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To evaluate the feasibility of generating a center-specific embryo morphokinetic algorithm by time-lapse microscopy to predict clinical pregnancy rates.A retrospective cohort analysis.Academic fertility clinic in a tertiary hospital setting.Patients who underwent in vitro fertilization with embryos that underwent EmbryoScope time-lapse microscopy and subsequent transfer between 2014 and 2018.None.Clinical pregnancy.A supervised, random forest learning algorithm from 367 embryos successfully predicted clinical pregnancy from a training set with overall 65% sensitivity and 74% positive predictive value, with an area under the curve of 0.7 for the test set. Similar results were achieved for live birth outcomes. For the secondary analysis, embryo growth morphokinetics were grouped into five clusters using unsupervised clustering. The clusters that had the fastest morphokinetics (time to blastocyst = 97 hours) had pregnancy rates of 54%, whereas a cluster that had the slowest morphokinetics (time to blastocyst = 122 hours) had a pregnancy rate of 71%, although the differences were not statistically significant (This study shows the feasibility of a clinic-specific, noninvasive embryo morphokinetic simple machine learning model to predict clinical pregnancy rates.

Background Understanding the needs and values of older people is vital to build responsive policies, services and research agendas in this time of demographic transition. Older peoples’ expectations and priorities for ageing, as well as their beliefs regarding challenges facing ageing societies, are multi-faceted and require regular updates as populations’ age. Objective To develop an understanding of self-perceptions of ageing and societal ageing among Canadian retirees of the education sector to define a meaningful health research agenda. Methods We conducted four qualitative focus groups among 27 members of a Canadian retired educators’ organisation. Data were analysed using an inductive thematic approach. Results We identified four overarching themes: (1) vulnerability to health challenges despite a healthier generation, (2) maintaining health and social connection for optimal ageing, (3) strengthening person-centred healthcare for ageing societies and (4) mobilising a critical mass to enact change. Participants’ preconceptions of ageing differed from their personal experiences. They prioritised maintaining health and social connections and felt that current healthcare practices disempowered them to manage and optimise their health. Although the sheer size of their demographic instilled optimism of their potential to garner positive change, participants felt they lacked mechanisms to contribute to developing solutions to address this transition. Conclusion Our findings suggest a need for health research that improves perceptions of ageing and supports health system transformations to deliver person-centred care. Opportunities exist to harness their activism to engage older people as partners in shaping solution-oriented research that can support planning for an ageing society.

Clinician-led memory interventions have been shown to increase knowledge, reduce anxiety, promote memory-strategy use, and increase brain-healthy lifestyle behaviours in older adults with normal age-related memory changes. A self-guided, e-learning version of the Baycrest Memory and Aging Program® was recently developed to increase accessibility to memory interventions. The objectives of the current study were to assess program feasibility (retention rate), acceptability (satisfaction), and participant-reported impact (memory concerns, behaviour change, goal attainment). As part of a larger study, participants were 139 healthy older adults (mean age: 73±7, 73% female). Ninety-two individuals completed the program (retention rate=66%). Anonymous feedback data indicated a high level of satisfaction with the program overall (98%), the pace and clarity of the learning modules (100%), and the organization and navigation of the interface (92%). Suggested improvements included offering more interaction with others and addressing minor platform glitches. There was a decrease in the level of concern about memory change, with 64% expressing concern at a level consistent with the Jessen et al. (2014) criteria for Subjective Cognitive Decline at baseline, and 23% expressing the same at post-test. The majority of participants reported increases in using memory-strategies (63-97%) and lifestyle-promoting behaviours (40-72%). All participants reported moderate to high satisfaction with personal goal attainment. Results support feasibility, acceptability, and impact of a self-guided e-learning adaptation of memory intervention. E-learning tools may be a promising avenue to deliver accessible brain health promotion in later life, especially in the context of the shift to virtual care during and beyond COVID-19.

