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Can Geriatr J 2020 Mar 1;23(1):149-151. Epub 2020 Mar 1.

Department of Epidemiology and Biostatistics, The University of Western Ontario, London, ON.

Can Geriatr J 2020 Mar 30;23(1):143-148. Epub 2020 Mar 30.

Department of Psychology, Western University, London, ON.

Background: Alcohol use disorder (AUD) is an increasingly common, under-recognized, and under-treated health concern in older adults. Its prevalence is expected to reach unprecedented levels as the Canadian population ages. In response, Health Canada commissioned the Canadian Coalition of Seniors' Mental Health to create guidelines for the prevention, screening, assessment, and treatment of AUD in older adults. Read More

Can Geriatr J 2020 Mar 30;23(1):135-142. Epub 2020 Mar 30.

Centre for Addiction and Mental Health, Toronto, ON.

Background: Cannabis Use Disorder (CUD) is an emerging and diverse challenge among older adults.

Methods: The Canadian Coalition for Seniors' Mental Health, with financial support from Health Canada, has produced evidence-based guidelines on the prevention, identification, assessment, and treatment of this form of substance use disorder.

Conclusions: Older adults may develop CUD in the setting of recreational and even medical use. Read More

Can Geriatr J 2020 Mar 30;23(1):123-134. Epub 2020 Mar 30.

Family Physician (in private practice), Comox, BC.

Background: In Canada, rates of hospital admission from opioid overdose are higher for older adults (≥ 65) than younger adults, and opioid use disorder (OUD) is a growing concern. In response, Health Canada commissioned the Canadian Coalition of Seniors' Mental Health to create guidelines for the prevention, screening, assessment, and treatment of OUD in older adults.

Methods: A systematic review of English language literature from 2008-2018 regarding OUD in adults was conducted. Read More

Can Geriatr J 2020 Mar 30;23(1):116-122. Epub 2020 Mar 30.

Department of Psychiatry, University of Montreal, Montreal, QC.

Background: Benzodiazepine receptor agonist (BZRA) use disorder among older adults is a relatively common and challenging clinical condition.

Method: The Canadian Coalition for Seniors' Mental Health, with financial support from Health Canada, has produced evidence-based guidelines on the prevention, identification, assessment, and management of this form of substance use disorder.

Results: Inappropriate use of BZRAs should be avoided by considering non-pharmacological approaches to the management of late life insomnia, anxiety, and other common indications for the use of BZRA. Read More

Can Geriatr J 2020 Mar 30;23(1):4-87. Epub 2020 Mar 30.

Can Geriatr J 2019 Dec 30;22(4):205-212. Epub 2019 Dec 30.

Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada.

Background: Frailty is characterized by increased vulnerability to adverse health outcomes. The prevalence of frailty across neurodegenerative disorders (NDD) is largely unknown. Symptoms of frailty and NDD overlap, calling into question a tautology in some frailty instruments. Read More

Can Geriatr J 2019 Dec 30;22(4):199-204. Epub 2019 Dec 30.

Centre on Aging, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB.

Background: Self-rated health (SRH) predicts death, but there are few studies over long-time horizons that are able to explore the effect age may have on the relationship between SRH and mortality.

Objectives: 1. To determine how SRH evolves over 20 years; and 2. Read More

Can Geriatr J 2019 Dec 30;22(4):190-198. Epub 2019 Dec 30.

Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.

Background: The aim of the present study was to calculate a frailty index (FI) in older adults (≥50) living with HIV, search for cross-sectional associations with the FI, and investigate the association between the FI score and two-year mortality.

Methods: Cross-sectional study with a short-term prospective component for the determination of two-year mortality was performed. The study took place in an HIV outpatient clinic in Calgary, Canada between November 1, 2016 and December 31, 2018. Read More

Can Geriatr J 2019 Dec 30;22(4):182-189. Epub 2019 Dec 30.

Department of Family Practice, University of British Columbia, Vancouver, BC, Canada.

