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The improving access to increasing amounts of biomedical data provides completely new chances for advanced patient stratification and disease subtyping strategies. This requires computational tools that produce uniformly robust results across highly heterogeneous molecular data. Unsupervised machine learning methodologies are able to discover de-novo patterns in such data. Biclustering is especially suited by simultaneously identifying sample groups and corresponding feature sets across heterogeneous omics data. The performance of available biclustering algorithms heavily depends on individual parameterization and varies with their application. Here, we developed MoSBi (Molecular Signature identification using Biclustering), an automated multi-algorithm ensemble approach that integrates results utilizing an error model-supported similarity network. We evaluated the performance of MoSBi on transcriptomics, proteomics and metabolomics data, as well as synthetic datasets covering various data properties. Profiting from multi-algorithm integration, MoSBi identified robust group and disease specific signatures across all scenarios overcoming single algorithm specificities. Furthermore, we developed a scalable network-based visualization of bicluster communities that support biological hypothesis generation. MoSBi is available as an R package and web-service to make automated biclustering analysis accessible for application in molecular sample stratification.

Optimizing heath care services for seniors in emergency departments (ED) is a core component of the “Senior Friendly Hospital Approach” being implemented in Quebec. We measured the availability of geriatric expertise in Quebec EDs and its relationship with ED characteristics such as university affiliation, number of stretchers, and geographical location. We surveyed (2013–2014) head nurses and head physicians at 116 adult, non-psychiatric Quebec EDs. We defined high level of availability in the three following components of geriatric expertise: 1) geriatric care coordinatioN = a designated clinician coordinating the care of older adults available every day; 2) multidisciplinarity = 4 or 5 different nonmedical professionals, i.e., specialized nurse, social worker, occupational therapist, physiotherapist, and pharmacist, available almost always/often (nurse-reported); and 3) geriatric consultation = a specialist or a general practitioner specialized in geriatrics available almost always/often (physician-reported). We performed descriptive analyses and Fisher’s exact test. Among participating EDs (N = 83), 73 (88%) nurses and 67 (81%) physicians participated in the survey. 18% of EDs had high level of geriatric care coordination, 41% provided high level of multidisciplinarity, and 33% received high level of geriatric consultation. We found that EDs that had greater number of stretchers were more likely to have high level of geriatric care coordination (p < .05) and consultation (p < .001). EDs in metropolitan areas were also more likely to receive high level of geriatric consultation (p < .01). High level of multidisciplinarity was not associated with any ED characteristics. 2/5 of Quebec EDs provide high level of multidisciplinarity varying in their characteristics, whereas smaller and non-metropolitan EDs lack geriatric care coordination and consultation. There is a need for reorganisation and finding innovative ways to use existing human resources in Quebec EDs., Background: Use of potentially inappropriate medication (PIMs) in the hospitalized elderly can lead to adverse drug events, and contribute to geriatric syndromes. PIMs are frequently prescribed to elderly hospitalized patients, indicating the need to develop strategies to reduce their use. Objectives: To assess 1) the applicability of a pharmacist-physician intervention model to reduce the use of high-risk medications and 2) the clinical relevance of the alerts generated by a computerized alert system (CAS). Methods: The study was conducted in patients aged 65 or older admitted to a teaching hospital between April and June 2014. In the intervention model, the pharmacist determined the clinical relevance of the CAS alerts, analyzed the patient’s pharmacotherapy, and elaborated a geriatric pharmacotherapeutic plan to be discussed with the treating physician. The alerts were based on the Beers criteria. The main outcome was the change rate, defined as the number of patient-days with a change in at least one medication out of the total number of patient-days with at least one intervention. Results: The CAS identified 200 patient-days with at least one alert. In 149 patient-days, at least one alert was judged to be clinically relevant for a positive predictive value of 74.5%. The change rate was 77.7%. The most frequent changes were drug discontinuation (40.9%), and dose reduction (31.1%). The most frequently targeted drug classes were bone resorption inhibitors (20.2%), antiemetics (18.1%), benzodiazepines (13.0%), antidepressants (11.9%), antipsychotics (9.8%), and opiate agonists (7.8%). The inpatient geriatric consultation team was involved in 42 (22.3%) of the 188 included hospitalizations. Conclusion: The intervention model reduced high-risk medication use in hospitalized older patients, most of whom, otherwise, did not have a comprehensive geriatric assessment., The GAI was recently developed to address the need of a screening test that is simple, brief, and tailors to an older adult healthy and clinical population while minimizing items assessing somatic symptoms (Pachana et al., 2007). The purpose of this study is to assess the psychometric properties of the GAI as a tool to measure severity of anxiety symptoms among geriatric outpatients. Participants (N = 190) were recruited from two geriatric outpatient clinics at the McGill University Health Centre (MUHC). The 20-item GAI was administered in English or French. The data were analyzed via the Rasch analysis (RUMM2030) to examine unidimensionality of the construct being measured and assess individual item fit. Unidimensionality was confirmed by good fit of all the GAI items to the Rasch model with no significant item-trait interaction. There were no residual correlations of items above 0.3 observed. The 20-item GAI hierarchy ranged a span of 3.61 logits with the least severe anxiety symptom as “think of myself as worrier” to the most severe anxiety symptom as “feel great knot in stomach.” Standard error for item estimates ranged from 0.21 to 0.43. Person separation index was 0.71 when excluding individuals who did not report anxiety symptoms (38.4%). GAI items appropriately capture the anxiety construct. Even though in our sample GAI does not allow fine discrimination among individuals with similar severity of anxiety symptoms, this may be due to the development of the GAI as a screening test. All 20 GAI items represent a unidimensional anxiety construct, hence the GAI is a valid measure to assess geriatric outpatients’ anxiety symptomatology., Population aging is a global phenomenon that creates challenges in the care of the elderly population may be jeopardized in their cognitive health. The objective of this study was to delineate the cognition of registered elderly caregivers in a family-USF Health Unit in an area of high social vulnerability. The sample consisted of 73 elderly caregivers, over the age of 60. The interviews were conducted in the homes of elderly people in previously scheduled days and times. The instruments used for data collection were a sociodemographic questionnaire, The Addenbrooke’s Cognitive Examination Revised (ACE-R), and Mini-Mental State Examination (MMSE). Of the 73 elderly caregivers 58 (73.45%) were females and 15 (20.54%) were male, with a mean age of 70.35 (± 8.50) years and average schooling of 2.31 years. Regarding cognitive assessment, the average total points in the ACE-R was 49.58 (± 18.11) and MMSE 19.9 (± 4.6). The average scores on the ACE-R were: Attention/orientation 11.84 (± 3.15) points; Memory 10.45 (± 6.05); Verbal fluency 4.32 (± 2.84); Language 14.9 (± 5.7); and spatial Viso 8.02 (± 3.63). Of the elderly, 39 (53.42%) did not have changes in cognition according to the MMSE, using education by cohort note. In females 48.27% had cognitive impairment and in males 40% of the elderly. There are few studies that bring the design of cognition of the elderly in a highly vulnerable population, showing the need to study this further. We conclude that low educational level, the advanced age of the caregiver and the percentage of caregivers with cognitive impairment signs are worrying factors in the elderly, highly vulnerable population., Identification of the risk of recurrent falls is complex in older adults. The aim of this study was to examine the efficiency of three artificial neural networks (ANNs): multilayer perceptron (MLP), modified MLP, and neuroevolution of augmenting topologies (NEAT) for the classification of recurrent fallers and non-recurrent fallers using a set of clinical characteristics corresponding to risk factors of falls measured among community-dwelling older adults. Based on a cross-sectional design, 3,289 community-dwelling volunteers aged 65 and older were recruited. Age, gender, body mass index (BMI), number of drugs daily taken, use of psychoactive drugs, diphosphonate, calcium, vitamin D supplements, and walking aid, fear of falling, distance vision score, Timed Up&Go (TUG) score, lower-limb proprioception, handgrip strength, depressive symptoms, cognitive disorders, and history of falls were recorded. Participants were separated into 2 groups based on the number of falls occurred over the past year: ≤ 1 fall and ≥ 2 falls. In addition, total population was separated into training and testing subgroups for ANNs analyses. Among 3,289 participants, 18.9% (N = 622) were recurrent fallers. NEAT using 15 clinical characteristics (i.e., use of walking aid, fear of falling, use of calcium, depression, use of vitamin D supplements, female, cognitive disorders, BMI < 21kg/m2, number of drugs daily taken > 4, vision score < 8, use of psychoactive drugs, lower-limb proprioception score ≤ 5, TUG score > 9 seconds, handgrip strength score ≤ 29(N), and age ≥ 75 years) showed the best efficiency for recurrent fallers identification: sensitivity (80.42%), specificity (92.54%), positive predictive value (84.38), negative predictive value (90.34), accuracy (88.39) and Cohen’s kappa (0.74) compared to MLP and modified MLP. Our results show that NEAT and modified MLP are both efficient ANNs for the identification of recurrent fallers, the most effective ANN being NEAT. NEAT using a set of 15 clinical characteristics was an efficient ANN for the identification of recurrent fallers in older community-dwellers., Fear of falling (FOF) and increased gait variability are independent markers of gait instability. There is a complex interplay between them. The purposes of this study were 1) to perform a qualitative analysis of all published studies on FOF-related changes in gait variability through a systematic review, and 2) to quantitatively synthesize FOF-related changes in gait variability. A systematic Medline literature search was conducted on May 2014 using the Medical Subject Heading (MeSH) terms “Fear” OR “fear of falling” combined with “Accidental Falls” AND “Gait” OR “Gait Apraxia” OR “Gait Ataxia” OR “Gait disorders, Neurologic” OR “Gait assessment” OR “Functional gait assessment” AND “Self efficacy” OR “Self confidence” AND “Aged” OR “Aged, 80 and over.” Systematic review and fixed-effects meta-analysis using an inverse-variance method were performed. Of the 2184 selected studies, 10 observational studies (including 5 cross-sectional studies, 4 prospective cohort studies and one case-control study) met the selection criteria. All were of good quality. The number of participants ranged from 52 to 1,307 older community-dwellers (26.2 to 85.0% women). The meta-analysis was performed on 10 studies with a total of 999 cases and 4,502 controls. In one study, the higher limits of the effect size’s confidence interval (CI) were lower than zero. In the remaining studies, the higher limits of the CI were positive. The summary random effect size of 0.29 [95% CI: 0.13; 0.45] was significant, albeit of small magnitude, and