Age-related memory changes pose considerable concerns for aging adults, and can adversely affect their daily living and cause worry even when changes experienced are not clinically significant. The Memory and Aging Program® is a validated psychoeducation and memory strategy-training program that teaches the public about memory changes during aging and trains them to use evidence-based strategies to support brain health. The program has been offered in-person for over 20 years, and a self-guided eLearning version was recently developed to improve program accessibility. This study evaluated the self-reported impacts of memory changes in older adults who completed this eLearning against a control group. We randomized 202 older adults, without neurological or psychiatric diagnoses (71.6 years; 69 % female; 15.6 years of education), into the eLearning program or a control group that received no intervention. All participants reported their perceived impact of memory changes using the Memory Impact Questionnaire at pre-, post-, and 6-8 weeks follow-up. A significant reduction in negative impact of memory changes on daily living and a significant improvement in positive coping with memory changes relative to controls was observed at post-test (13.4 versus 2.5 points reduction and 7.4 versus 0.1 point improvement, respectively, both p < 0.05), but these did not persist at follow-up. The adoption of digital tools has hastened across all ages. Our study showed that self-guided digital tools, such as the eLearning Memory and Aging Program®, may be a promising avenue to help aging individuals reduce the impact of memory changes on daily living.

Background Real-life community mobility (CM) measures for older adults, especially those with Parkinson’s disease (PD), are important tools when helping individuals maintain optimal function and quality of life. This is one of the first studies to compare an objective global positioning system (GPS) sensor and subjective self-report CM measures in an older clinical population. Methods Over 14 days, 54 people in Ontario, Canada with early to mid-stage PD (mean age = 67.5 ± 6.3 years; 47 men; 46 retired) wore a wireless inertial measurement unit with GPS (WIMU-GPS), and completed the Life Space Assessment and mobility diaries. We assessed the convergent validity, reliability and agreement on mobility outcomes using Spearman’s correlation, intraclass correlation coefficient, and Bland-Altman analyses, respectively. Results Convergent validity was attained by the WIMU-GPS for trip frequency (rs = .69, 95% confidence interval [CI] = 0.52–0.81) and duration outside (rs = .43, 95% CI = 0.18–0.62), but not for life space size (rs = .39, 95% CI = 0.14–0.60). The Life Space Assessment exhibited floor and ceiling effects. Moderate agreements were observed between WIMU-GPS and diary for trip frequency and duration (intraclass correlation coefficients = 0.71, 95% CI = 0.51–0.82; 0.67, 95% CI = 0.42–0.82, respectively). Disagreement was more common among nonretired individuals. Conclusions WIMU-GPS could replace diaries for trip frequency and duration assessments in older adults with PD. Both assessments are best used for retired persons. However, the Life Space Assessment may not reflect actual mobility.

