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Background: Because there are no standardized reporting systems specific to residents of retirement homes in North America, little is known about the health of this distinct population of older adults. We evaluated rates of health services use by residents of retirement homes relative to those of residents of long-term care homes and other populations of older adults. Methods: We conducted a retrospective cohort study using population health administrative data from 2018 on adults 65 years or older in Ontario. We matched the postal codes of individuals to those of licensed retirement homes to identify residents of retirement homes. Outcomes included rates of hospital-based care and physician visits. Results: We identified 54 733 residents of 757 retirement homes (mean age 86.7 years, 69.0% female) and 2 354 385 residents of other settings. Compared to residents of long-term care homes, residents of retirement homes had significantly higher rates per 1000 person months of emergency department visits (10.62 v. 4.48, adjusted relative rate [RR] 2.61, 95% confidence interval [CI] 2.55 to 2.67), hospital admissions (5.42 v. 2.08, adjusted RR 2.77, 95% CI 2.71 to 2.82), alternate level of care (ALC) days (6.01 v. 2.96, adjusted RR 1.51, 95% CI 1.48 to 1.54), and specialist physician visits (6.27 v. 3.21, adjusted RR 1.64, 95% CI 1.61 to 1.68), but a significantly lower rate of primary care visits (16.71 v. 108.47, adjusted RR 0.13, 95% CI 0.13 to 0.14). Interpretation: Residents of retirement homes are a distinct population with higher rates of hospital-based care. Our findings can help to inform policy debates about the need for more coordinated primary and supportive health care in privately operated congregate care homes., In the continuum of care services and settings for older adults lies home care at one end and long-term care at the other. (1) Home care services may include, but [...]

BACKGROUND: Prognostication tools that report personalized mortality risk and survival could improve discussions about end-of-life and advance care planning. We sought to develop and validate a mortality risk model for older adults with diverse care needs in home care using self-reportable information--the Risk Evaluation for Support: Predictions for Elder-Life in the Community Tool (RESPECT). METHODS: Using a derivation cohort that comprised adults living in Ontario, Canada, aged 50 years and older with at least 1 Resident Assessment Instrument for Home Care (RAI-HC) record between Jan. 1, 2007, and Dec. 31, 2012, we developed a mortality risk model. The primary outcome was mortality 6 months after a RAI-HC assessment. We used proportional hazards regression with robust standard errors to account for clustering by the individual. We validated this algorithm for a second cohort of users of home care who were assessed between Jan. 1 and Dec. 31, 2013. We used Kaplan-Meier survival curves to estimate the observed risk of death at 6 months for assessment of calibration and median survival. We constructed 61 risk groups based on incremental increases in the estimated median survival of about 3 weeks among adults at high risk and 3 months among adults at lower risk. RESULTS: The derivation and validation cohorts included 435 009 and 139 388 adults, respectively. We identified a total of 122 823 deaths within 6 months of a RAI-HC assessment in the derivation cohort. The mean predicted 6-month mortality risk was 10.8% (95% confidence interval [CI] 10.7%-10.8%) and ranged from 1.54% (95% CI 1.53%-1.54%) in the lowest to 98.1% (95% CI 98.1%-98.2%) in the highest risk group. Estimated median survival spanned from 28 days (11 to 84 d at the 25th and 75th percentiles) in the highest risk group to over 8 years (1925 to 3420 d) in the lowest risk group. The algorithm had a c-statistic of 0.753 (95% CI 0.750-0.756) in our validation cohort. INTERPRETATION: The RESPECT mortality risk prediction tool that makes use of readily available information can improve the identification of palliative and end-of-life care needs in a diverse older adult population receiving home care., Most people in high-income countries die of causes with progressive, predictable trajectories of decline. (1-4) Since 2000, the 3 leading causes of death in Canada--accounting for 55% of all deaths--have [...]