indicated that gait variability was overall 0.29 SD higher in FOF cases compared to controls. This systematic review and meta-analysis shows that FOF is associated with a small significant increase in gait variability (i.e., worst performance of gait). In addition, mixed results of qualitative analysis suggest that this association may be influenced by other covariables that should be taken into account when examining it. Our findings show that FOF is associated with a statistically significant, albeit of small magnitude, increase in gait variability., Behavioural and psychological symptoms of dementia (BPSD) are common among older adults with dementia in long-term care (LTC) facilities. There is controversy regarding the prevalence of different manifestations of BPSD across the stages of dementia. This study examined the prevalence of BPSD in LTC in urban Nova Scotia. We also aimed to create a profile of different components of BPSD across the spectrum of dementia severity. LTC chart reviews were conducted between September 1, 2011, and January 31st, 2012, using a Comprehensive Geriatric Assessment (CGA) tool adapted for Long-Term Care: the LTC-CGA. A total of 269 LTC residents from 10 LTC facilities (LTCF) in Halifax, Nova Scotia with documented cognitive status were included, of whom 199 had a diagnosis of dementia. Group comparison of demographic variables, cognition (assessed using the Mini-Mental State Examination), BPSD symptoms, and function in Activities of Daily Living (ADLs) were performed across stages of dementia severity. BPSD were present in 76.9% of 199 residents with dementia, and a similar behavior pattern without physical aggression was also reported in up to 45% without a dementia diagnosis. The prevalence of psychological symptoms increased only slightly with dementia severity (28%, 31%, and 32% for mild, moderate, and severe, respectively), and were in fact most prevalent among those without dementia (36%; p < .001). Behavioural symptoms did increase with severity of cognitive impairment (p < .001). BPSD are highly prevalent among residents of LTC facilities in Nova Scotia. In contrast to often-held views that BPSD are a manifestation of severe dementia, here BPSD appeared to be prevalent across the spectrum of dementia severity, and many behavioral and psychological clusters were indeed identified in residents without a documented diagnosis of dementia., To identify the predictors of outcomes of elderly patients admitted to a slow-stream, low-intensity, long-duration inpatient rehabilitation (SSR) program after an acute hospitalization because they were unable to tolerate traditional inpatient rehabilitation. Prospective cohort study with assessments conducted on admission and discharge. 104 patients above age 60 admitted between September 2011 and December 2012 to Baycrest’s 30-bed SSR Unit in Toronto, Ontario. Admission assessments included motor Functional Independence Measure (FIM), Montreal Cognitive Assessment (MoCA), grip strength, ability to ambulate, Berg Balance Scale, Older American Resources and Services Activities of Daily Living (OARS ADL) based on functional status prior to the hospitalization, Short Form Health Survey (SF-12), Confusion Assessment Method (CAM), Patient Health Questionnaire (PHQ-9), and Comprehensive Geriatric Assessment Frailty Index (CGA-FI). Discharge outcomes included change in motor FIM from admission to discharge, residential status at discharge, and length of stay. Univariate and multivariate analyses were performed. Mean age was 81.6 ± 8.4 years and 68.3% were females. Mean length of SSR stay was 82.5 ± 26.4 days. Mean change in motor FIM from admission to discharge was 21.0 ± 12.2 (p < .001). Higher MoCA, higher Berg, lower CGA-FI and lower motor FIM at admission showed significant association with greater improvements in motor FIM. Lower CGA-FI was associated with returning to previous living situation. No significant predictors of lengths of stay were found in the multivariable analyses. Lower frailty scores, higher cognitive function, lower falls risk, and lower functional independence scores at admission were associated with greater improvements in motor FIM. Lower frailty scores on admission was associated with greater likelihood of returning to previous living situation. Admission frailty scores were strong predictors of outcomes for patients admitted to SSR., Twitter is a microblogging platform that overcomes physical barriers, allows unrestricted participation, and enables interactive discussions. Twitter-based journal clubs have demonstrated growth, sustainability, and worldwide communication, using a hashtag(#) to trend journal club participation. To date, there is no reported Twitter-based geriatric medicine journal club. We describe the first five months of #GeriMedJC. @GeriMedJC moderates #GeriMedJC, a monthly 26-hour asynchronous journal club that complements the live, 1-hour, traditional-format geriatric medicine journal club based at the University of Toronto. Growth metrics including number of tweets, number of participants, tweet amplification, and impressions were obtained from Symplur. Thematic analysis of tweets was performed to categorize content into areas of clinical practice, medical education, health policy, and critical appraisal. In the first five months, @GeriMedJC has grown 217 followers, including 30%, 25%, and 16% from the U.K., Canada, and U.S.A., respectively. Most followers were physicians (35%), with two-thirds representing geriatricians. There was an increase in all growth metrics for the first few months with a mean of 83 tweets, 36 retweets, 16 participants, and 34,750 impressions per journal club session. The content of tweets were most relevant to clinical practice, medical education, critical appraisal, and health policy in 39%, 18%, 16% and 4% of tweets, respectively. There has been a steady increase in growth metrics for #GeriMedJC with demonstrated discussion in areas of clinical practice, medical education, critical appraisal, and health policy. #GeriMedJC is another example of using Twitter to engage international and interprofessional appraisal of medical literature. Future directions include demonstrating sustainability and analyzing factors associated with the growth of #GeriMedJC., Urodynamics (UD) refers to a broad range of investigations of lower urinary tract function such as bladder diaries and post-void residual measurement as well as invasive procedures such as multi-channel cystometry. According to the 5th International Consultation on Incontinence, the level of evidence supporting UD in the in frail older persons is weak. To assess the body of evidence, a scoping study was conducted by searching OVID Medline, OVID Embase, Cochrane Central Register of Controlled Trials, CINAHL, and Web of Science. The search was limited to English studies of patients > 18 years old, published from 1965 to November 18, 2014. A total of 10,246 abstracts meeting the search criteria were found; studies included bladder diaries, the pad test, post-void residuals, uroflowmetry, filling and voiding cystometry, and abdominal leak point pressure measurement. Studies involving the frail elderly were few but some themes emerged: non-invasive UD (bladder diaries and pad tests) were found useful prior to treatment and to assess treatment response. Post-void residual measurement and uroflowmetry showed benefit in preventing urinary retention when performed prior to initiation of pharmacological therapy or invasive urological procedures. Voiding cystometry was of benefit to both male and female older adults prior to surgery and in the assessment of postsurgical incontinence. UD was well-tolerated by the geriatric population. Based on current evidence, both non-invasive and invasive UD can be considered in selected elderly patients to guide treatment decisions, especially when considering surgical intervention. More research is needed in deciding which elderly patients will benefit from UD investigation., The aims of this study were 1) to confirm that combinations of brief geriatric assessment (BGA) items were significant risk factors for prolonged LHS among geriatric patients hospitalized in acute-care medical units after their admission to the emergency department (ED); and 2) to determine whether these combinations of BGA items could be used as a prognostic tool of prolonged LHS. Based on a prospective observational cohort design, 1,254 inpatients (mean age ± standard deviation, 84.9 ± 5.9 years; 59.3% female) recruited upon their admission to ED and discharged in acute-care medical units of Angers University Hospital, France, were selected in this study. At baseline assessment, a BGA was performed and included the following 6 items: age > 85 years, male gender, polypharmacy (i.e., ≥ 5 drugs per day), use of home-help services, history of falls in previous 6 months and temporal disorientation (i.e., inability to give the month and/or year). The LHS in acute care medical units was prospectively calculated in number of days using the hospital registry. Area under receiver operating characteristic (ROC) curves of prolonged LHS of different combinations of BGA items ranged from .50 to .57. Cox regression models revealed that combinations defining a high risk of prolonged LHS, identified from ROC curves, were significant risk factors for prolonged LHS (hazard ratio > 1.16 with p > .010). Kaplan-Meier distributions of discharge showed that inpatients classified in high-risk group of prolonged LHS were discharged later than those in low-risk group (p < .003). Prognostic value for prolonged LHS of all combinations was poor with sensitivity under 77%, a high variation of specificity (from 26.6 to 97.4) and a low likelihood ratio of positive test under 5.6. Our results show that combinations of BGA items were significant risk factors for prolonged LHS in geriatric patients admitted to ED and discharged to acute-care medical units. However, the prognostic value for prolonged LHS of these combinations of BGA items was poor, whatever the BGA items or their combinations used. Combinations of 6-item BGA tool were significant risk factors for prolonged LHS but their prognostic value was poor in the studied sample of older inpatients., Fragility fracture risk assessment tools are increasingly being used to inform treatment decisions. Three commonly used tools are FRAX, Garvan, and Qfracture. However, these tools produce different results for 10-year risks of sustaining major osteoporotic fractures and hip fractures and potentially may lead to different treatment decisions. The aim of this study was to evaluate if employing these different tools with their associated guidelines would impact on the decision to treat or not in a group of postmenopausal women. Clinicians used a questionnaire to collect information to populate the 3 tools in patients attending osteoporosis clinics and the 10-year fracture risks were calculated. For FRAX (UK), the National Osteoporosis Guideline Group (NOGG) age-related treatment thresholds were used, and for Garvan and Qfracture, a set 20% threshold was used to determine the need for intervention. 