Frailty Management Practices for Older Adults in Primary Care Clinics: A Cross-Sectional Study

Objective: To describe practices used to diagnose and manage frailty in primary care clinics, prior to the implementation of the Canadian Foundation for Healthcare Improvement Initiative. Methods: This is a cross-sectional study of the current frailty management practices in a convenience sample of five primary care clinics in Ottawa, Canada. Data was collected using a survey and qualitative content analysis of the survey data was performed. Results: None of the clinics had established a systematic frailty screening or management program. Primary care providers reported informally using select screening tools, clinical instinct, and case findings in their day-to-day practice to identify patients with frailty and refer them to community resources. Frailty identification and management varied across the clinics and across providers within the same clinic. Conclusion: Our findings indicate that primary care providers recognize the need to identify and manage frailty in their clinical practice. In the absence of guidelines or training, providers are developing their own strategies to address frailty

A life-course approach to healthy ageing: maintaining physical capability.

Research on healthy ageing lacks an agreed conceptual framework and has not adequately taken into account the growing evidence that social and biological factors from early life onwards affect later health. We conceptualise healthy ageing within a life-course framework, separating healthy biological ageing (in terms of optimal physical and cognitive functioning, delaying the onset of chronic diseases, and extending length of life for as long as possible) from changes in psychological and social wellbeing. We summarise the findings of a review of healthy ageing indicators, focusing on objective measures of physical capability, such as tests of grip strength, walking speed, chair rises and standing balance, which aim to capture physical functioning at the individual level, assessing the capacity to undertake the physical tasks of daily living. There is robust evidence that higher scores on these measures are associated with lower rates of mortality, and more limited evidence of lower risk of morbidity, and of age-related patterns of change. Drawing on a research collaboration of UK cohort studies, we summarise what is known about the influences on physical capability in terms of lifetime socioeconomic position, body size and lifestyle, and underlying physiology and genetics; the evidence to date supports a broad set of factors already identified as risk factors for chronic diseases. We identify a need for larger longitudinal studies to investigate age-related change and ethnic diversity in these objective measures, the dynamic relationships between them, and how they relate to other component measures of healthy ageing. Robust evidence across cohort studies, using standardised measures within a clear conceptual framework, will benefit policy and practice to promote healthy ageing

A multidisciplinary systematic literature review on frailty: Overview of the methodology used by the Canadian Initiative on Frailty and Aging

<p>Abstract</p> <p>Background</p> <p>Over the past two decades, there has been a substantial growth in the body of literature on frailty in older persons. However, there is no consensus on its definition or the criteria used to identify frailty. In response to this lack of consensus, the Canadian Initiative on Frailty and Aging carried out a set of systematic reviews of the literature in ten areas of frailty research: biological basis; social basis; prevalence; risk factors; impact; identification; prevention and management; environment and technology; health services; health and social policy. This paper describes the methodology that was developed for the systematic reviews.</p> <p>Methods</p> <p>A Central Coordination Group (CCG) was responsible for developing the methodology. This involved the development of search strategies and keywords, article selection processes, quality assessment tools, and guidelines for the synthesis of results. Each review was conducted by two experts in the content area, with the assistance of methodologists and statisticians from the CCG.</p> <p>Results</p> <p>Conducting a series of systematic literature reviews involving a range of disciplines on a concept that does not have a universally accepted definition posed several conceptual and methodological challenges. The most important conceptual challenge was determining what would qualify as literature on frailty. The methodological challenges arose from our goal of structuring a consistent methodology for reviewing literature from diverse fields of research. At the outset, certain methodological guidelines were deemed essential to ensure the validity of all the reviews. Nevertheless, it was equally important to permit flexibility in the application of the proposed methodology to capture the essence of frailty research within the given fields.</p> <p>Conclusion</p> <p>The results of these reviews allowed us to establish the status of current knowledge on frailty and promote collaboration between disciplines. Conducting systematic literature reviews in health science that involve multiple disciplines is a mechanism to facilitate interdisciplinary collaboration and a more integrated understanding of health. This initiative highlighted the need for further methodological development in the performance of multidisciplinary systematic reviews.</p