Background: Advance care planning (ACP) is a process that enables individuals to describe, in advance, the kind of health care they would want in the future, and has been shown to reduce hospital-based interventions at the end of life. Our goal was to describe the current state of ACP in a home-based primary care program for frail homebound older people in Vancouver, Canada. We did this by identifying four key elements that should be essential to ACP in this program: frailty stage, documentation of substitute decision-makers, and decision-making with regard to both resuscitation (i. Read More

Can Geriatr J 2019 Dec 30;22(4):171-181. Epub 2019 Dec 30.

School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.

Background: Older adults living with heart failure (HF) in long-term care (LTC) experience frequent hospitalization. Using routinely available clinical information, we examined resident-level factors that precipitate hospitalization within 90 days of admission to LTC.

Methods: This was a retrospective cohort study of older adults diagnosed with HF, who were admitted to LTC in Ontario, Canada, between 2011 and 2013. Read More

Can Geriatr J 2019 Sep 30;22(3):165-170. Epub 2019 Sep 30.

Occupational Therapy, Chinook Regional Hospital, Alberta Health Services, Lethbridge, AB, Canada.

Background: The life-course model of modifiable risk factors for dementia now recognizes managing hearing loss and addressing social isolation.

Objective: To investigate the contribution and inter-relationship of hearing ability and behaviour change on cognitive ability.

Methods: We present the preliminary findings from a prospective longitudinal study of 35 non-demented participants ages 60-93, recruited from community rehabilitation and acute-care programs of Geriatric Medicine, who underwent baseline hearing, behavioural, and cognitive testing. Read More

Can Geriatr J 2019 Sep 30;22(3):148-164. Epub 2019 Sep 30.

ICES, ON, Canada.

Background: In older adults, hip fractures have been described to peak in cooler months. Seasonal differences in patient vulnerability to fracture and social/behavioural factors might contribute to these trends.

Methods: Using linked health-care databases in Ontario Canada, we examined monthly variation in hip fracture hospitalizations in those > 65 years (2011-2015). Read More

Can Geriatr J 2019 Sep 30;22(3):143-147. Epub 2019 Sep 30.

Division of Rheumatology, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.

Background: Patients who have suffered fragility fractures are at an increased risk for subsequent fractures. The Osteoporosis (OP) Clinic at Markham Stouffville Hospital (MSH) was set up in July 2015 to screen, diagnose, and treat patients with fragility fractures. The goal of this study was to identify differences in OP screening and treatment initiation between patients seen in the OP clinic versus usual care. Read More

Can Geriatr J 2019 Mar 30;22(1):23-33. Epub 2019 Mar 30.

Toronto Rehabilitation Institute, University Health Network, Toronto, ON.

Background: Patient engagement in research priority-setting is intended to democratize research and increase impact. The objectives of the Canadian Frailty Priority Setting Partnership (PSP) were to engage people with lived or clinical experience of frailty, and produce a list of research priorities related to care, support, and treatment of older adults living with frailty.

Methods: The Canadian Frailty PSP was supported by the Canadian Frailty Network, coordinated by researchers in Toronto, Ontario and followed the methods of the James Lind Alliance, which included establishing a Steering Group, inviting partner organizations, gathering questions related to care, support and treatment of older adults living with frailty, processing the data and prioritizing the questions. Read More

Can Geriatr J 2019 Mar 30;22(1):13-22. Epub 2019 Mar 30.

SABER Unit, University of Michigan, Ann Arbor, MI, U.S.A.

Background: The trajectory of dementia through time is characterized by common transitions which are difficult for persons with dementia (PWDs) and their families and friends. Our study sought to identify determinants for the quality of transition outcomes.

Method: A 24-month, prospective, longitudinal design identified specific transitions as they occurred in 108 person-with-dementia/caregiver dyads, and assessed the perceived transition quality from the perspective of the caregiver and what we denote as the 'summative' transition quality outcome variable (as explained in the Data Processing section under Methods). Read More

Can Geriatr J 2019 Mar 30;22(1):7-12. Epub 2019 Mar 30.

Department of Rehab Science, Aging & Health Program, Queen's University, Kingston, ON.