90 women (mean age 69.5 ± 12.9 years) were studied. FRAX recommended treatment in 45.6% (95% CI = 35.3–55.9%; N = 41) versus 71.7% (95% CI = 61.7–80.5%; N = 64) in Garvan and 40% (95% CI = 29.9–50.1%; N = 36) in Qfracture. There was substantial discordance in treatment recommendation between the groups with only 17.8% (N = 16) of patients having the recommendation to treat by all three tools. Compared to FRAX-NOGG (UK), employing the Garvan tool (20% threshold) significantly over-treated and the Qfracture tool (20% threshold) tended to undertreat and there was substantial misclassification on whether or not to treat between the three groups. Clinicians should be aware that choosing one fracture risk assessment tool over another (with associated treatment guidelines) may strongly influence their treatment decisions., Understanding how and why dementia occurs is key to understanding its prevention and management. Recently, standard laboratory values have been used together as an index to identify adverse outcomes in the presence of frailty. We sought to investigate whether this laboratory frailty index (the FI-Lab) was associated with a diagnosis of dementia. A secondary analysis was done of a prospective cohort study consisting of community and institutionally dwelling individuals aged 65 and older. The FI-Lab was created from laboratory tests used in the first clinical examination of the Canadian Study of Health and Ageing. Univariate and multivariate logistic regression for a diagnosis of dementia at five years was performed to identify any association with the FI-Lab. Of 1,013 patients, 467 were alive at follow-up, of whom 391 (83.7%) had a follow-up diagnostic evaluation. Those 76 missing diagnosis had similar demographics to the study group. In univariate analysis, the FI-Lab (mean 0.25) was significantly associated with a diagnosis of dementia (p = .003). In multivariate analysis the FI-Lab remained significant (p = .019). Combining the FI-Clinical and FI-Lab the FI-Combined (p < .001), education (p = .002), age (p = .019) and sex (p = .032) were all predictive of dementia. Sex was not significantly associated with a dementia diagnosis. A standard laboratory index (FI-Lab), modelled after the frailty index, was associated with a future diagnosis of dementia. The FI-Lab did not include any classical dementia biomarkers. This contributes further to the possibility that dementia most often occurs in those who are frail. This further supports the potential mechanism to dementia being an impaired neurocognitive repair process. Standard laboratory tests, when combined, are able to identify individuals who are at increased risk of dementia., Among hospitalized older adults, delirium is a common complication of acute illness and contributes significantly to patient morbidity and mortality. The aim of our study was to investigate the incidence of delirium among older adults admitted to the Clinical Teaching Unit (CTU) in the Royal University Hospital in Saskatoon, the factors associated with development of delirium, and subsequent management practices. This information will provide us with an opportunity to develop delirium prevention, diagnosis, and management strategies. A chart review of 170 patients over the age of 70 at admission to the CTU was completed. A validated chart review tool was used to diagnose delirium from patient charts. Delirium diagnosis was defined as a recorded diagnosis of delirium or a documentation of “mental status change” or “acute/fluctuating” along with at least one other key term documentation (acute onset, agitation, disorganized thinking, disorientation, hallucinations, inappropriate behaviour, inattention). The delirium rate in the sample was 30.8%, (95% CI: [21.9%, 39.7%]). Delirium management ranged from non-pharmacologic interventions such as reorientation and reassurance, to invasive strategies such as physical or chemical restraint (predominantly haloperidol). Management techniques were applied inconsistently when delirium was present. This project has demonstrated a significant presence of delirium within the CTU, with variable management strategies. Although delirium was commonly encountered, physician documentation of delirium within the chart was rare. Furthermore, benzodiazepines were occasionally used as a first-line management tool, in contrast to the Choosing Wisely Canada guidelines. Management of delirium requires appropriate recognition and coordinated strategies for appropriate intervention. Recognizing the significant burden of delirium on the health-care system bears important implications for health resource planning and improved patient outcomes, particularly among vulnerable elderly populations., Influenza results in over 200,000 hospitalizations and 36,000 deaths per year in the United States. Ninety percent of influenza-related deaths occur in those older than 65. In order to appropriately advise the public and direct future vaccination strategies and research, the Canadian Immunization Research Network’s Serious Outcomes Surveillance (SOS) Network calculates vaccine effectiveness by monitoring the annual burden of influenza illness resulting in hospitalization. Surveillance for influenza is conducted at 15 SOS Network sites across Canada. All patients aged 16 years or older admitted with possible influenza (e.g., acute respiratory illness, fever) received a nasopharyngeal swab testing for influenza via reverse-transcriptase PCR or viral culture. Viral strain, vaccination status, intensive care admission, and death were recorded and compared among confirmed cases and test-negative controls. Interim data for the 2014/15 influenza season indicate: A poor match between the circulating virus and vaccine strain, with poor vaccine effectiveness in all age groups (e.g. −25.4% (90% CI: −65, 4.6) for those older than 65);69% of hospitalized cases are older than 75 years;11% required intensive care; 8% associated mortality. One of the defining features of aging is declining immune function. Age-related changes in T-cell function result in lessened ability of elderly people, especially those who are frail, to mount a protective immune response. Given the lack of vaccine effectiveness in a mismatch year and the high associated mortality in the elderly population, multiple strategies such as biomarkers for vaccine response, high-dose vaccines, and vaccine adjuvants need to be explored to mitigate adverse outcomes in future influenza outbreaks. Further research into frailty-informed assessments of vaccine responsiveness is imperative to reduce influenza-related morbidity and mortality., A thorough falls assessment can successfully reduce future events and injuries in elderly patients presenting to hospital with a fall. However, the frequency with which patients receive such an assessment is not clear. We sought to characterize the management of elderly patients presenting to the ED with a fall. Records from a single large tertiary care center ED between 2003 and 2014 were searched. A random sample of 96 charts, describing visits for a “fall” in individuals ≥ 65 years, were selected. Charts were reviewed using a detailed pre-specified data abstraction form documenting fall management. Of the 96 patients, mean age was 78.2 years (SD ± 8.53), and 61.5% were women. Most (42.8%) lived at home with family, 11.5% lived alone, and 16.6% lived in nursing homes or assisted living. Fall-related injuries were common with 54.2% sustaining a new fracture. In terms of falls assessment, only 2% patient charts had documentation of the presumed etiology of their fall. Orthostatic vital signs were performed in 1% of patients, 1% had a visual assessment, 3% underwent assessment of cognition, and 3% had a medication review. Following assessment, 69.7% of patients were discharged from the ED and 25% of patients were admitted to home hospital (4.1% transferred elsewhere, 1% died in ED). Of those discharged, 29% of patients did not have follow-up arranged, 28% were referred for community supports, and 14% were discharged with a new walking device. Two (2.2%) were started on Vitamin D and calcium, and 1% on a bisphosphonate. Very few elderly patients presenting to the ED with a fall received a proper falls assessment or treatment plan. These results suggest a significant care gap and highlight an area of opportunity for future quality improvement., Frailty is a multicausal syndrome including weight loss, exhaustion, and lack of strength and mobility, which puts older adults at risk for adverse outcomes including falls, hospitalization, and death. High burden in caregivers of older adults is associated with physical and psychiatric morbidities. Limited research suggests a relationship between frailty in older adults and their caregivers’ self-reported burden. This study analyzed the relationship between frailty in older adults attending a geriatric outpatient clinic and their caregivers’ self-reported burden. The study population consisted of 50 older adults attending an outpatient geriatric clinic in 2013 and 2014 accompanied by a caregiver. Participants’ degree of frailty was evaluated using the Fried Frail Scale (FFS). Independence in activities of daily living was assessed using the Katz Index. Patient charts were reviewed for prior diagnosis of dementia. Caregivers’ self-reported burden was evaluated using the Short Zarit Burden Interview (ZBI). Multivariable linear regression was performed with ZBI score as the dependent variable, and age, gender, dementia, Katz Index, and frailty status as independent variables. Caregivers of frail (FFS ≥ 3; N = 21) patients had a mean ZBI score of 19.4 (SD = 11.3). Caregivers of non-frail (FFS < 3; N = 29) subjects had a mean ZBI score of 13.6 (SD = 8.4). Frailty and prior diagnosis of dementia significantly predicted caregiver burden. Age, Katz Index, and gender did not significantly predict caregiver burden. Caregivers of frail older adults attending a geriatric outpatient clinic reported a significantly higher level of burden than caregivers of non-frail patients. Prior diagnosis of dementia was a significant predictor of caregiver burden. Further examination of the relationship between frailty and caregiver burden is warranted., Older adults with functional impairment are cared for by physiatrists in rehabilitation. With the aging population, acquiring geriatric-related competencies will be essential. Literature is limited on geriatric learning needs in physiatry but suggests that education is suboptimal. To develop a geriatric rehabilitation curriculum, a needs assessment was conducted to understand comfort level of geriatric-related competencies and resident learning needs in physiatry residents, physiatrists, and key informants (KI). A mixed methods approach was taken. Physiatry residents at the University of Toronto were invited to participate in a questionnaire and focus group. Physiatrists in Ontario were invited to complete a questionnaire and participate in follow-up one-on-one inter views. KIs were purposively selected to participate in both surveys. Questionnaires assessed comfort level (0 very uncomfortable, 5 very comfortable) on geriatric-related competencies. Focus groups and interviews explored learning experiences and needs in geriatrics rehabilitation. Descriptive statistics were used to analyze questionnaires. NVivo software was used for qualitative analysis within a grounded theory approach. Eighteen (87%) residents and 27 (21%) physiatrists completed the questionnaire. More than 50% of residents were somewhat to very uncomfortable on geriatric topics such as age-related pharmacokinetics and dynamics, pain management, frailty, physiology of aging, and depression. Physiatrists identified similar topics in addition to cognitive impairment (including delirium), medication management, and end-of-life care. Initial qualitative analysis sheds further light on these identified learning needs; in particular, how applicability can be enhanced in the post acute care setting. A large proportion of physicians in physiatry do not feel comfortable on core geriatric-related competencies, which were similarly identified as learning needs by physicians in physiatry. Initial insights may provide educators with an understanding on how to improve geriatric education in physiatry., Biological aging is a stochastic process that can be characterized by the number of health deficits individuals accumulate (i.e., their frailty index). As people with HIV exhibit excess risk for multiple age-related health problems, they might age differently than people without HIV. Secondary analysis of four-year follow-up data from the Italian Modena HIV Metabolic Clinic cohort (MHMC; N = 963; mean age 46.8 ± 7.1 years; 29% women) and the Italian sample of the general community-based Survey of Health, Ageing and Retirement in Europe (SHARE; N = 1,391; mean age 65.7 ± 8.8 years; 56% women). Health state was quantified as the number of deficits accumulated out of 31 health variables, selected separately in each cohort. Multistate transition modelling provided probabilities of health state changes, including death. In both cohorts, mean deficit count at four years follow-up showed a similar, linear relationship with deficit count at baseline; MHMC consistently had smaller standard deviations in deficit counts at follow-up. Mortality was 3.0% in MHMC and 7.7% in SHARE. Adjusted for baseline deficit count, age, and gender, MHMC participants had more deficits at follow-up than SHARE participants (RR 1.28, 95% CI 