prospective pilot study of the safety and feasibility of early cycle ergometry in mechanically ventilated (MV) adult patients). Our secondary objective was to determine if the consent rate was different for consent given by a patient versus a substitute decision maker (SDM). Methods: We analyzed data for the first 35 consent encounters in TryCYCLE at St. Joseph’s Healthcare, Hamilton. Patients were eligible for TryCYCLE if they were invasively MV for ≤ 4 days, within their first week of ICU admission and able to ambulate independently pre-hospital. Research personnel approached eligible critically ill patients or their SDM for informed consent. We collected demographic data on all eligible patients approached for consent and reasons for declining consent, and hypothesized there would be no difference in consent rates between older and younger adults. Additionally, we hypothesized that there would no difference in consent rates between consent given by patients and SDMs. We used Fisher’s exact test to determine if there was a significant difference in consent rates. Results: Between October 28, 2013 and July 25, 2014, we approached 35 eligible patients or their SDMs for informed consent. The mean (standard deviation) age of eligible patients was 66.9 (11.9) years, and 17 (48.6%) were female. Our overall consent rate was 31 (88.6%). The consent rate for older versus younger patients was 20 (83.3%) and 11 (100%), respectively (p = .285 for the difference). The consent rate for patients versus SDMs was 7 (100%) and 24 (85.7%), respectively (p = .562 for the difference). Reasons for declining consent included: concern for Achilles tendon rupture (n = 1), lack of interest by SDM (n = 1), impression that the patient would not enjoy cycling (n = 1), and unknown (n = 1). Conclusions: Based on preliminary data, we found no difference in the consent rates between older and younger critically ill adults for this early rehabilitation trial. Twenty percent of patients provided first person informed consent. We also found no difference in consent rates between patients and SDMs approached for this study. Our results demonstrate that older adults are equally as likely as younger adults to consent to an early in-bed cycling study for critically ill, mechanically ventilated adults. As this research program expands to a multi-centre randomized pilot study, our preliminary results underscore the feasibility of recruiting both older and younger critically ill patients to an early rehabilitation study., Background: Quality care at the end of life is about achieving the goals of the patient, as well as supporting caregivers. In Southeastern Ontario, two interventions—an advanced care planning tool and symptom response kits—were implemented to enhance and maintain quality care of terminally ill patients at home. These interventions are being evaluated to determine their impact on place of care and place of death. Additional evaluation is needed to determine family caregivers’ perceptions of these interventions in the context of publicly-funded home care services. Aim: To determine the most appropriate method of assessing the quality of palliative home care from the perspective of family caregivers. Methods: A scoping literature review was conducted using the York framework. 47 peer-reviewed articles were identified from the MEDLINE, CINAHL, EMBASE, and Health and Psychosocial Instruments databases. A numeric analysis of common approaches used to ascertain perceptions of palliative home care was performed by the first author. Themes emerging from the numeric analysis were then mapped onto the “Seven key benefits for individuals and families” identified in the Ontario Ministry of Health and Long-Term Care’s 2011 policy document, “Advancing High Quality, High Value Palliative Care in Ontario”. Gaps in the literature were identified. Results: 41 articles were published since 2000 and reflect a diversity of palliative care interventions delivered at home. Six studies were conducted in Canada; 4 in Ontario. 83% of the studies used qualitative approaches, relying primarily on face-to-face interviews with a small number of caregivers. More than two-thirds of studies took place before the patients died, of which only three included follow-up after death. Studies were typically broad in scope, asking questions about satisfaction, expectations, and positive and negative aspects of palliative home care. Of the seven benefits, “individual and/or family member engagement in care” and “keeping patients and families fully informed” were most commonly raised by patients and family caregivers. In contrast, the benefits of “inter-professional teams” and “consistency of staff/services” were rarely mentioned. Additional themes that did not map onto the seven benefits included staff competency, symptom control, and caregiver support (emotional and practical) pre- and post-death. Discussion: The methods used in assessing patients’/family caregivers’ perceptions of palliative home care varied, depending on the intervention under study and the level of detail sought. The nature of the intervention tended to guide the selection of particular benefits on which the evaluation was focused. The seven benefits identified by Ontario’s policy document do not fully encompass all that patients/caregivers value; other issues need to be included when evaluating palliative home care interventions. These preliminary results will be confirmed by having co-authors independently review selected papers. Conclusion: Evaluation of palliative home care interventions should include all seven benefits in addition to other important themes identified. The methods used should be adapted to the context, and should take into consideration relevant methodological challenges. When evaluating the two Southeastern Ontario interventions, we recommend developing a standardized, self-administered questionnaire for increased representativeness, followed by an in-depth, face-to-face interview guide for increased understanding., Population aging is placing extensive pressure on home care programs to provide the necessary services for complex care clients to remain in their homes and avoid institutionalization or hospitalization. Finding innovative and cost-effective ways of meeting the health-care needs of older adults and the health-care workers who support them is becoming a press-ingly urgent issue. Assistive in-home technologies, such as tools for fall prevention and medication management, have been demonstrated to positively affect health outcomes and the quality of life of autonomous older adults living in the community. This literature review identifies technologies that may improve home care of frail older adults, while reducing caregiver stress through comprehensive examination of current literature in the field of “gerontechnology.” Past research has demonstrated assistive technologies are beneficial in retaining elder independence while reducing risk of falls, medication errors, and caregiver burnout. The findings of this review highlight how technologies are currently integrated into home care and how the health-care system can better include these assistive tools in the care of community-dwelling older adults.

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.

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