In Canada, up to 32,000 older adults experience a fragility hip fracture. In Ontario, the Ministry of Health and Long Term Care has implemented strategies to reduce surgical wait times and improve outcomes in target areas. These best practice standards advocate for immediate surgical repair, within 48 hours of admission, in order to achieve optimal recovery outcomes. Read More

Can Geriatr J 2019 Mar 30;22(1):1-6. Epub 2019 Mar 30.

Lawson Health Institute, London, ON, Canada.

Background: Post-operative delirium (POD) is associated with higher rates of functional decline and death. Ondansetron is a serotonin antagonist which could represent a therapeutic or preventive option in POD.

Methods: A systematic review of MEDLINE, EMBASE, CENTRAL, and PsychINFO was performed. Read More

Can Geriatr J 2019 Jun 30;22(2):64-74. Epub 2019 Jun 30.

Geriatric Medicine, Dalhousie University, Halifax, NS, Canada.

Background: Standardized frailty assessments are needed for early identification and treatment. We aimed to develop a frailty scale using visual images, the Pictorial Fit-Frail Scale (PFFS), and to examine its feasibility and content validity.

Methods: In Phase 1, a multidisciplinary team identified domains for measurement, operationalized impairment levels, and reviewed visual languages for the scale. Read More

Can Geriatr J 2019 Jun 30;22(2):55-63. Epub 2019 Jun 30.

Division of Nephrology, University of Virginia Health System, Charlottesville, VA, USA.

Background: Little is known about the perceptions of older adults with end-stage kidney disease (ESKD) on chronic hemodialysis (HD) even though this could potentially influence how treatment is received. This study explores the perceptions of older adults with ESKD on HD, specifically their decision to initiate HD, preconceptions and expectations of HD, perceived difficulties with HD, and coping strategies.

Design: Cross-sectional. Read More

Can Geriatr J 2019 Jun 30;22(2):49-54. Epub 2019 Jun 30.

Department of Neurology, King Fahad Medical City, Riyadh, Saudi Arabia.

Background: Elderly people have a high risk of potentially inappropriate medications (PIMs) and drug-related problems (DRPs) due to polypharmacy, physical and mental limitations, pharmacokinetic, and pharmacodynamics changes.

Purpose: To determine the role of geriatric pharmacists in reducing drug-related problems and potentially inappropriate medication.

Methods: The observational study was conducted from October 2014 to October 2017 to show the prevalence of DRPs, and PIMs. Read More

Can Geriatr J 2018 Dec 30;21(4):310-319. Epub 2018 Dec 30.

Department of Pathology and Molecular Medicine, Division of Clinical Pathology, McMaster University, Hamilton, ON, Canada.

Background: Typically, long-term care home (LTCH) residents are transferred to hospital to access intravenous (IV) therapy. The aim of this study was to pilot-test an in-home IV therapy service, and to describe outcomes and key informants' perceptions of this service.

Method: This service was pilot-tested in four LTCH in the Hamilton-Niagara region, Ontario. Read More

Can Geriatr J 2018 Dec 30;21(4):307-309. Epub 2018 Dec 30.

Calgary Fall Prevention Clinic, Specialized Geriatric Services, Alberta Health Services, Edmonton, AB, Canada.

A 77-year old woman presented with a history of falls. Known health problems included biopsy-proven collagenous colitis treated with bismuth subsalicylate. On examination, in addition to impaired balance and gait, she was found to have tremors and cognitive deficits. Read More

Can Geriatr J 2018 Dec 30;21(4):303-306. Epub 2018 Dec 30.

Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada.

Background: Frailty is an established predictor of admission into long-term care (LTC) and mortality in the elderly population. Assessment of frailty among adults with intellectual and developmental disabilities (IDD) using a generic frailty marker may not be as predictive, as some lifelong disabilities associated with IDD may be interpreted as a sign of frailty. This study set out to determine if adding the Home Care-Intellectual and Developmental Disabilities Frailty Index (HC-IDD Frailty Index), developed for use in home care users with IDD, to a basic list of predictors (age, sex, rural status, and the Johns Hopkins Frailty Marker) increases the ability to predict admission to long-term care or death within one year. Read More

Can Geriatr J 2018 Dec 30;21(4):297-302. Epub 2018 Dec 30.

Trent Centre for Aging and Society, Trent University, Peterborough, ON, Canada.