1.22–1.35), but mortality differences were non-significant (OR 0.85, 0.45–1.61). Adjusted mean deficits at follow-up were 8.25 (7.99–8.52) in MHMC and 6.87 (6.66–7.07) in SHARE (p < .001). Despite differences between cohorts (e.g., HIV clinic vs. community-based, age and gender distributions) and in the health variables making up the frailty indices, HIV-positive MHMC participants and general population SHARE participants demonstrated similar patterns of deficit accumulation. MHMC participants generally accumulated more deficits and exhibited greater homogeneity in outcomes. People with HIV appear to age in patterns similar to the general population, but experience poorer and less variable outcomes over four years., Anticholinergic drug therapy may worsen cognitive performance and is particularly concerning when prescribed to older adults with dementia. Care provided by multiple physicians may contribute to this inappropriate prescribing. We explored the association between the number of unique physicians providing care and anticholinergic drug burden among older persons newly initiated on cholinesterase inhibitor therapy for the management of dementia. A population-based cross-sectional study of community and long-term care dwelling older adults with dementia in Ontario. The number of unique physicians providing care and anticholinergic drug burden using the Anticholinergic Risk Scale (ARS) were measured within the prior year. We identified 79,067 community-dwelling older adults and 12,113 LTC residents newly dispensed cholinesterase inhibitors. In the community (mean age 81.0 years, 60.8% women), individuals saw an average of 8 unique physicians in the prior year. The odds of high anticholinergic drug burden (ARS score of ≥ 2) increased by 24% for every 5 additional physicians providing care (adjusted odds ratio, 1.24; 95% confidence interval, 1.21–1.26). Female sex, low-income status, previous hospitalization, and higher comorbidity score were also associated with high anticholinergic drug burden. In LTC (mean age 84.3 years, 67.2% women) individuals saw an average of 10 unique physicians in the prior year. Relative to the community setting, the anticholinergic drug burden based on the number of physicians providing care was similar but attenuated in LTC. Among older adults with dementia newly dispensed cholinesterase inhibitor drug therapy, a greater number of physicians providing care was associated with higher anticholinergic drug burden scores. Improved communication amongst physicians, and a medication review prior to prescribing a new drug therapy, as suggested by Choosing Wisely, are important strategies to improve prescribing quality., Older adults who become ill often demonstrate impairments in mobility and balance. Such impairments are more common in frail adults, and independently are associated with death. Even so, little work has related frailty to recovery time, which was our objective here. This is a secondary analysis of a cohort study of 409 older adult inpatients at a Canadian teaching hospital (mean age = 81 ± 7 standard deviation, 64% women). Frailty was measured using a frailty index based on a comprehensive geriatric assessment (FI-CGA), at baseline (two weeks prior to admission; mean 0.31 ± 0.10), and on admission (mean 0.40 ± 0.10). Mobility and balance was quantified using the Hierarchic Assessment of Balance and Mobility (HABAM). Recovery was measured as the difference in HABAM scores between discharge and admission. The odds of no or incomplete recovery increased by 1.06 (95% confidence interval: 1.01–1.11) for each 0.1 increment in the baseline FI-CGA. Recovery was similarly dependent on age, but independent of mobility scores on admission. Frailer patients showed longer recovery times, especially with an increase in FI-CGA scores between baseline and admission (r = 0.35, p < .001). Recovery time was independent of age. Recovery has been shown to be dependent both on severity of illness and baseline level of frailty. Tracking mobility and balance can help providers, patients, and families understand the course of acute illness in older adults. Frailer patients are at a greater risk of incomplete recovery from impaired mobility and balance. Further work into how frailty and illness severity together impact recovery — perhaps through a measure that combines the two — is needed., Studies suggested that antipsychotic-induced weight gain is not as much of a concern in the elderly compared to the younger population. Part 1 of this study was to determine whether atypical antipsychotics induced weight change in elderly patients with various psychiatric diagnoses. Part 2 was to identify whether certain antipsychotics induced weight change in elderly patients. In Part 1, a retrospective chart review was done on 115 geriatric inpatients. After exclusion, patients were divided into four groups: control (N = 17), new treatment (N = 18), long-term treatment (N = 13), and medication switch groups (N = 8). In Part 2, a medication review was performed on 169 geriatric inpatients. After exclusion, patients were divided into three groups: aripiprazole (N = 18), olanzapine (N = 49), and risperidone (N = 57). Body weights were obtained at two different time points. No significant weight change was observed among the control (1.5 kg), new treatment (0.8 kg), long-term treatment (−0.3 kg), and medication switch (1.9 kg) groups. No significant weight change was observed between patients with and without dementia (0.8 and 1.1 kg, respectively). The weight change in the aripiprazole group (−2.0 kg; −2.30% from baseline) was significantly different from the weight change in the olanzapine group (0.7 kg; +1.87% from baseline; p < .05), but not from the risperidone group (−0.4 kg; −0.45% from baseline). Clinically significant weight gain (> 7% increase in body weight) occurred in 14.3% of the olanzapine patients, a percentage significantly higher than the 3.5% in the risperidone group. Although antipsychotics generally caused no weight change in the elderly population, aripiprazole and olanzapine were associated with significant weight loss and weight gain, respectively. Prospective trials are needed to confirm whether aripiprazole and olanzapine cause weight change in the elderly population., Background: As no widely accepted screening tool that predicts patient rehabilitation outcomes on a Geriatric Rehabilitation Unit (GRU) exists, determination of those who will benefit from admission and how to maximize rehabilitation gains remains challenging. Objective: Does pre-morbid frailty, as assessed with the 9-point clinical frailty scale (CFS), predict rehabilitation outcomes? Methods: A retrospective chart review was conducted on all patients admitted to Parkwood Institute’s GRU between September 2013 and May 2014. CFS scores were assigned retrospectively based on pre-morbid health and functional status data recorded in the patient’s chart. Rehabilitation outcomes, including Relative Functional Gain (RFG), and Relative Functional Efficiency (RFE) were calculated. Results: Ninety-six (41.4%) of the 232 GRU patients were male and 44% had experienced a lower-extremity fracture. Mean age was 82.8 years (range: 59 to 96), mean CFS on admission was 4.9 (range: 1–7), mean FIM on admission was 69.9 (range: 20–109), mean RFG was 0.43 (range: −0.21 to 0.88), and mean RFE was 0.02 (range: −0.01 to 0.10). Regression modeling that included physical health (Charlson comorbidity index [CCI], BMI, use of gait aids, Braden score, MMSE, number of admission medications), emotional health (geriatric depression scale), and demographic variables (age, sex, education, presence of extended family, living alone) suggested that CFS score accounted for 19.7% of RFG variability. An additional 17.6% of the RFG variability was explained by the combination of CCI, MMSE, Braden Score, education, and lack of extended family. Conclusion: Of all measures considered, pre-morbid CFS score was the strongest predictor of patient rehabilitation outcomes., The Queen’s Geriatric Interest Group (QGIG) is a student-run initiative aimed at fostering interest in geriatric medicine. Pre-clerkship observerships have been documented as valuable methods for increasing exposure and interest in a given specialty. QGIG leaders collaborated with the Division of Geriatric Medicine to arrange observerships at St. Mary’s of the Lake Hospital. Participants were paired with a preceptor for a four-hour weekend observership on an inpatient geriatric rehabilitation unit. Participants were asked to complete surveys before and after the observership, which consisted of: (1) internally-developed Likert scale questions assessing students’ experiences and interest in geriatric medicine; (2) University of California Los Angeles – Geriatric Attitudes Scale (UCLA-GAS); and (3) narrative feedback. Forty-two students participated in the program between October 2013 and May 2014. Twenty-seven participants completed the pre-observership survey (response rate 64%), and 22 completed the post-observership survey (response rate 52%). All participants found the process of setting up the observership easy. The majority (72.7%) described the experience as leading to positive changes in their attitude toward geriatric medicine and 54.5% felt that it stimulated their interest in the specialty. No statistically significant change in UCLA-GAS scores was detected (p = .35). All participants agreed that the program should continue, and 90% stated that they would participate again. Despite the lack of a statistically significant difference in attitudes, the observership program was positively received by students. They enjoyed learning about the specialty, working with the preceptor and patients, the opportunity to practise clinical skills, the ease of setting up the observership and the pace of geriatric medicine. Structured pre-clerkship observerships may be a feasible method for increasing exposure to geriatric medicine., Delirium is a frequent complication among hospitalized elderly patients and is associated with poor outcomes. Many predictive models have been elaborated to identify patients at risk of developing delirium, but none of them have been validated in a geriatric assessment unit (GAU). We sought to determine the prevalence, incidence, and effects of delirium in a GAU and to validate Inouye’s predictive model for delirium in this population. We conducted a retrospective study of consecutive admissions in a GAU at Saint-Luc Hospital (Centre Hospitalier de l’Université de Montréal) between March and December 2012. Delirium risk was assessed by using Inouye’s predictive model, which is based on four risk factors at admission: visual impairment, severe illness, cognitive impairment, and high blood urea nitrogen/creatinine ratio. Delirium cases were diagnosed with the DSM-IV-TR criteria. One hundred thirty-six patients were included. The mean age was 85.6 ± 5.7 years old; 64% were women. Thirty-eight patients were diagnosed with delirium at arrival (prevalence 27.9%); 16 patients developed delirium during their hospitalization (incidence 16.7%). New-onset delirium was associated with prolonged hospital stay (46.1 ± 20.4 days vs. 28.2 ± 23.7 days, p < .005) and increased mortality (18.8% vs. 5.0%, p < .05). Application of the predictive model did not succeed in stratifying risk of delirium within this population (low risk: RR 1.0, intermediate risk: RR 0.97, high risk: RR 1.94; chi-square test for trend: p = .248). Delirium is common in our GAU and is associated with prolonged length of stay and increased mortality. Application of Inouye’s predictive model, validated previously in an elderly population hospitalized on a medical ward, did not predict accurately the occurrence of delirium in a GAU population., The “Pain Assessment Checklist for Seniors with Limited Ability to Communicate” (PACSLAC) is considered by many as the reference tool to assess pain in seniors who have difficulty communicating. Despite its excellent psychometric qualities, clinicians often report that the high number of items of the PACSLAC hampers its use in clinical setting. (1) To evaluate the relationship between two short assessment scales (the revised version of the PASCLAC [PACSLAC-II] and the Pain in Advanced Dementia [PAINAD]) and the original version of the PACSLAC; (2) to compare the administration times of the three tools. 