Bruyère

Social isolation and loneliness (SIL) have emerged as critical population health concerns linked to various adverse health outcomes, including cardiovascular disease, stroke, dementia, depression, and premature mortality. However, the absence of a standard categorization for interventions aimed at reducing SIL has impeded consistent comparison, evaluation, and the accumulation of knowledge, affecting evidence-based policy decisions. To address this gap, we developed and empirically evaluated the ASSeTS (Access, Skills, Social engagement, Therapeutic and psychological, Systemic) classification system, a standardized approach for categorizing SIL interventions. We conducted a systematic review to identify and evaluate existing classification systems used for SIL interventions. Seventeen databases were searched from inception to September 2023, with no language restrictions. Inclusion criteria encompassed established and widely used reviews with clear intervention categorizations and broad applicability to general population groups. Expert consultations supplemented the systematic review, providing iterative feedback and additional relevant literature missed from the literature search, to inform the development of the ASSeTS classification framework. The developed ASSeTS system was empirically tested by independent experts for clarity, applicability, and reliability, with inter-rater agreement assessed using Fleiss' kappa. The review identified 11 studies covering a range of SIL intervention categorization approaches. Based on synthesis and expert feedback, the ASSeTS system was structured into five main categories: Access, Skills, Social engagement, Therapeutic and psychological, and Systemic interventions. Empirical testing yielded moderate inter-rater reliability (κ = 0.419), indicating acceptable usability among expert raters. Higher agreement was found for categories such as therapeutic and psychological interventions, whereas systemic interventions showed lower reliability, suggesting opportunities for future refinement. The ASSeTS classification system provides a much-needed standardized framework for categorizing SIL interventions, facilitating comparability, rigorous evaluation, cumulative knowledge, and evidence-based policy decisions. Future work should focus on refining less reliable categories, validating ASSeTS across various contexts, and integrating it into global policy frameworks to more effectively address the public health implications of SIL.

Hip fractures represent sentinel events in older adults' lives that can lead to a loss of function and permanent disability. Our team developed an evidence-based pathway intervention: PATH FOR timely transfer of geriatric HIP fracture patients from hospital to rehabilitation to home (PATH4HIP). The goal of the pathway is to facilitate early transfer of hip fracture patients to geriatric rehabilitation without having a negative impact on their rehabilitation outcomes. The purpose of this study was to pilot PATH4HIP with post-operative geriatric hip fracture patients during their transition from hospital to rehabilitation to home. We conducted a mixed methods feasibility study using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework to evaluate the feasibility, acceptability, and preliminary effects of PATH4HIP. Quantitative data were accessed through administrative databases, and qualitative data were collected from patients, caregivers, and clinicians to report on the five RE-AIM domains. A total of 317 hip fracture patients were screened between January and September 2022, and 152 met the study eligibility criteria. Reach was achieved, with 77.0% of eligible patients (n = 117) agreeing to participate (progression criteria of ≥ 75.0%). Effectiveness outcomes including rehabilitation length of stay, functional gains, discharge to the community, and 30-day emergency department return rates were comparable to previously reported data for this population. Adoption was also high, with 76.9% of enrolled patients (n = 90) completing the pathway. Implementation was carried out with minimal protocol variations; however, only 48.9% of patients (n = 44) were discharged from acute care by post-operative day 6 (progression criteria of ≥ 75.0%), falling short due to challenges associated with the COVID-19 pandemic. Finally, participants indicated that the PATH4HIP intervention was acceptable, supporting its Maintenance. The study confirmed the feasibility and acceptability of the pathway, while key rehabilitation outcomes were not negatively affected. This pathway design prioritized best practices for hip fracture care and collaboration across health care sectors. This intervention was low cost as it used existing resources to improve use of surgical beds, while enhancing post-surgery hip fracture care. Further research is needed to examine the implementation of this intervention on a larger scale.

ABSTRACT Introduction Medicine-related harm associated with polypharmacy is a pertinent global health challenge. Deprescribing (reducing or stopping) medicines that cause more potential harm than benefit could mitigate the risk of medicine-related harm. However, the existing deprescribing research-to-practice gap threatens the long-term sustainability and scalability of deprescribing efforts. Research design and methods To address this, key stakeholders including healthcare practitioners, academics, policymakers and representatives of peak professional organizations, gathered at a World Café workshop to reflect on progress achieved in the deprescribing research and practice landscape while exploring the top future priorities for deprescribing. Results Thirty participants agreed on three top priorities: improving the clinical management of deprescribing; engaging consumers and gaining their perspectives; and raising awareness to enhance communication. Emerging themes and related barriers and catalysts were derived and mapped to a socio-ecological model offering a bird-eye’s view of these factors on an individual, interpersonal, organizational, and societal level. Conclusions Our World Cafe’ highlights opportunities for future deprescribing research and practice. To promote the uptake of deprescribing in practice, catalysts could include leveraging new technology, promoting deprescribing via social media and optimizing workforce staff and knowledge. Ultimately, this knowledge may motivate deprescribing efforts and bridge the research-to-practice gap.

There are fewtools to help physiciansconduct serious illnessconversations during a health crisis, where there is a high probability of imminent death. The Serious Illness Conversation Guide (SICG) offers physicians a framework to lead conversations with seriously ill patients in a stable setting and may be adaptable to crisis communication. To identify the communication skills and strategies used by expert clinicians in crisis situations and to determine if the SICG can be adapted for use in crisis situations. We performed semi-structured interviews of physicians with experience in crisis communication and analyzed the transcripts using thematic analysis. Based on our results, we developed a preliminary adaptation of the SICG for crisis communication. We interviewed general internists (n = 8), intensive care (n = 3), and emergency medicine physicians (n = 7) who worked at The Ottawa Hospital, a tertiary care hospital in Ottawa, Canada. Physicians described several challenges to conducting serious illness conversations in crisis, including time constraints, uncertaintyin prognosis, limited access to the patient's medical history, lack of an established therapeutic relationship, and a potentially high symptom burden. They outlined strategies to support communication in these settings, such as rapidly establishing trust, being transparent about uncertainty and allowing space for emotional expression. While all physicians agreed the SICG was adaptable to crisis settings, they noted the need to modify some of the language to better reflect the high-acuity setting. Elements of crisis communication absent from the SICG included gathering information on the medical context and prior wishes, assessing capacity, establishing the substitute decision-maker, involving family, and understanding the patient's pre-hospital quality of life and illness experience. We identified key skills and strategies for crisis communication. The SICG is relevant and adaptable for crisis communication. Future studies should test the adapted guide amongst patients and their caregivers.