Background: Older adults living with frailty represent a complex group who are increasingly accessing regional geriatric services. Goal-based care planning is the industry standard in the care of older adults, yet few studies illustrate how goal-based care planning is being conducted with this population. Understanding how frailty impacts goal-based care planning in regional geriatric services is key to improving patient care. Read More

Can Geriatr J 2018 Dec 30;21(4):292-296. Epub 2018 Dec 30.

Department of Family Medicine, University of Alberta, Edmonton, AB, Canada.

Background: Family caregivers who provide care to seniors at no cost to the healthcare system are an integral part of the healthcare system. Caregiving, however, can cause significant emotional, physical and financial burden. We held a one-day symposium on how to best involve and support family caregivers in the healthcare system. Read More

Can Geriatr J 2018 Dec 30;21(4):290-291. Epub 2018 Dec 30.

Department of Psychiatry & Biobehavioral Science, University of California, Los Angeles, CA, USA.

Can Geriatr J 2018 Sep 30;21(3):284-289. Epub 2018 Sep 30.

Centre de recherche, Institut universitaire de gériatrie de Montréal, Montréal, QC, Canada.

Background: An exercise program involving patients, caregivers, and professionals, entitled SPecific Retraining in INTerdisciplinarity (SPRINT), has been developed to prevent functional decline during hospitalization of older patients.

Goal: Assess the feasibility of implementing SPRINT in the context of a Geriatric Assessment Unit (GAU).

Methods: GAU's health-care professionals were instructed with the SPRINT. Read More

Can Geriatr J 2018 Sep 30;21(3):274-283. Epub 2018 Sep 30.

Toronto General Hospital, University Health Network, Toronto, ON, Canada.

Background: Hip fracture (HF) is common and requires communication between patient, family, surgeons, and hospitalists. Patient and family understanding of the seriousness of HF is unclear.

Methods: We interviewed older patients (age > 65 years) hospitalized with HF at two Canadian academic hospitals, or their surrogate decision-makers (SDMs). Read More

Can Geriatr J 2018 Sep 30;21(3):269-273. Epub 2018 Sep 30.

Leslie Dan Faculty of Pharmacy, University of Toronto, ON, Canada.

Background: Utilization of psychotropic medications among the elderly has garnered attention due to concerns about safety and degree of efficacy, but may be used differently across regions.

Methods: We conducted a cross-sectional study of all antipsychotic, benzodiazepine, and trazodone prescriptions dispensed to seniors ( ≥ 65 years) leveraging IQVIA (Durham, NC) GPM data in 2013. We report the units dispensed (per 100 seniors) by province. Read More

Can Geriatr J 2018 Sep 30;21(3):264-268. Epub 2018 Sep 30.

Bruyère Research Institute, University of Ottawa, Ottawa, ON.

Objective: A pilot study to determine the feasibility of recruiting patients with MCI to test for cognitive interventions.

Method: Thirty patients with amnestic MCI were to be divided into two intervention arms and one control group. Participants went to local sites and completed brain training for one hour three times per week for nine weeks. Read More

Can Geriatr J 2018 Sep 30;21(3):262-263. Epub 2018 Sep 30.

Faculty of Medicine, The University of British Columbia | Vancouver Campus, Vancouver, BC.

Can Geriatr J 2018 Sep 30;21(3):210-217. Epub 2018 Sep 30.

Department of Medicine, Division of Geriatrics, University of Toronto, Toronto, ON, Canada.

We present the top 11 articles in geriatric medicine in the past two years. The topics range from new diagnostic criteria for Lewy Body dementia, advances in biomarker diagnosis of Alzheimer's disease, a major review of dementia and risk factors, the optimal cutoff for the Montreal Cognitive Assessment, antipsychotics in delirium prevention, mobilization of inpatients, intensive blood pressure treatment and statin therapy for primary prevention in older adults, and comprehensive geriatric assessment in vascular surgery and non-small cell lung cancer. Read More

Can Geriatr J 2018 Jun 30;21(2):173-209. Epub 2018 Jun 30.

Division of Geriatric Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.