46 residents in long-term care (mean age = 83 ± 10 yrs.) with dementia and difficulty to communicate were observed during transfer or mobilization (two potentially painful procedures) by three independent evaluators. Each of them used a different assessment tool (PACSLAC, PACSLAC-II, or PAINAD; randomly assigned). Correlational analyses were used to determine the relationship between the PACSLAC and PACSLAC-II and between the PACSLAC and PAINAD; an ANOVA was used to compare the administration times for the three tools. The PACSLAC-II and PAINAD were both moderately correlated with the PACSLAC (r = 0.63 and r = 0.65; all p values < .001). The mean administration times for the PACSLAC-II (96 ± 22 sec.) and PAINAD (63 ± 10 sec.) were significantly lower than that for the PACSLAC (135 ± 29 sec.; all p values < .001). Our results suggest that the PACSLAC-II and PAINAD can both be used to quickly assess pain in individuals with dementia. However, given the moderate association observed and the relatively small differences in administration time, we believe that the original version of the PACSLAC should be preferred when possible., Despite a rapidly aging population, there remains a shortage of geriatric specialists throughout the world. The factors associated with psychiatric residents’ interest in geriatric psychiatry had not been previously examined in a nationally-representative sample. This was an online survey of 226 Canadian psychiatry residents (24.3% response rate). The main outcome was interest in becoming a geriatric psychiatrist. Bivariate and multivariate analyses were performed to better understand what demographic, educational, and vocational variables were associated with interest in becoming a geriatric psychiatrist. A number of respondents had an interest in becoming a geriatric psychiatrist (29.0%, N = 60), in doing a geriatric psychiatry fellowship (20.3 %, N = 42), or in doing geriatric psychiatry as a part of the clinical practice (60.0%, N = 124). Demographic characteristics (e.g., age, gender, ethnicity) did not correlate with interest in geriatric psychiatry. The variables most robustly associated with interest in geriatric psychiatry were: 1) completion of geriatric psychiatry rotation(s) before 3rd year of residency (OR 5.13 [95% CI: 1.23–21.4]); 2) comfort working with geriatric patients and their families (OR 18.6 [95% CI: 2.09–165.3]); 3) positive experiences caring for older adults prior to medical school (OR 12.4 [95% CI: 1.07–144.5]); and 4) the presence of annual conferences in the resident’s field of interest (OR 4.50 [95% CI: 1.12–18.2]). Exposing medical students to clinical geriatric psychiatry rotations that increase comfort in working with older adults may help improve recruitment of geriatric specialists. This poster will describe the protocol of a proposed randomized trial exposing medical students to geriatric psychiatry during clerkship psychiatry rotations., Polypharmacy and multimorbidity are common among older people in long-term care facilities (LTCFs). This is associated with increased hospitalizations, adverse drug events, drug interactions, and cognitive impairment. Reducing polypharmacy may reduce adverse events and improve resident quality of life. Deprescribing refers to cessation of medications after consideration of therapeutic goals, benefits and risks, and medical ethics. The purpose of the study was to rank factors which general practitioners (GPs), nurses, pharmacists, and residents perceive are most important when deciding whether or not medications should be deprescribed. Discipline-specific groups of GPs (N = 13), nurses (N = 6), pharmacists (N = 9) and residents/representatives (N = 6) associated with LTCFs were conducted in South Australia. Nominal group technique was used to discuss, explore, and rank factors each discipline perceived as important when deciding whether or not to deprescribe medications. Participants identified a wide range of factors with considerable overlap between disciplines; however, no two disciplines ranked factors in the same order. The highest ranked factors for each discipline were: GPs — evidence for deprescribing; communication with family/residentNurses — GP receptivity to deprescribing; nurses ability to advocate for residents;Pharmacists — clinical appropriateness of therapy for individual residents; identifying a resident’s goal of care; andResidents — residents well-being; poor continuity of nursing staff. The results corresponded with published frameworks for GP and patient-identified factors. This study extends those frameworks to include nurses and pharmacists. Furthermore, factors were prioritized, providing guidance for practice and future research. Multiple factors that influence deprescribing decisions in LTCFs were identified, with each discipline having different priorities. The factors important to each discipline need to be considered in the design of deprescribing interventions in this setting., Polypharmacy and multimorbidity are common among older people in long-term care facilities (LTCFs). Polypharmacy has been associated with increased hospitalizations, adverse drug events, drug interactions and cognitive impairment. Reducing polypharmacy may reduce adverse events and improve quality of life. Deprescribing refers to cessation of medications after consideration of therapeutic goals, benefits and risks, and medical ethics. The purpose of the study was to rank factors that metropolitan and regional multidisciplinary groups (comprising general practitioners [GPs], nurses, pharmacists, and residents’ representatives) consider most important when deciding whether or not medications should be deprescribed in the LTCF setting. Multidisciplinary groups were convened in metropolitan and regional South Australia. Using nominal group technique, the groups discussed, explored, and ranked factors they perceived important for deprescribing. The metropolitan group ranked “adequacy of a resident’s medical and medication history” as the most important factor. The regional group ranked “identifying a resident’s goal of care” the most important factor. Both metropolitan and regional groups ranked the “structure of the health system” as an important factor impacting their decision to deprescribe. Both groups identified factors relating to interdisciplinary cohesiveness as important, with the metropolitan group ranking these factors more highly. Previous research involving GPs found a perceived “lack of evidence” for deprescribing. We discovered all health-care practitioners felt this was important. Addressing the range of factors identified may improve deprescribing success in LTCFs. Patient-centred factors were the most important overall. However, the structure of the health system had a considerable impact on the decision to deprescribe. Metropolitan and regional multidisciplinary groups prioritized different factors. This suggests that for deprescribing to be effective, local factors should be taken into account while implementing a patient-centred, multifaceted approach., Avoiding unnecessary emergency room transfers (ERTs) is recognized as an opportunity to improve health outcomes for elderly residents living in long-term care facilities (LTCFs). Prior research has identified improved communication between health-care professionals as a means of lowering ERT rates, but few studies have assessed nurses’ perceptions and use of communication tools following their implementation. As such, this investigation sought to: (1) evaluate nursing use of a modified communication tool implemented in a LTCF to reduce unnecessary ERTs; and (2) explore nursing attitudes towards this tool post-implementation. This study employed a mixed-methods approach. Intensity of communication tool use was established using chart abstraction and electronic institutional records. Semi-structured interviews were conducted with registered nurses in a Montreal LTCF currently implementing the tool. Of the 29 nurses who participated in the study (91% response rate), 11 had used the tool in 60% or more of transfer cases (high-intensity users), 8 had used the tool in approximately 50% of cases (mid-intensity users), and 10 had used the tool in less than 40% of cases (low-intensity users). More experienced nurses (>10 years) tended to be low/middle users, while newer nurses tended to be more frequent users. Overall, nurses found the communication tool especially helpful for surveillance purposes, but tedious to complete during time-sensitive emergencies. Observed differences in tool use may stem from nurses’ confidence in their ability to effectively manage emergency situations. Nurses with less experience may also be more likely to adhere to protocols, in general. ERT rates are a common benchmark for LTCF quality improvement. Given the potential applicability of nursing communication tools to other facilities, understanding how users perceive and use such tools may prove useful for future program implementations., Elder abuse (EA) is a social phenomenon with important health implications, particularly in long-term care (LTC). Residents of LTC institutions are at high risk of EA due to their physical and mental frailties, increased dependency and vulnerability, and social isolation. Despite this, studies of EA detection and prevalence have largely neglected institutionalized seniors and seniors with cognitive impairment (CI). EA screening instruments are also not suitable for these populations. As such, the objectives of this study are: (1) to identify how an existing, rapidly administered, EA screening instrument (Elder Abuse Suspicion Index) may be adapted to reflect the realities of institution-living (including residents with CI); (2) to create a LTC version of this tool informed by expert panel recommendations; and (3) to pilot the use of this newly modified instrument within a sample of LTC residents. A mixed-methods design will be employed. Recommendations for tool modification will be obtained from a carefully selected Delphi panel of twelve health-care professionals with experience in LTC and/or EA. The revised EA screening tool will then be administered to 75 consenting residents with varying degrees of CI. Data from the Delphi panel questionnaires will be analyzed to identify common and conflicting viewpoints. Once the tool has been modified to reflect group consensus, content validity will be determined using specificity, sensitivity, and positive and negative predictive value metrics. In targeting the early detection of EA in a previously untested, vulnerable population, this analysis will begin to generate insight on EA prevention measures in LTC. The rapid detection of at-risk, institutionalized seniors may lead to an institutional response at the earliest sign of suspicion, resulting in improved health outcomes for this population., Heart Failure (HF) patients often experience a poor prognosis, evidenced by frequent hospitalizations and limited survival. Appropriate management of HF is contingent on an accurate diagnosis. Part of the physical examination for suspected/worsening HF is assessing JVP and this can be a difficult, often underutilized maneuver. The Venous 1000 is a non-invasive, commercially available device providing a JVP measure and waveform. Our aim in this study is to assess the usability, perceived barriers, and acceptability of the device in the primary and long-term care (LTC) setting by physicians and registered nursing staff. An exploratory, ethnographic design was utilized and data were collected through four focus-group interviews. Participants were presented with a training module and had an opportunity to use the device on a test subject. Two research assistants independently coded the transcripts. Initial results indicate a high degree of acceptability and usability, despite difficulty in locating the fourth intercostal and interpreting the JVP. Barriers include resident behavior, interprofessional communication/structure, perceived adequacy with current clinical skills, and a belief that HF patients were appropriately diagnosed despite rarely measuring JVP. There is an evident lack of utility of JVP despite its having a role in the Canadian Cardiovascular Society Guidelines for diagnosing Heart Failure. The device appears best