Correlates of dietary intake in Mohawk elementary school children

Increased understanding of dietary habits of Aboriginal children can contribute to improved nutrition education programs. To determine correlates of high soft drink intake, high fruit intake and high vegetable intake, Aboriginal children in grades 4-6 from two Kanien'keha:ka (Mohawk) communities completed classroom-administered questionnaires and participated in anthropometric measures and a run/walk fitness test. Independent correlates of high soft drink consumption identified by multivariate logistic regression included higher levels of television-watching, odds ratio [OR] 3.1, (95% confidence interval 1.5-6.4), and higher levels of physical activity, OR 3.0 (1.3-7.1) among girls, and increased video game-playing, OR 6.7 (1.8-25.5), and failing to meet the minimal fitness standard on the run/walk test, OR 2.2 (1.2-4.2), among boys. Independent correlates of high fruit consumption included each year of increasing age among boys OR 0.7 (0.5-1.0), and higher levels of physical activity among girls OR 4.0 (2.0-7.9) and boys OR 3.5 (1.5-7.7). Independent correlates of high vegetable intake included age among boys OR 0.7 (0.5-1.0), increased video game-playing among girls OR 4.5 (1.4-14.9), and higher levels of physical activity among girls OR 3.5 (1.5-7.7) and boys OR 2.8 (1.2-6.5). These findings suggest targets for interventions aimed at improving eating habits of Aboriginal children