Background: In order to provide appropriate care for the aging population, many countries are adopting a National Dementia Strategy (NDS). On June 22, 2017, Canada announced it will become the 30th country to launch a NDS. In light of this announcement and as Canada prepares to develop its own NDS, we conducted this review to examine and compare the NDSs of the other previous 29 countries with Canadian government's policies to date. Read More

Can Geriatr J 2018 Jun 30;21(2):166-172. Epub 2018 Jun 30.

Li Ka Shing Research Institute, University of Toronto, Toronto, ON, Canada.

Background: Twitter is a microblogging platform increasingly used in medicine to overcome geographic barriers and promote international connections. Tweets, the 280-character microblogs, are catalogued by hashtags (#). This study evaluates and describes the participation, content, and impact of Twitter at the 2015 Canadian Geriatrics Society (CGS) Annual Scientific Meeting, during which #CGS2015 was the official conference hashtag. Read More

Can Geriatr J 2018 Jun 30;21(2):157-165. Epub 2018 Jun 30.

Department of Medicine, Division of Neurology, University of Alberta, Edmonton, AB, Canada.

Background: Motor and cognitive impairments are common among older adults and often co-exist, increasing their risk of dementia, falls, and fractures. Gait performance is an accepted indicator of global health and it has been proposed as a valid motor marker to detect older adults at risk of developing mobility and cognitive declines including future falls and incident dementia. Our goal was to provide a gait assessment protocol to be used for clinical and research purposes. Read More

Can Geriatr J 2018 Jun 30;21(2):152-156. Epub 2018 Jun 30.

Département de médecine, Faculté de médecine, Université de Montréal, Montréal QC, Canada.

Background: Early assessment of cognitive symptoms is an issue in geriatrics. This study investigated the delay from the onset of cognitive symptoms to initial clinical assessment and its associations with patients' sociodemographic and clinical characteristics.

Methods: This is a cross-sectional retrospective study using medical chart review of 316 patients referred for assessment to a university-affiliated memory clinic. Read More

Can Geriatr J 2018 Jun 30;21(2):143-151. Epub 2018 Jun 30.

Department of Psychiatry, Queen's University, Kingston, ON, Canada.

Background: Primary care-based memory clinics were established to meet the needs of persons with memory concerns. We aimed to identify: 1) physical examination maneuvers required to assess persons with possible dementia in specialist-supported primary care-based memory clinics, and 2) the best-suited clinicians to perform these maneuvers in this setting.

Methods: We distributed in-person and online surveys of clinicians in a network of 67 primary care-based memory clinics in Ontario, Canada. Read More

Can Geriatr J 2018 Jun 30;21(2):139-142. Epub 2018 Jun 30.

Neuropsychopharmacology Research Group, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada.

Background: The purpose of this pilot study was to explore the potential of eye-tracking technology in monitoring symptoms and predicting outcomes in apathetic Alzheimer's disease (AD) patients treated with methylphenidate (MTP).

Methods: Neuropsychological tests and eye-tracking measurements were completed at baseline and following at least four weeks of treatment with MTP (5-10 mg BID). Eye-movements were measured while patients viewed novel and social stimuli. Read More

Can Geriatr J 2018 Jun 30;21(2):138. Epub 2018 Jun 30.

Canadian Geriatrics Journal.

Can Geriatr J 2018 Mar 26;21(1):26-31. Epub 2018 Mar 26.

Department of Psychiatry, Sunnybrook Health Sciences Centre, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.

Background: With an increasingly aged, frail population that holds a disproportionate amount of wealth, clinicians (especially those with expertise in older adults) may be asked with more frequency to offer a clinical opinion on testamentary capacity (TC), the mental capacity to make a will.

Method: This paper reviews the legal criteria as well as the empirical research on assessment tools for determining testamentary capacity (TC). We also review the relevance of instruments used for the assessment of other decisional capacities in order to evince the potential value of developing a standardized assessment of TC for clinician experts. Read More

Can Geriatr J 2018 Mar 26;21(1):14-25. Epub 2018 Mar 26.

School of Health Studies, Faculty of Health Sciences, Western University, London, ON, Canada.