suited for long-term care and utilized by nursing staff due to the nature of physician availability and lack of diagnostic investigative tests. Educational initiatives are needed for nursing staff and physicians and our findings can help direct development of future technological devices and their implementation in these settings. This device has tremendous potential to help establish new-onset or worsening Heart Failure by providing a jugular venous pressure measurement and waveform., Patient selection for surgical oncologic treatment is a challenge, particularly with elderly patients. The purpose of this study was to compare patient’s characteristics with geriatrician recommendation as fit or non-fit for surgery and to identify baseline characteristics associated with adverse immediate postoperative outcomes. We conducted a retrospective study of patients seen in our geriatric oncology clinic before an elective surgical intervention for gastrointestinal cancer between 2010 and 2014. Patients were referred by surgeons or oncologists. Clinical and geriatric assessment variables and postoperative data were collected by chart review. Univariate analyses were used to identify baseline patient’s characteristics associated with decision prior to surgery and with postoperative outcomes (length of hospital stay and discharge status). Forty-four patients were included (14 had hepatic metastasis of a colorectal cancer, 13 had rectal cancer, 7 had pancreatic adenocarcinoma, 3 had colon cancer, and 7 had other types). Median age was 80.1 years (70–89). Nine patients (20.5%) were advised against surgery; they were more dependent for IADLs (p = .003), had lower grip strength (p = .003) and lower gait speed (p = .029). Twenty-three patients were operated. The median hospital stay was 10 days. Eighteen patients (78%) had complications: 13 minors and 5 majors, including 1 death. Seven patients had delirium. Falls in the last 6 months (p = .022) and polypharmacy (p = .043) were associated with prolonged hospital stay. Eight patients (36%) were discharged in rehabilitation or convalescent unit: they had lower grip strength (p = .019). Low grip strength is associated with postoperative discharge in convalescent or rehabilitation unit in our study. A prospective study is needed to confirm the results. Low gait speed and grip strength seem to influence preoperative decisions in our geriatric oncology clinic., The Web allows access to people with dementia and their care partners who can provide information about important symptoms that might otherwise receive little attention. Verbal repetition in dementia is common, troubling, and little studied. The objectives were to see how often and at which stage verbal repetition was tracked in an online list of symptoms, how it related to other symptoms, and whether frequency was less in patients on a cholinesterase inhibitor. Verbal repetition data came from the DGI Clinical website. Care partners of people with dementia selected symptoms for tracking from a 60-item SymptomGuide. Of 1,665 respondents, 895 reported a dementia diagnosis, in whom verbal repetition was identified as a target symptom in 267. Compared to those in whom verbal repetition was not targeted, those in whom it was were more often women (70% vs 60%, p < .01) and more likely to have mild dementia (43% vs 22%, p < .01). When reported, verbal repetition was associated with symptoms of irritability, frustration, misplacing objects, and impaired recent memory. The most common descriptions were repeating the same questions about upcoming events (98%) or the same stories at successive encounters (94%). Verbal repetition was reported occurring 10 times/day in patients treated with a cholinesterase inhibitor vs 20/day in those not treated. Verbal repetition can be seen at all stages of dementia, but most commonly is targeted to track treatment in the mild stages. Repetitive questioning about upcoming events was the most frequent symptom. Treatment with a cholinesterase inhibitor was associated with reports of fewer episodes of verbal repetition. Verbal repetition is a commonly targeted symptom in the mild stages of dementia that might respond to treatment., Goals-of-care discussions occur between patients, family members, and clinicians to establish decisions about plans of care, including the use or non-use of life-sustaining treatments. In previous studies, learners have reported insufficient training in end-of-life communication, but most studies have focused on development or evaluation of specific educational interventions. The objective of this study was to explore senior medical students’ experiences with goals-of-care discussions, specifically 1) whether real-life informal training reinforces or subverts formal training, 2) what behaviours are role-modelled by residents or staff physicians, and 3) whether students are observed or receive feedback on their discussions. We conducted one-on-one, semi-structured interviews with consecutive McMaster University medical students who responded to our study invitation during or after their Internal Medicine clerkship. We analyzed a subset of interview transcripts in triplicate, using conventional content analysis to develop a consensus list of codes and organize them into meaningful themes. Data were analyzed concurrently with data collection to inform further interviews. To date, we have completed coding and analysis of 5 interviews. Preliminary data suggest that students 1) believe goals of care discussions are important, 2) conduct discussions independently after observing residents, 3) feel uncomfortable conducting these discussions, 4) are not observed and do not receive feedback on their discussions, and 5) perceive significant differences between their formal and informal training. Medical students have identified significant educational gaps around goals-of-care discussions. Despite lack of experience and supervision, they routinely conduct these discussions, raising concerns about the quality of decisions made based upon these conversations. Our findings suggest medical students need improved education on goals-of-care discussions. This may be achieved through adoption of a competency-based curriculum., A non-pharmacologic, family-delivered intervention directed at modifying delirium risk factors was found to prevent delirium in Chile. The feasibility of doing a similar delirium prevention intervention was tested in a pilot study at the London Health Sciences Centre (LHSC). Eligible participants were free of delirium on admission and were community-dwelling seniors (≥ 70 years of age) consecutively admitted to the medical units. Patient-caregiver dyads were randomized (stratified by age and known dementia diagnosis) to receive a delirium prevention pamphlet (with a bedside explanation of ways to prevent delirium) or a general health brochure (placebo). Caregivers were asked to complete a survey and maintain a log of the time spent visiting the patient. The Confusion Assessment Method was used for delirium diagnosis. Out of 146 eligible patient-caregiver dyads, 79 (54.1%) agreed to participate (67 of 146 eligible caregivers either refused or were unavailable to participate). Five patients (6.7%) became delirious in hospital: 2 patients (5.1%) in the placebo group and 3 patients (7.5%) in the intervention. Surveys were returned by 52 (66%) caregivers. Challenges caregivers faced were parking costs and the overall time required (average of 5.6 hours per day were spent by caregivers). Caregivers did not find the study difficult to participate in (mean score 1.9 on 1 to 5 Likert scale; in the intervention group, mean score 1.8), and 51 of 52 (98.1%) of respondents found the overall experience at least somewhat rewarding. Although 45.9% of caregivers were not interested in participating in this study, those who did participate found it to be a rewarding experience. A family-delivered delirium prevention intervention may be another way to decrease delirium., There are anecdotal and case reports of the development or worsening of Parkinsonian symptoms after the initiation of androgen deprivation therapy (ADT) in men with prostate cancer. Medical castration using gonadotropin-releasing hormone (GnRH) agonists (e.g., goserelin, leuprolide) results in approximately 90% reductions in circulating testosterone, and reduction of estradiol levels by 80–90%. Literature from animals and humans suggests that androgens and estrogens have important effects on the nigrostriatal dopaminergic system but their relative contributions, and how those are influenced by androgen deprivation, is uncertain. This is a propensity-matched cohort study using linked administrative databases at the Institute for Clinical and Evaluative Sciences (ICES) and the Ontario Cancer Registry (OCR). We will compare men with prostate cancer receiving at least 6 months of ADT with those not receiving ADT. A separate non-matched cohort including all men who receive ADT will be examined to determine if the duration of ADT has an effect on the risk of developing PD. Primary outcome: New diagnosis of Parkinson’s — We will identify men who receive a new diagnosis of Parkinson’s disease if they received one hospital discharge or two physician outpatient service claims with the following ICD codes: G20.X (ICD-10) or 332.0 (ICD-9). Statistical Analysis: For the primary outcome, Cox proportional hazards models will be used based on the groups defined. Unadjusted and then adjusted hazard ratios will be calculated, along with 95% confidence intervals, using the following covariates: total duration of ADT, age, history of stroke. Results and analysis anticipated to be available by March 2015, and ready for presentation at CGS in April., Background: Parkinson’s disease is a neurodegenerative disorder which is very prevalent in older individuals. Depression is a common non-motor symptom of Parkinson’s disease (PD), with an estimated prevalence of 35%. However, the detection of depression can be challenging in this population. Objective: To examine the diagnostic accuracy of depression screening tools for case-finding in adult outpatients with Parkinson’s Disease (PD), as compared with psychiatric diagnosis based on DSM or ICD criterion. Methods: We conducted a literature search of MEDLINE, PsychINFO, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews from database inception until October 28, 2014. All citations, full text articles, quality assessments, data extraction, and analysis were independently examined by two authors. Study eligibility criteria were diagnostic accuracy studies involving adults with PD in an outpatient setting that validated a depression screening tool compared to a gold standard interview (DSM or ICD). Meta-analysis of results was completed where feasible. Results: From a total of 7,196 citations 21 studies were included, which incorporated 15 tools. Prevalence of depression pooled from 17 unique study populations was 29.4% (95% CI 23.3, 35.5). We were able to perform meta-regression analysis for three screening tools. The GDS-15 (N = 6 studies) had a pooled sensitivity of 0.85 (95% CI 0.78, 0.90) and specificity of 0.86 (95% CI 0.81, 0.89). The BDI-I/Ia (N = 4 studies) had a pooled sensitivity of 0.79 (95% CI 0.68, 0.90) and specificity of 0.85 (95% CI 0.79, 0.96). The MADRS (N = 4 studies) had a pooled sensitivity of 0.74 (95% CI 0.6, 0.83) and specificity of 0.93 (95% CI 0.85, 0.97). Discussions: Screening tools for depression case-finding assist clinicians to identify patients who require further assessment. These tools are not diagnostic, but use of accurate tools may help facilitate appropriate use of specialty mental health services. Conclusions: There are many validated tools available to screen for depression in PD. Based on the current evidence, the GDS-15 is an accurate tool to use for depression case-finding in PD patients, which is also favourable from a logistical standpoint given its ease of use, absence of copyright protection, and lack of overlapping questions with PD symptomatology., The MoCA is widely used for Mild Cognitive Impairment (MCI) screening in elderly individuals. Memory is assessed by a free recall of 5 words, which is done after two trials of repetition. Providing category or multiple-choice cues is optional. Using Rasch analysis, we investigated