BackgroundOur study strived to 1) describe the characteristics of older adults incurring delayed discharge days in Alberta from Apr 01, 2019 to March 31, 2022; 2) examine the prevalence and length of delayed discharge days during the COVID-19 pandemic.MethodWe conducted a cross-sectional descriptive study using provincial health administrative data. We included adults ≥65 discharged from hospital from Apr 01, 2019–Mar 31, 2022 in Alberta and whose hospital stay included at least one delayed discharge day. The demographic characteristics of participants were reported in proportions or mean/median. Study period was divided into pandemic waves (pre-pandemic: Apr 1, 2019-Jan 31, 2020; Wave 1: Feb 1, 2020-Aug 31, 2020; Wave 2: Sept 1, 2020–Feb 14, 2021; Wave 3 and beyond: Feb 15, 2021-Mar 31, 2022). Prevalence of delayed discharge in each wave and their median length of stay (IQR) were reported.ResultsFrom Apr 01, 2019 to Mar 31, 2022, there were 367,912 hospitalizations among older adults living in Alberta. 3.73% (n=13,717) contained at least one delayed discharge day. The percentage of delayed discharge prior to COVID-19 and during each wave stayed consistent. Wave 3 had the shortest median length of stay (29, IQR 15–51). Wave 2 (45.2%) and Wave 3 (45.3%) had higher proportion of patients requiring maximal assistance on the Activities of Daily Living (ADLs). From pre-COVID to Wave 3, there were increases in the proportions of patients discharged to long term care (36.4% in pre-COVID to 40.8% by Wave 3).ConclusionsFrequency of delayed discharge hospitalizations was consistent across the pandemic waves. Wave 3 had shorter length of delayed discharge hospitalization. The proportion of patients who were discharged to LTC increased over the course of the pandemic.

Limited anxiety tools validated against a diagnostic gold standard in the context of dementia have been identified. A systematic review update was completed to identify publications since 2017 describing tools to detect anxiety in persons with dementia compared to a diagnostic gold standard. The original search strategy was replicated in MEDLINE, Embase, and PsycINFO. Pooled prevalence and diagnostic accuracy estimates were calculated based on three or more studies presenting comparable information from either the original or updated review search. No pooled estimates were calculated in the original review given limited evidence. One study evaluating the Rating Anxiety in Dementia (RAID) scale, Neuropsychiatric Inventory, and Hamilton Anxiety Rating Scale met review inclusion criteria. The pooled prevalence of generalized anxiety disorder (GAD) (n=3, 36.7%, 95% Confidence Interval (CI): 24.3–49.2%) and diagnostic accuracy outcomes for the RAID scale (≥11 cut-off) to detect GAD (n=3, sensitivity: 89%, 95% CI: 78–95%; specificity: 73%, 95% CI: 60–82%) were calculated using data from two studies identified in the original review and the newly included study from the review update. The RAID scale has the most evidence and adequate sensitivity to support its use in identifying anxiety in persons with dementia. Validated tools to detect anxiety in persons with dementia remain understudied.

BackgroundPrimary care is essential in dementia management, offering diagnosis, treatment, and support for people living with dementia (PLWD) and their caregivers. Telemedicine became a key advancement during the COVID-19 pandemic, offering crucial access to care. This study explores the pros and cons of telemedicine for dementia care during the pandemic to guide future improvements.MethodsData collection involved semi-structured interviews with caregivers recruited from a Montreal memory clinic and secondary analysis of two other studies related to dementia and telemedicine, focusing on the educational needs of patients and the impact of the pandemic on health-care services. Data analysis employed the framework method, combining inductive and deductive approaches to code the data and develop categories aligned with Chang’s framework, providing insights into caregivers’ experiences and the challenges and benefits of telemedicine.ResultsThe study involved interviews with four caregivers of people with dementia, complemented by secondary analysis from two Canadian studies. Through framework analysis, four themes were developed: relationship and communication; the advantages and selective suitability of telemedicine (TM) in dementia care; preferences for in-person consultations; and the need to improve awareness and technical confidence in TM.ConclusionThis study highlights the potential of telemedicine (TM) as an effective modality for dementia care, particularly during situations like the COVID-19 pandemic, but emphasizes that it cannot fully replace in-person consultations due to the enduring preference for face-to-face interactions.