The purpose of this systematic review is to summarize information about the impact different classes of medications and polypharmacy have on recurrent falls, defined as two or more falls in a 12-month period, in community-dwelling older adults. After adjustment for confounders such as age, gender, weight or depression symptoms, the reviewed studies suggested that older adults who use antidepressants, sedatives or hypnotics and anti-epileptics were more likely to experience recurrent falls than non-users. Polypharmacy (use of four or more prescription medications daily) caused 1. Read More

Can Geriatr J 2018 Mar 26;21(1):6-13. Epub 2018 Mar 26.

CFPC Working Group on the Assessment of Competence in Care of the Elderly, Mississauga, ON, Canada.

Background: With Canada's senior population increasing, there is greater demand for family physicians with enhanced skills in Care of the Elderly (COE). The College of Family Physicians Canada (CFPC) has introduced Certificates of Added Competence (CACs), one being in COE. Our objective is to summarize the process used to determine the Priority Topics for the assessment of competence in COE. Read More

Can Geriatr J 2018 Mar 26;21(1):1-5. Epub 2018 Mar 26.

Division of Geriatric Medicine, St. Joseph's Health Care London, Parkwood Institute, London, ON, Canada.

Background: Frailty, a common clinical syndrome in older adults associated with increased risk of poor health outcomes, has been retrospectively calculated in previous publications; however, the reliability of retrospectively assigned frailty scores has not been established. The aim of this study was to see if frailty scores, based on chart review data, agreed with clinician-determined scores based on a comprehensive geriatric assessment.

Methods: Per standard practice, all patients seen by one nurse clinician (JW) from the Southwestern Ontario Regional Geriatric Program, a tertiary care-based outreach service, between August 15, 2013 and December 31, 2015 received a comprehensive geriatric assessment which included the assignment of an interview-based Clinical Frailty Scale score (CFS-I). Read More

Can Geriatr J 2017 Dec 22;20(4):268-269. Epub 2017 Dec 22.

Department of Medicine, University of Toronto, Toronto, ON.

Can Geriatr J 2017 Dec 22;20(4):264-267. Epub 2017 Dec 22.

Professor of Geriatric Medicine (retired), University of Calgary, Calgary, AB.

Going from physician to patient is a journey from which few of our tribe will be spared, and about which we have comparatively little formal reflection. This paper describes some of the lessons learned on such a journey from a retired Professor of Geriatric Medicine, whose course of vascular parkinsonism offers lessons both professional and personal. Read More

Can Geriatr J 2017 Dec 22;20(4):253-263. Epub 2017 Dec 22.

Mount Sinai Hospital, Toronto, ON, Canada.

Appropriate and optimal use of medication and polypharmacy are especially relevant to the care of older Canadians living with frailty, often impacting their health outcomes and quality of life. A majority (two thirds) of older adults (65 or older) are prescribed five or more drug classes and over one-quarter are prescribed 10 or more drugs. The risk of adverse drug-induced events is even greater for those aged 85 or older where 40% are estimated to take drugs from 10 or more drug classes. Read More

Can Geriatr J 2017 Dec 22;20(4):246-252. Epub 2017 Dec 22.

Department of Psychiatry, Mount Sinai Hospital, Sinai Health System, Toronto, ON.

Background: Our hospital identified delirium care as a quality improvement target. Baseline characterization of our delirium care and deficits was needed to guide improvement efforts.

Methods: Two inpatient units were selected: 1) A general internal medicine unit with a focus on geriatrics, and 2) a surgical unit. Read More

Can Geriatr J 2017 Dec 22;20(4):241-245. Epub 2017 Dec 22.

Department of Medicine Division of Geriatrics, Faculty of Medicine, The Ottawa Hospital, Ottawa, ON.

Background: For persons with dementia (PWD), driving becomes very dangerous. Physicians in Canada are legally responsible to report unfit drivers and then must disclose that decision to their patients. That difficult discussion is fraught with challenges: physicians want to maintain a healthy relationship; patients often lack insight into their cognitive loss and have very strong emotional reactions to the loss of their driving privileges. Read More

Can Geriatr J 2017 Dec 22;20(4):240. Epub 2017 Dec 22.

Canadian Geriatrics Journal.