Calcium channel blockers (CCBs) are commonly prescribed agents for hypertension that can cause peripheral edema. A prescribing cascade occurs when the edema is misinterpreted as a new medical condition and a diuretic is subsequently prescribed to treat the edema. The extent to which this prescribing cascade occurs at a population level is not well understood.To measure the association between being newly dispensed a CCB and subsequent dispensing of a loop diuretic in older adults with hypertension.A population-based cohort study was performed using linked health administrative databases of community-dwelling adults 66 years or older with hypertension and new prescription drug claims from September 30, 2011, to September 30, 2016, in Ontario, Canada. The dates of analysis were September 1, 2018, to May 30, 2019.Individuals who were newly dispensed a CCB were compared with the following 2 groups: (1) individuals who were newly dispensed an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker and (2) individuals who were newly dispensed an unrelated medication.Hazard ratios (HRs) with 95% CIs were estimated for individuals who were dispensed a loop diuretic within 90 days of follow-up using Cox proportional hazards regression models.The cohort included 41 086 older adults (≥66 years) with hypertension who were newly dispensed a CCB, 66 494 individuals who were newly dispensed another antihypertensive medication, and 231 439 individuals who were newly dispensed an unrelated medication. At index (ie, the dispensing date), the mean (SD) age was 74.5 (6.9) years, and 191 685 (56.5%) were women. Individuals who were newly dispensed a CCB had a higher cumulative incidence at 90 days of being dispensed a loop diuretic than individuals in both control groups (1.4% vs 0.7% and 0.5%, P .001). After adjustment, individuals who were newly dispensed a CCB had increased relative rates of being dispensed a loop diuretic compared with individuals who were newly dispensed an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker (HR, 1.68; 95% CI, 1.38-2.05 in the first 30 days after index [days 1-30]; 2.26; 95% CI, 1.76-2.92 in the subsequent 30 days [days 31-60]; and 2.40; 95% CI, 1.84-3.13 in the third month of follow-up [days 61-90]) and individuals who were newly dispensed unrelated medications (HR, 2.51; 95% CI, 2.13-2.96 for 1-30 days after index; 2.99; 95% CI, 2.43-3.69 for 31-60 days after index; and 3.89; 95% CI, 3.11-4.87 for 61-90 days after index). This association persisted, although slightly attenuated, from 90 days to up to 1 year of follow-up and when restricted to a subgroup of individuals who were newly dispensed amlodipine.Many older adults with hypertension who are newly dispensed a CCB subsequently receive a loop diuretic. Given how widely CCBs are prescribed, interventions are needed to raise clinicians' awareness of this common prescribing cascade to reduce the prescribing of potentially unnecessary medications that may cause harm.

To systematically describe the resources available on preventing, detecting, and reversing prescribing cascades using a scoping review methodology.We searched Medline, EMBASE, PsychINFO, CINAHL, Cochrane Library, and Sociological Abstracts from inception until July 2017. Other searches (Google Scholar, hand searches) and expert consultations were performed for resources examining how to prevent, detect, or reverse prescribing cascades. We used these three categories along the prescribing continuum as an organizing framework to categorize and synthesize resources.Of 369 resources identified, 58 met inclusion criteria; 29 of these were categorized as preventing, 20 as detecting, and 9 as reversing prescribing cascades. Resources originated from 14 countries and mostly focused on older adults. The goal of preventing resources was to educate and increase general awareness of the concept of prescribing cascades as a way to prevent inappropriate prescribing and to illustrate application of the concept to specific drugs (e.g., anticholinergics) and conditions (e.g., inflammatory bowel disease). Detecting resources included original investigations or case reports that identified prescribing cascades using health administrative data, patient cohorts, and novel sources such as social media. Reversing prescribing cascade resources focused on the medication review process and deprescribing initiatives.Prescribing cascades are a recognized problem internationally. By learning from the range of resources to prevent, detect, and reverse prescribing cascades, this review contributes to improving drug prescribing, especially in older adults. J Am Geriatr Soc 66:2079-2085, 2018.

Importance Subtle but important differences have been described in the way that male and female physicians care for their patients, with some evidence suggesting women are more likely to adhere to best practice recommendations. Objective To determine if male and female physicians differ in their prescribing practices as measured by the initiation of lower-than-recommended dose cholinesterase inhibitor (ChEI) drug therapy for dementia management. Design, setting, and participants All community-dwelling Ontario residents aged 66 years and older with dementia and newly dispensed an oral ChEI drug (donepezil, galantamine, or rivastigmine) between April 1, 2010 and June 30, 2016 were included. Main outcome and measures The association between physician sex and the initiation of a lower than recommended-dose ChEI was examined using generalized linear mixed regression models, adjusting for patient and physician characteristics. Data were stratified by specialty. Secondary analyses explored the association between physician sex and cardiac screening as well as shorter duration of the initial prescription. Results The analysis included 3,443 female and 5,811 male physicians and the majority (83%) were family physicians, Female physicians were more likely to initiate ChEI therapy at a lower-than-recommended dose (Adjusted odds ratio = 1.43,95% confidence interval = 1.17 to 1.74). Compared to their male counterparts, female physicians were also more likely to follow other conservative prescribing practices including cardiac screening (55.1% vs. 49.2%, P-value