Older adults may require longer recovery periods prior to being discharged from the hospital after an acute care stay. For some, returning to their previous living arrangement may no longer be safe or feasible after an acute care admission, and they may require alternate levels of care. It can be challenging to evaluate which patients may benefit most from inpatient rehabilitation versus those for whom alternate levels of care are more suitable. Using a prioritization procedure, this study identified and ranked predictive factors for successful inpatient rehabilitation (defined as discharge to previous living arrangement) from most to least important. The final round of the prioritization procedure resulted in a list of the top 20 predictive factors, ranked by health-care providers in the field, from most to least important. Predictive factors included demographic information, past medical history factors, acute care illness factors, and results of investigations performed during the index hospitalization. The top ranked predictive factors related to patients’ previous living arrangements, level of independence before hospitalization, and presence or absence of cognitive impairment. The bottom ranked predictive factors related to physical measures and results of inpatient investigations at the time of transfer. These findings highlight the importance of considering patients’ lived experiences prior to hospitalization when determining who may obtain the greatest benefit from further, intensive inpatient rehabilitation following an acute care hospitalization.

BackgroundOlder adults with cirrhosis have complex medical needs that are not satisfied by organ specific management. Interdisciplinary approach may mitigate comorbidity and improve patient satisfaction.MethodsA pilot study consisted of dual specialist interdisciplinary referral pathway and mixed virtual care delivery model are prospectively evaluated in older adults (65 years and older) with cirrhosis during the COVID-19 pandemic between September and December 2022. Participant attitudes towards telemedicine were surveyed.Results68 participants with cirrhosis were consecutively assessed by hepatology. The mean age was 73 years. 39 (57%) screened positive for one or more geriatric syndrome(s). Comprehensive geriatric assessments were conducted via telemedicine in 18 participants, with additional referrals to physiotherapy and nutritional education. Compared to a historic cohort matched for age, sex, and Child-Pugh class, acute health service utilization measured by ER visits among those received dual specialist interdisciplinary consultation were lowered by 1.11 per patient at three-month follow up period (p = .0006, 95% CI 0.47–1.74). Majority participants (87.6%) preferred telemedicine or mixed method visits.ConclusionAn interdisciplinary approach to older adults with cirrhosis will likely be beneficial, and routine screening for geriatric syndrome may lead to reduced acute health-care utilization in the short term. Telemedicine and virtual screening tools in seniors should be fully explored to improve access to care.

BackgroundAt the end of life, individuals may experience physical symptoms such as pain, and guidelines recommend medications to manage these symptoms. Yet, little is known about the symptom management long-term care (LTC) residents receive at the end of life. Our research team developed a metric—whether residents receive one or more prescriptions for an end-of-life symptom management medication in their last two weeks—to explore end-of-life care for LTC residents. This qualitative study aimed to inform the refinement of the end-of-life prescribing metric, including the acceptability and applicability to assess the quality of a resident’s symptom management at end-of-life.MethodsWe conducted 14 semi-structured interviews with Ontario health-care providers (physicians and nurses) who work in LTC homes and family caregivers of residents who died in LTC. Interviews were conducted virtually between February 2021 and December 2022, and were analyzed using thematic analysis.ResultsWe identified three major themes relating to perceptions of the metric: 1) appropriateness, 2) health-care provider applicability, and 3) caregiver applicability. Participants noted that the metric may be appropriate to assess end-of-life care, but noted important nuances. Regarding applicability, health-care providers found value in the metric and that it could inform their practice. Conversely, caregivers found limited value in the metric.ConclusionThe proposed metric captures a very specific aspect of end-of-life care—whether end-of-life medications were prescribed or not. Participants deemed that the metric may reflect whether LTC homes have processes to manage a resident’s end-of-life symptoms with medication. However, participants thought the metric could not provide a complete picture of end-of-life care and its quality.