Physical function and survival in older adults

Background: Physical function refers to the ability to perform specific physical actions that involve the whole person. In older persons, measures of physical function such as walking speed or grip strength are believed to capture the complexity of multiple diseases and provide a global measure of health. Recently, an emerging body of literature has indicated a strong association between poor physical function and mortality. Based on these findings, physical function is being recommended as a clinical tool for identifying older persons at higher risk of death, and targeting care accordingly.However, in my review of the literature, I identify important limitations in the methodological approach to establish the association between physical function and survival. Previous studies use time of entry into a study of aging as the time zero in their estimation of survival time. An estimate of survival time that is anchored at study entry computes likelihood of surviving based on how long an individual has been in the study, which is of little (if any) substantive interest in studies of aging. Furthermore, those studies fail to account for changes in physical function over time, and for possible confounding by health and lifestyle covariates, which also change over time. These methodological limitations need to be addressed and lead to the two objectives of my research: 1)To examine the relationship between a time-varying measure of physical function and survival in men and women aged 70 years and over, while accounting for the time-varying effects of health and lifestyle characteristics2)To examine whether time-to-death is associated with physical function in older women and men, after accounting for age and time-varying effects of health and lifestyleStudy population: The studies contained within this thesis use data from the Cardiovascular Health Study (CHS). The CHS is a cohort study of 5,201 American adults aged 65 years and over at study entry. The CHS was initiated in 1989 with data on physical function measured annually over a ten-year period, and monitoring for survival until 2010. Study 1: In the first study, I use age, instead of time since study entry, as the timescale to estimate the association between time-varying measures of physical function and survival, while accounting for the time-varying effects of health and lifestyle characteristics. In doing so, I find a significant association between higher gait speed and survival in women, but no evidence of an association between gait speed and survival in men, and no evidence of an association between grip strength and survival in both women and men.Study 2: In the second study, I use time-of-death as the time zero and estimate the association between time-to-death and physical function. This approach, modeled on methods previously used in the literature on terminal decline in cognitive function, provides a meaningful time zero for estimating the association between physical function and the imminence of mortality. The results indicate a significant association between physical function and time-to-death. However, the strength of the association is modest compared to that of physical function and age. Adjustment for health and lifestyle covariates attenuates the relationship between physical function and time-to-death substantially, suggesting that unadjusted associations are confounded by demographic, health and lifestyle characteristics.Conclusion: While some investigators have already called for the use of physical function as a clinical tool, my work serves as a note of caution. Methods and results of my research demonstrate that our understanding of the relationship between physical function and survival can be improved through the use of more meaningful timescales and the assessment of time-varying measurement of physical function, as well as health and lifestyle characteristics.Contexte : La fonction physique (FP) renvoie à la capacité d'effectuer des actions physiques spécifiques qui impliquent tout le corps. On estime que chez les personnes âgées, les mesures de la FP, comme la vitesse de marche ou la force de préhension, captent la complexité de plusieurs maladies et fournissent une mesure de l'état de santé global. Récemment, de nouvelles recherches ont révélé une forte association entre une FP faible et la mortalité, menant à la recommandation que les mesures de la FP physique soient utilisées comme outil de dépistage pour cibler les soins chez les aînés.Cependant, lors de ma revue de la littérature, j'ai identifié d'importantes limites à l'approche méthodologique utilisée pour établir l'association entre la FP et la survie. Les études antérieures ont utilisé le temps d'entrée dans une étude sur le vieillissement comme temps zéro pour estimer le temps de survie. En liant l'estimation du temps de survie à l'entrée à l'étude, la probabilité de survie des participants se trouve calculée en fonction de la durée de leur participation à l'étude, ce qui présente peu (ou pas) d'intérêt pour les études sur le vieillissement. De plus, ces études ne tiennent pas compte des changements dans la FP au fil du temps et des effets possibles de covariables telles que la santé et le style de vie, qui changent aussi avec le temps. Ces limites méthodologiques doivent être abordées et elles seront centrales aux deux objectifs de ma recherche :1) Examiner la relation entre une mesure variable dans le temps de la FP et la survie chez les hommes et les femmes âgés de 70 ans et plus, tout en tenant compte des effets de la variation dans le temps des caractéristiques liées à la santé et au mode de vie.2) Examiner si le temps jusqu'au décès est associé à la FP chez les femmes et les hommes plus âgés, après avoir pris en compte l'âge et les effets dans le temps de la santé et du style de vie.Population étudiée : Les études contenues dans cette thèse utilisent des données de l'Étude sur la santé cardiovasculaire (CHS). La CHS est une étude de cohorte portant sur 5 201 adultes américains de 65 ans et plus. Des données sur la FP ont été recueillies chaque année sur une période de dix ans.Étude 1 : Dans la première étude, au lieu du temps écoulé depuis l'entrée dans l'étude, j'utilise l'âge comme échelle de temps pour estimer l'association entre les mesures de la FP variant dans le temps et la survie, tout en tenant compte des effets de la variation dans le temps des caractéristiques liées à la santé et au mode de vie. Ce faisant, je constate une association significative entre la vitesse de marche et la survie chez les femmes, mais aucune preuve d'association entre la vitesse de la marche et la survie chez les hommes ou entre la force de préhension et la survie chez les femmes et les hommes.Étude 2 : Dans la deuxième étude, j'utilise le moment du décès comme temps zéro et j'estime l'association entre le temps jusqu'au décès et la FP. Cette approche, modélisée sur des méthodes précédemment utilisées dans la littérature sur le déclin terminal de la fonction cognitive, fournit un temps zéro pertinente pour estimer l'association entre la FP et l'imminence de la mort. Les résultats indiquent une association significative entre la FP et le temps jusqu'au décès. Cependant, la force de l'association est modérée comparativement à celle entre la FP et l'âge. L'ajustement pour les covariables de la santé et du style de vie atténue considérablement la relation entre la FP et le temps jusqu'au décès.Conclusion : Bien que certains chercheurs aient déjà demandé que la FP soit utilisée comme instrument clinique, mon travail appelle à la prudence. Mes recherches démontrent que notre compréhension de la relation entre la FP et la survie peut être améliorée en utilisant des échelles de temps plus pertinentes et en tenant compte des changements dans le temps de la FP et des caractéristiques liées à la santé et au style de vie