whether scoring the two trials of repetition, cued and multiple-choice recall improves MoCA’s psychometric properties and ability to distinguish among three groups: No Cognitive Impairment (NCI), MCI, and Alzheimer’s Disease (AD). People with NCI (N = 35), MCI (N = 197), and AD (N = 122), who were administered MoCA in the course of normal clinical care, were selected from a geriatric database. Rasch analysis was performed using two new scoring methods, which were compared to the original scoring: 1) each word for both repetition and recall was scored separately; 2) items Repeat1, Repeat2, RecallFree, RecallCue and RecallMultipleChoice each reflected performance on the set of 5 words. Significant difference between the mean ability values of the groups was observed for original and both new scoring methods (NCI > MCI > Dementia, p < .0001, one-way ANOVA). Separation of AD and MCI was better (smaller overlap and higher difference in mean values) than separation of MCI and NCI groups. Although new scoring methods equally improved sensitivity to distinguish persons by their ability at the individual level (Person Separation Index 0.86 for both new vs. 0.84 for original scoring), they negatively affected separation of the groups. Original and both new scoring methods allow better discrimination of AD vs. MCI than NCI vs. MCI. Observed difference among the three groups proves MoCA’s discriminant validity. Measuring and screening properties of the same tool can be affected in opposite ways while introducing changes in scoring., Late-Life Depression (LLD) affects 3–5% of older Canadians. Unfortunately, it is inadequately treated with antidepressants, necessitating additional treatment options. Various mind-body therapies are being embraced by patients as they are considered safe and potentially effective. Sahaj Samadhi, a form of Automatic Self-Transcending Meditation (ASTM), may offer particular benefit in LLD. We are conducting a large single-centre, single-blind, longitudinal randomized controlled naturalistic trial to determine if ASTM improves depressed mood, anxiety, and quality of life in patients with LLD (N = 96). Patients with LLD are randomized either to ASTM plus treatment as usual (TAU) or TAU alone. ASTM training, provided by certified teachers from the Art of Living Foundation, is administered for four consecutive days (120 minutes per day) in the first week, followed by 60-minute sessions in each of the 11 subsequent weeks. Participants are assessed at baseline (week 0), and 4, 8, and 12 weeks into the study. With 25 patients (ASTM=11; TAU=14) having completed the 12 weeks of monitoring, we found that ASTM led to improvement in Hamilton Depression (HAM-D 17) scores from 15.5 at baseline to 8.5 at week 12 (p < .001) with 7 of 11 treated patients achieving remission with a score below 8. A significant (p = .006) clinical improvement was also noted using the Clinical Global Impression (CGI) scale, and Geriatric Depression Scale (GDS) scores improved from a mean of 9.3 to 6.2 (p = .03). In comparison, subjects in the TAU group showed no significant differences in scores over time (p > .05) other than a worsening on CGI (p = .02). Upon study completion, if ASTM continues to show effectiveness, it could be readily adapted into routine clinical care and delivered in a range of settings at relatively little cost., Adherence to catheter guidelines is poor and may be a particular problem in emergency departments (ED). We aimed to describe catheter insertion practice in the ED of an urban Western Canadian hospital to inform a catheter reduction strategy. Prospective convenience sample of adult patients catheterised in the ED. Data on patient demographics, diagnosis, indications and perceptions of catheter appropriateness from char t review and interviews. Appropriateness was determined by the research team using current guidelines. Beliefs regarding catheterisation were collected by surveys. Of 150 cases of catheterisation, 62.7% occurred in patients over 65, 43.3% had a written order and 5.3% a documented reason. Based on guidelines, 58.7% were deemed inappropriate. Nurses identified more than one reason in most cases, with close monitoring of urine output for critically ill patients cited in 42.2%. Of the inappropriate cases, 24.7% occurred in non-critically ill patients, 24% to manage urinary incontinence, 19.3% for mobility impairment, and 18% for confusion/dementia. Survey data revealed 96.7% of physicians and nurses perceived close monitoring of urine output for critically ill patients an appropriate indication. Both groups viewed gross haematuria (56% and 77.2% respectively) and stroke (32% and 55.9% respectively) as appropriate indications. There was likely a difference in understanding of the phase “critically ill,” a frequent nurse-identified reason. Of concern is the large proportion catheter insertions designed to manage urinary incontinence, mobility, or cognitive deficits. Current guideline criteria do not address gross haematuria and stroke, which nurses and physicians identified as appropriate indications. Current practice guidelines provide only general indications for appropriate catheter use and there is a need for novel knowledge translation strategies within the ED environment to encourage appropriate catheter use., ApoE genotype, serum plasmalogen (PlsEtn) levels, and biomarkers of reverse cholesterol transport (RCT) have been shown to be associated with cognition in elderly persons. Using a community-based sample of 904 well-characterized elderly persons from the Rush University Religious Orders Study and Memory and Aging Project, the relationships between ApoE genotype, serum PlsEtn, triglycerides (TAG), cholesterol (CHO), HDL and the CHO/HDL ratio (HDLr) levels on cognition were measured. Effects of serum PlsEtn status was assessed using a quantitative PlsEtn Biosynthesis Value (PBV) that was generated for each person by combining the relative serum levels of three key PlsEtn species. ApoE allele effects were assessed by combining four allele combinations into one of three genotype groups (ε2 = ε2ε3, ε3 = ε3 ε3, ε4 = ε3ε4 + ε4ε4). Using a base model that corrected for age, education, and gender we assessed the effects of each variable independently and collectively on cognition. When all variables were considered, only PBV (coef = 0.606, p < .0001), ApoE (ε3 = ref.); ε2 (coef = 0.156, p = .007) ε4 (coef = −0.236, p < .0001), and HDLr (coef = −0.534, p = .015) remained significantly associated with cognition. PBV and ApoE did not interact with each other. Both ApoE (coef = 0.173, p = .02) and PBV (coef = 0.226, p = .004) interacted with HDLr. No effect of gender was observed. The different ApoE alleles have different cholesterol efflux capacities with ε2>ε3>ε4. Increasing membrane concentration of DHA-PlsEtn increases cholesterol efflux. The ratio of total cholesterol to HDL is a measure of RCT capacity. These data suggest that low RCT capacity may be a common underlying mechanism associated with lower cognition. Metabolic and genetic mechanisms affecting RCT have a negative effect on cognition in the elderly., Family caregivers are often overwhelmed by the stresses of caregiving, conflicting with other demands like work and childcare, resulting in deterioration of their health. Caregivers, thus, require support to ensure that they can continue to provide care, while maintaining their own well-being. However, there is a gap between what is known to help caregivers and what is available. This study will determine the strengths, gaps, and barriers to the provision of caregiver supports, including resource utilization and costs, and research priorities. A CIHR-funded conference was held in Edmonton on April 14–15, 2014. On Day 1, the conference brought together over 120 researchers, health-care providers, community organizations, government, and caregivers to discuss ways to understand and support family caregivers of seniors. On Day 2, 76 participants focused on research needs for caregivers of seniors with complex needs. NVivo was utilized to support ethnographic thematic analysis. On Day 1, barrier/gaps were identified: caregiving involves managing a multitude of tasks impacting caregivers’ ability to tend to their own personal needs; changing roles and obligations; inadequate communication and information; scattered resources; need for system navigation; negative economic impact; and lack of supportive policies. On Day 2, initial research priorities were identified: defining caregivers; timing and type of support; ‘Goals of Care’ for caregivers; enhanced case management; system navigation supports; impactful change and funding models; and knowledge exchange strategies. A 5-year research program was proposed with two key priorities: a longitudinal study of caregivers and their needs, and an economic cost analysis. There’s a need for centralization and navigation of resources with enhanced case management, goals of care for caregivers, education for health-care professionals and caregivers, and the development of provincial frameworks and policies., Older people at an increased risk of adverse health outcomes compared with others their own age are said to be frail. How best to assess frailty in acutely ill older adults is disputed. In this observational cohort study, patients from the emergency department were evaluated using routine tests, and a standardized comprehensive geriatric assessment (CGA). We compared a frailty index based on a CGA (FI-CGA) with one constructed from clinical and laboratory data (FI-Lab) to determine which was better at predicting the risk of death. Consecutive older adults (aged 65+) were enrolled and followed for at least 6 months. The FI-CGA was comprised of 55 items and the FI-Lab, which included clinical, laboratory, and ECG data, was comprised of 24 items. Kaplan-Meier plots were done to illustrate the event curves by frailty status. Predictive validity for 6-month mortality was tested by Cox proportional hazards analysis. Of 438 participants, 109 (55 men and 54 women) died during 6-month follow-up. Mean FI scores in the least frail group were 0.151 ± 0.033 using the FI-CGA vs. 0.148 ± 0.043 using the FI-Lab, and 0.653 ± 0.048 (FI-CGA) vs. 0.660 ± 0.037 (FI-Lab) in the frailest group. Mortality increased significantly as the frailty scores increased, both for FI-CGA and FI-Lab. An age- and gender-adjusted model showed a clear dose-response relationship of the FI with mortality. The hazard ratios for FI-Lab and FI-CGA were 1.553 (1.334 to 1.808) and 1.380 (1.186 to 1.605), respectively. The impact on the discriminative ability of combining both FIs was modest: the area under the receiver operating characteristic (ROC) curve was 0.653 for the FI-CGA, 0.663 for the FI-Lab and 0.690 for the combined FI. Frailty can be screened using either the standard FI (FI-CGA) or routinely collected laboratory and clinical data (FI-Lab). Both of FI-CGA and FI-Lab, singly or jointly, could identify acutely ill older patients at increased risk of death. Compared with the traditional method for calculating the FI (FI-CGA), the novel FI-Lab, based on routine clinical data and laboratory data, was more easily collected for clinicians and requires minimal participation by patients. Therefore the novel FI-Lab may be more suitable to measure frailty in patients with serious conditions. Further evaluation of this approach in clinical settings is encouraged., Time spent in moderate-to-vigorous activity (MT) in young adults is the best predictor of daily caloric expenditure (CE); conversely CE is best predicted in older adults by time spent in light activity (LT). Some studies have suggested that increasing MT in older adults has no impact on CE due to a compensatory increase in daily sedentary time (ST). We examined highly active older adults to examine the biggest contributors to energy expenditure in this population. 