BackgroundDischarge summaries are important educational tools, guiding trainees in their collection and documentation of data. As geriatric competencies are integrated in medical curricula, documentation on in-patient geriatric rotations should represent the unique care and education provided, yet often follow generic templates. What content should be included in a geriatric discharge summary has not previously been explored and was the purpose of this study.MethodsA mixed-methods, designed-based research approach was used to assess note quality on a geriatric in-patient unit and iteratively co-develop a template with examples through three phases: 1) needs assessment, 2) consensus building, and 3) template development.ResultsSixty-eight discharge summaries were assessed by five geriatricians, with 14 gaps identified. Many of these reflected elements that were present but addressed generically without attention to the specificity required from a geriatric perspective. In response, the team developed a geriatric-specific template with explicit examples. Through the consensus process three barriers to quality notes and trainee education were identified: the chronic state of low-quality notes being accepted as the norm, time limitations due to the high volume of patients, and high volume of clinical documents.ConclusionsThe identification of gaps in geriatric discharge summaries allowed for the co-development of an instructional template and examples that goes beyond simple headings and highlights the importance of applying and documenting geriatric competencies. Although we encourage others to take up and modify the tools for trainees in their local context, more importantly, we encourage them to take up the dialogue about note quality.

Background/Purpose: Fall-related injuries can reduce older adults' independence and result in personal and economic burden. The type and use of assistive technologies as well as home modifications likely influences fall reduction and injury prevention. This effect is poorly understood. We sought to detail the contributions of assistive technology and in-home modification on falls, fall frequency, fall severity and fall location within the homes of community-dwelling older adults through a systematic review. Method: From 3 databases (Medline; CINAHL; Web of Science Core Collection) 3920 articles were sourced and assessed using inclusion and exclusion criteria. The outcome variables of interest were fall frequency, fall location, injury, mortality, and hospitalization. Two independent reviewers screened each study and completed data extraction. Reporting is in accordance with PRISMA 2020. Twenty-two studies met the criteria. The most frequent assistive technologies and home modifications reported were canes (n=4), walkers (n=4), handrails (n=9), and grab bars (n=15). Their influence on falls depends on a variety of factors including fall history, history of assistive device use, and whether the device was present at the time of the fall. Discussion: Our findings may provide a basis for more intentional prescription of ambulatory assistive technologies and evidence-based recommendations of home modifications to prevent falls among community-dwelling older adults. This systematic review provides an understanding of how fall-related outcomes vary with the use of assistive technologies and home modifications in different areas of the home of community-dwelling older adults. Study protocol registration (PROSPERO ID: CRD42022370172).

BackgroundFinancial decision-making is complex and requires an in-depth assessment. In the presence of communication disorders, like aphasia, such assessments become challenging and require the use of a dedicated communication aid. No communication aid currently exists to support financial decision-making capacity (DMC) assessments for persons with aphasia (PWA).(1) We sought to establish the validity, reliability, and feasibility of a newly constructed communication aid desigqned for this purpose.MethodsA mixed methods study was performed, divided into three phases. Phase one was aimed at capturing current understanding of DMC and communication by community-dwelling seniors, using focus groups. The second phase involved the development of a new communication aid to assist with the assessment of financial DMC for PWA. The third phase aimed to establish the psychometric properties of this new visual communication aid.ResultsThe new communication aid is a 37-page, paper-based document, with 34 picture-based questions. Due to unforeseen difficulties in participant recruitment for evaluating the communication aid, a preliminary evaluation was performed on the results from eight participants. These indicated the communication aid had moderate inter-rater reliability (Gwet’s AC1 kappa of 0.51 [CI 0.4362 to 0.5816, p < .000]), good internal consistency (0.76), and was usable.ConclusionsThis newly developed communication aid is one of a kind, and provides essential support for PWA requiring a financial DMC assessment, which was not previously available. Preliminary evaluation of its psychometric properties is promising; however, further validation is required to confirm its validity and reliability in the proposed sample size.