Frailty, an Emerging Research and Clinical Paradigm: Issues and Controversies

Ne pas citer. Version pour diffusion uniquement. Citer l'article une fois publié. / Not to be cited. For distribution only. Cite article once published.[À l'origine dans / Was originally part of : ESPUM - Dép. gestion, évaluation et politique de santé - Travaux et publications]Clinicians and researchers have shown increasing interest in frailty. Yet, there is still considerable uncertainty around the concept and its definition. In this paper, we present perspectives on key issues and controversies discussed by scientists from 13 different countries, representing a diverse range of disciplines, at the 2006 Second International Working Meeting on Frailty and Aging. The following fundamental questions are discussed: what is the distinction, if any, between frailty and aging? What is its relationship with chronic disease? Is frailty a syndrome or a series of age-related impairments that predict adverse outcomes? What are the critical domains in its operational definition? Is frailty a useful concept? The implications of different models and approaches are examined. While consensus has yet to be attained, work accomplished to date has opened exciting new horizons. The paper concludes with suggested directions for future research.Financial support for the Second International Working Meeting on Frailty and Aging was provided by: Max Bell Foundation; Quebec Network for Research on Aging (Fonds de la recherche en santé du Québec); Institute of Aging - Canadian Institutes of Health Research (CIHR); CIHR International Opportunity Program – Development Grant 68739; Gustav Levinschi Foundation; The Dr. Joseph Kaufmann Chair in Geriatric Medicine, McGill University

Electronic consultation use by advanced practice nurses in older adult care—A descriptive study of service utilization data

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

Profiles of socially isolated community-dwelling older adults during the COVID-19 pandemic: A latent class analysis

Sourial N, Beauchet O, Kruglova K, et al. Profiles of socially isolated community-dwelling older adults during the COVID-19 pandemic: A latent class analysis. Maturitas. 2023;171:1-6

Natural Language Processing to Identify Digital Learning Tools in Postgraduate Family Medicine: Protocol for a Scoping Review

BackgroundThe COVID-19 pandemic has highlighted the growing need for digital learning tools in postgraduate family medicine training. Family medicine departments must understand and recognize the use and effectiveness of digital tools in order to integrate them into curricula and develop effective learning tools that fill gaps and meet the learning needs of trainees. ObjectiveThis scoping review will aim to explore and organize the breadth of knowledge regarding digital learning tools in family medicine training. MethodsThis scoping review follows the 6 stages of the methodological framework outlined first by Arksey and O’Malley, then refined by Levac et al, including a search of published academic literature in 6 databases (MEDLINE, ERIC, Education Source, Embase, Scopus, and Web of Science) and gray literature. Following title and abstract and full text screening, characteristics and main findings of the included studies and resources will be tabulated and summarized. Thematic analysis and natural language processing (NLP) will be conducted in parallel using a 9-step approach to identify common themes and synthesize the literature. Additionally, NLP will be employed for bibliometric and scientometric analysis of the identified literature. ResultsThe search strategy has been developed and launched. As of October 2021, we have completed stages 1, 2, and 3 of the scoping review. We identified 132 studies for inclusion through the academic literature search and 127 relevant studies in the gray literature search. Further refinement of the eligibility criteria and data extraction has been ongoing since September 2021. ConclusionsIn this scoping review, we will identify and consolidate information and evidence related to the use and effectiveness of existing digital learning tools in postgraduate family medicine training. Our findings will improve the understanding of the current landscape of digital learning tools, which will be of great value to educators and trainees interested in using existing tools, innovators looking to design digital learning tools that meet current needs, and researchers involved in the study of digital tools. Trial RegistrationOSF Registries osf.io/wju4k; https://osf.io/wju4k International Registered Report Identifier (IRRID)DERR1-10.2196/3457

Implementing a Telehealth Support Tool for Community-Dwelling Older Adults During the COVID-19 Pandemic: A Qualitative Investigation of Provider Experiences

Dassieu L, Develay E, Beauchet O, et al. Implementing a Telehealth Support Tool for Community-Dwelling Older Adults During the COVID-19 Pandemic: A Qualitative Investigation of Provider Experiences. Journal of Aging &amp; Social Policy. 2022:1-18