CONTEXTE : L'epidemiologie de l'infection au SRAS-CoV-2 dans les residences pour aines (offrant une aide a la vie autonome), est pour une bonne part inconnue. Nous avons etudie le lien entre les caracteristiques des residences et des communautes avoisinantes et le risque d'eclosion de SRAS-CoV-2 dans les residences pour aTnes depuis le debut de la premiere vague de la pandemie de COVID-19. METHODES : Nous avons procede a une etude de cohorte retrospective dans la population des residences pour aTnes certifiees en Ontario, au Canada, entre le 1er mars et le 18 decembre 2020. Notre parametre principal etait toute eclosion de SRAS-CoV-2 ([greater than or equal to] 1 cas confirme parmi les residents ou le personnel au moyen d'un test d'amplification des acides nucleiques). Nous avons utilise la methode des risques proportionnels avec predicteurs chronologiques pour modeliser les liens entre les caracteristiques des residences et des communautes avoisinantes et les eclosions de SRAS-CoV-2. RESULTATS : Notre cohorte a inclus l'ensemble des 770 residences privees pour aTnes (RPA) certifiees en Ontario qui hebergeaient 56 491 residents. On a denombre 273 (35,5 %) residences pour aines qui ont connu 1 eclosion de SRAS-CoV-2 ou plus; 1944 residents (3,5 %o) et 1101 employes (3,0 %o) ont contracte l'infection. Ces cas etaient inegalement distribues entre les residences. En effet, 2487 cas parmi les residents et le personnel (81,7 %o) sont survenus dans 77 residences (10 [degrees]%). Le rapport de risque ajuste d'une eclosion de SRAS-CoV-2 dans une residence a ete clairement associe aux etablissements qui avaient une grande capacite d'accueil, qui comportaient des unites de soins de longue duree, qui appartenaient a de plus grandes bannieres et offraient plusieurs services sur place, qui se trouvaient dans des regions marquees par une hausse de l'incidence regionale de SRAS-CoV-2 et ou la concentration ethnique a l'echelle de la communaute etait superieure. INTERPRETATION : Certaines caracteristiques facilement identifiables des residences pour aTnes sont associees de maniere independante aux eclosions de SRAS-CoV-2 et peuvent faciliter devaluation des risques et orienter la priorisation de la vaccination., Les adultes ages fragiles qui vivent dans des milieux de vie collectifs ont ete au centre de la pandemie de COVID-19 au Canada et ailleurs dans le monde (1,2). Les [...]

BACKGROUND: The epidemiology of SARS-CoV-2 infection in retirement homes (also known as assisted living facilities) is largely unknown. We examined the association between home-and community-level characteristics and the risk of outbreaks of SARS-CoV-2 infection in retirement homes since the beginning of the first wave of the COVID-19 pandemic. METHODS: We conducted a population-based, retrospective cohort study of licensed retirement homes in Ontario, Canada, from Mar. 1 to Dec. 18, 2020. Our primary outcome was an outbreak of SARS-CoV-2 infection ([greater than or equal to] 1 resident or staff case confirmed by validated nucleic acid amplification assay). We used time-dependent proportional hazards methods to model the associations between retirement home--and community-level characteristics and outbreaks of SARS-CoV-2 infection. RESULTS: Our cohort included all 770 licensed retirement homes in Ontario, which housed 56 491 residents. There were 273 (35.5%) retirement homes with 1 or more outbreaks of SARS-CoV-2 infection, involving 1944 (3.5%) residents and 1101 staff (3.0%). Cases of SARS-CoV-2 infection were distributed unevenly across retirement homes, with 2487 (81.7%) resident and staff cases occurring in 77 (10%) homes. The adjusted hazard of an outbreak of SARS-CoV-2 infection in a retirement home was positively associated with homes that had a large resident capacity, were co-located with a long-term care facility, were part of larger chains, offered many services onsite, saw increases in regional incidence of SARS-CoV-2 infection, and were located in a region with a higher community-level ethnic concentration. INTERPRETATION: Readily identifiable characteristics of retirement homes are independently associated with outbreaks of SARS-CoV-2 infection and can support risk identification and priority for vaccination., Frail older adults living in congregate care settings have been at the centre of the COVID-19 pandemic in Canada and internationally. (1,2) Long-term care facilities--whose residents are the congregate living [...]

CONTEXTE : Les foyers de soins de longue duree (SLD) ont jusqu'a present ete l'epicentre de la pandemie de maladie a coronavirus 2019 (COVID-19) au Canada. Selon des etudes anterieures, les soins offerts dans les foyers de SLD a but lucratif sont de qualite inferieure pour toute une gamme d'indicateurs de resultats et de processus, ce qui souleve la question suivante : les consequences de la COVID-19 ont-elles ete pires dans les foyers a but lucratif que dans ceux a but non lucratif? METHODES : Une etude de cohorte retrospective basee sur l'ensemble des foyers de SLD en Ontario a ete menee pour la periode du 29 mars au 20 mai 2020 a partir de la base de donnees sur les eclosions de COVID-19 alimentee par le ministere des Soins de longue duree de l'Ontario. Des methodes logistiques hierarchiques et basees sur des donnees de comptage ont ete utilisees pour modeliser les associations entre le statut financier des foyers de SLD (a but lucratif, a but non lucratif ou municipal) et les eclosions de COVID-19 dans ces derniers, l'ampleur des eclosions (nombre de residents infectes) et le nombre de deces de residents attribuables a la COVID-19. RESULTATS : L'analyse portait sur les 623 foyers de SLD de l'Ontario, qui comptent 75 676 residents. Parmi ces foyers, 360 (57,7 %) sont a but lucratif; 162 (26,0 %) sont a but non lucratif; et 101 (16,2 %) sont des foyers municipaux. Au total, 190 (30,5 %) eclosions de COVID-19 ont ete enregistrees dans des foyers de SLD. Elles ont touche 5218 residents et entraTne 1452 deces, ce qui represente un taux de letalite general de 27,8 %. Les probabilites d'une eclosion dans un foyer ont ete associees a l'incidence de la COVID-19 dans la circonscription sanitaire entourant celui-ci (rapport de cotes [RC] ajuste 1,91; intervalle de confiance [IC] a 95 % 1,19-3,05), au nombre de residents dans l'etablissement (RC ajuste 1,38; IC a 95 % 1,18-1,61) et a l'application des anciennes normes d'amenagement (RC ajuste 1,55; IC a 95 % 1,01-2,38), mais pas au statut financier d'un foyer. Comparativement au statut << a but non lucratif >>, le statut << a but lucratif >> a ete associe a l'ampleur d'une eclosion dans un foyer de SLD (risque relatif [RR] 1,96; IC a 95 % 1,26-3,05) ainsi qu'au nombre de deces de residents (RR ajuste 1,78; IC a 95 % 1,03-3,07). Ces associations s'expliquent par une plus grande prevalence des anciennes normes d'amenagement dans les foyers de SLD a but lucratif ainsi qu'a l'appartenance a une chaTne de proprietes. INTERPRETATION : Le statut << a but lucratif >> est associe a l'ampleur d'une eclosion de COVID-19 et au nombre de deces de residents dans un foyer de SLD, mais pas au risque d'eclosion. Deux principaux facteurs expliquent les differences entre les foyers a but lucratif et non lucratif, soit l'application des anciennes normes d'amenagement et l'appartenance a une chaTne de proprietes. Ceux-ci devraient etre au creur des futures mesures et politiques de lutte contre les infections., Au Canada, les foyers de soins de longue duree (SLD) sont devenus l'epicentre de la pandemie de maladie a coronavirus 2019 (COVID-19). En effet, les residents de ces etablissements comptent [...]

BACKGROUND: Long-term care (LTC) homes have been the epicentre of the coronavirus disease 2019 (COVID-19) pandemic in Canada to date. Previous research shows that for-profit LTC homes deliver inferior care across a variety of outcome and process measures, raising the question of whether for-profit homes have had worse COVID-19 outcomes than nonprofit homes. METHODS: We conducted a retrospective cohort study of all LTC homes in Ontario, Canada, from Mar. 29 to May 20, 2020, using a COVID-19 outbreak database maintained by the Ontario Ministry of Long-Term Care. We used hierarchical logistic and count-based methods to model the associations between profit status of LTC homes (for-profit, nonprofit or municipal) and COVID-19 outbreaks in LTC homes, the extent of COVID-19 out breaks (number of residents infected), and deaths of residents from COVID-19. RESULTS: The analysis included all 623 Ontario LTC homes, comprising 75 676 residents; 360 LTC homes (57.7%) were for profit, 162 (26.0%) were nonprofit, and 101 (16.2%) were municipal homes. There were 190 (30.5%) outbreaks of COVID-19 in LTC homes, involving 5218 residents and resulting in 1452 deaths, with an overall case fatality rate of 27.8%. The odds of a COVID-19 outbreak were associated with the incidence of COVID-19 in the public health unit region surrounding an LTC home (adjusted odds ratio [OR] 1.91, 95% confidence interval [CI] 1.19-3.05), the number of residents (adjusted OR 1.38, 95% CI 1.18-1.61), and older design standards of the home (adjusted OR 1.55, 95% CI 1.01-2.38), but not profit status. For-profit status was associated with both the extent of an outbreak in an LTC home (adjusted risk ratio [RR] 1.96, 95% CI 1.26-3.05) and the number of resident deaths (adjusted RR 1.78, 95% CI 1.03-3.07), compared with nonprofit homes. These associations were mediated by a higher prevalence of older design standards in for-profit LTC homes and chain ownership. INTERPRETATION: For-profit status is associated with the extent of an outbreak of COVID-19 in LTC homes and the number of resident deaths, but not the likelihood of outbreaks. Differences between for-profit and nonprofit homes are largely explained by older design standards and chain ownership, which should be a focus of infection control efforts and future policy., Long-term care (LTC) homes have become the epicentre of the coronavirus disease 2019 (COVID-19) pandemic in Canada, with residents of these care homes accounting for more than 80% of the [...]