54 community-dwelling men and women > 65 years of age (mean 71.5 years) were enrolled in this cross-sectional observational study. All were members of the Senior’s Whistler Ski Team and all met current Canadian guidelines for physical activity. Activity levels (ST, LT, and MT per day) were recorded with accelerometers worn continuously for 7 days. CE was measured using accelerometry, galvanic skin response, skin temperature, and heat flux (SenseWear armband). Significant variables were then entered into a stepwise multivariate linear model containing activity levels, age and gender. The average proportion of time spent at a sedentary activity level each day was 72%. The main predictors of higher CE were time spent in moderate-to-vigorous activity (MT, Standardized β, 0.360 ± 0.086, p < .001) and male gender (Standardized β, 1.421 ± 0.171, p < .001). A model containing only MT and gender explained 66 percent of the variation in CE. An increase in MT by one minute per day was associated with an additional 13 calories expended in physical activity. The relationship between activity intensity and CE in athletic seniors is similar to that observed in young adults. Active older adults still spend a substantial proportion of the day engaged in sedentary behaviours., For the person with dementia (PWD), the loss of driving privilege is often worse than a diagnosis of cancer. Physicians in Canada are placed in a position where they are legally responsible and liable to report unfit drivers. Skills such as empathy, clear communication, referral to resources, and follow-up are crucial. In some cases the discussion is “rushed” within the context of multiple medical issues, leaving the PWD and caregivers with a strong emotional reaction and lack of information. We developed a module (1.5–2 hrs) containing background material on issues specific to dementia and driving, communication strategies, links to resources, and representative video clips. Two videos were produced (demonstrating the less and more ideal), simulating real-life disclosure and management of emotionally charged discussion that often ensue. The videos were pilot tested at a CME event for Family Physicians, using an adapted form of the Calgary Cambridge Communication scale, to ensure validity. The module was then presented to postgraduate trainees at an academic half day. A pre- and post-test was administered to evaluate the effectiveness of the module. Using the adapted Calgary Cambridge Communication Scale, validity was established regarding accurate demonstration of contrasting communication styles of the two videos. Results from pre and post survey of the module demonstrated that confidence increased (p < .0001), as well as comfort and willingness in discussing the subject. This project involved the development and evaluation of a module which demonstrated positive impact on health professionals’ attitude for communication on driving cessation with PWD. This module can to add to teaching methods around the topic of driving and dementia, such as lectures and workshops., Enoxaparin is used for anticoagulation usually without requirements and capability for laboratory monitoring. Its dosage in severe chronic renal disease needs to be reduced. However, its dosage in the elderly is not required to be lowered. This raises concerns since the elderly could have rapidly fluctuating renal functions which require immediate adjustments in drug dosage. We will report a case of spontaneous retroperitoneal hemorrhage in an elderly on dose-appropriate enoxaparin. Case Report: An 81-year-old lady with chronic renal failure was admitted for diagnostics on falls/pain. She also had a pulmonary embolism four months prior to admission for which she had been treated and maintained on enoxaparin (1 mg/kg subcutaneously b.i.d.). Her other medications included aspirin. On admission, her laboratory results were consistent with chronic renal failure and anemia. During hospitalization, she developed vomiting, diarrhea, and melena. Abdominal CT scan showed a large retroperitoneal hematoma. We aggressively managed the ensuing hypotension and acute renal failure. We also discontinued enoxaparin and aspirin. Supportive care was provided in the intensive care unit until her renal function recovered. Low-molecular-weight heparin (LMWH; e.g., enoxaparin) is frequently prescribed in geriatric patients. It is preferred over unfractionated heparin because LMWH does not need coagulation monitoring, is administered with ease, and is associated with decreased hospitalization cost. However, the use of enoxaparin in the elderly population poses some safety concerns. When the elderly patient is stable, enoxaparin dosing could be maximally effective; but the same dosing could rapidly become harmful when kidney function deteriorates. With vigilance, the dose could be decreased immediately during compromised renal functions; however, the risk of thrombosis would consequently increase. The safety of enoxaparin in the elderly needs to be established., Current estimates of the prevalence of late-life depression (LLD) in Canada have been found to be as high as 16% and are expected to increase further as we face a more aged population. Evidence has shown that LLD is associated with a three-fold increased risk of cardiovascular disease, which may be mediated by autonomic dysfunction. Further complicating this relationship is the adverse effect some antidepressants have on autonomic tone. Therefore the aim of this study is to assess the cardiovascular benefits of a category of meditation referred to as automatic self-transcending meditation (ASTM) in LLD. We present preliminary results (N = 20) from an ongoing single-centre, single-blind, longitudinal RCT assessing the effects of a 12-week augmentation program of ASTM vs. treatment as usual (TAU) on heart rate variability (HRV), an autonomic parameter. Participants between 60 and 85 years of age with an Axis I diagnosis of mild to moderate LLD were randomized to the ASTM (N = 9) or TAU (N = 11) study arms. ASTM training was administered on four consecutive days (2hrs/day), followed by weekly 1hr follow up sessions for 11 subsequent weeks. ECGs were completed at baseline (week 0) and post-intervention (week 12). Thus far, the findings are promising; although only approaching significance at the current sample size, paired t-tests identify improvements in low-frequency HRV with ASTM training (p = .06) as compared to TAU (p = .6). These preliminary results suggest that ASTM may improve autonomic tone in LLD. The study is ongoing (target N = 96) and will require further analysis. If the results continue to show the effectiveness of ASTM in improving autonomic parameters, such a treatment could be readily adapted into routine clinical care., Primary care memory clinics (PCMCs) are being established in Ontario to enhance system capacity for dementia care and efficient integration with specialized services. Preliminary evaluations are favourable, though variability in documentation of the physical examination (PE) suggests the need for Quality Indicators (QI) specific to this domain. While dementia diagnostic guidelines recommend PE, opinion varies regarding which manoeuvres are essential. PCMC physicians and affiliated specialists were surveyed to rate the importance of PE manoeuvres as essential, discretionary, or unnecessary to the diagnostic process. Participants were asked to identify who should perform specific PE manoeuvers. Ninety surveys were completed (78/112 PCMC physicians, 9/23 specialists, and 3 unspecified). Most considered the assessment of orthostatic vital signs as essential and the responsibility of allied health professionals. Assessment of nutritional state and hygiene was deemed essential and the responsibility of referring or PCMC physicians. General PE manoeuvers were considered discretionary or unnecessary, and the responsibility of referring physicians. Gait assessments was considered essential. Specialists were significantly more likely than PCMC physicians to consider examination for facial asymmetry, extra-ocular movements, and pyramidal and extrapyramidal signs as essential. General PE was considered the purview of the referring physician. Specialists considered most neurological examination manoeuvres the purview of PCMC physicians, who generally considered these the responsibility of referring physicians. Time constraints were cited as important barriers to PE. This study identified PE manoeuvers considered important to the assessment of patients referred to a PCMC. A tiered approach to the PE of patients seen in PCMCs may be warranted, based on a shared understanding of roles and responsibilities of clinicians involved, and considering potential training requirements., Geriatrics is an increasingly challenging field of practice in which there are limited opportunities for continuing education. The Geriatric Certificate Program was developed for practising regulated and unregulated health-care providers to build capacity related to geriatric assessment, behaviour management, and geriatric best practices. This study provides a preliminary evaluation of this program, examining impact on self-reported changes in knowledge, skills, and competence. All graduates completed an on-line evaluation survey upon completing program requirements. A total of 189 individuals are registered in the program, including nurses (30%), allied health professionals (19%), other regulated professionals (7%), unregulated health professionals (19%), and physicians (3%). Twenty individuals have graduated to date; 16 completed a survey. Mean ratings (5-point scale) reflect that the program was very relevant to clinical practice (4.1 ± .72) and very useful in enhancing clinical practice (4.1 ± .62). The majority of graduates (75%) reported that they are now more competent and more comfortable in providing geriatric care; 94% reported that the quality of care they provide has improved (69%, “much improved”; 25% “improved”). The program impacted the acquisition of new knowledge (81%) and skills (75%) “very much” or “to a great extent.” Self-reported knowledge transfer included increased use of standardized tools, use of evidence-based strategies for managing responsive behaviours, and more comprehensive care planning. Program and travel costs in the absence of financial support from employers was identified as challenge. This program provides a significant opportunity for increasing capacity in core competencies to advance the use of best practices for geriatric care across disciplines. This program will develop a workforce that is better prepared and supported to meet the needs of the aging population., Universal vitamin D supplementation is not desirable. The determination of serum vitamin D status remains yet much more expensive than corrective supplementation. To rationalize health costs, our objective was to develop and to test a clinical diagnostic tool for the identification of older community-dwellers with hypovitaminosis D without using a blood test. A total of 1,924 community-dwelling volunteers aged ≥ 65 years without vitamin D supplements were recruited in this cross-sectional study. A set of clinical variables (age, gender, living alone, individual deprivation, body mass index, undernutrition, polymorbidity, number of drugs used daily, psychoactive drugs, biphosphonates, strontium, calcium supplements, falls, fear of falling, vertebral fractures, Timed Up&Go test, walking aids, lower-limb proprioception, handgrip strength, visual acuity, wearing glasses, cognitive disorders, sad mood) was recorded from standardized questionnaires and medical examination at the time of serum 25-hydroxyvitamin D(25OHD) measurement. Hypovitaminosis D was defined as serum 25OHD ≤ 75nmol/L, ≤ 50nmol/L or ≤ 25nmol/L. The whole sample was separated into training and testing subsets to design, validate and test an artificial neural network (multilayer perceptron, MLP). In total, 1,729 participants (89.9%) had 25OHD ≤ 75nmol/L, 1,288 (66.9%) had 25OHD ≤ 50nmol/L, and 525 (27.2%) had 25OHD ≤ 25nmol/L. MLP using 16 clinical variables was able to diagnose hypovitaminosis D ≤ 75nmol/L with accuracy = 96.3%, area under curve (AUC) = 0.938, and κ = 79.3 indicating almost perfect agreement. It was also able to diagnose hypovitaminosis D ≤ 50nmol/L with accuracy = 81.5, AUC = 0.867 and κ = 57.8 (moderate agreement); and hypovitaminosis D ≤ 25nmol/L with accuracy = 82.5, AUC = 0.385 and κ = 55.0 (moderate agreement). We developed an algorithm able to detect, from 16 clinical variables, hypovitaminosis D with almost perfect agreement among older community-dwellers taking no vitamin D supplements. Such an inexpensive tool will undoubtedly help clinicians in decisions to supplement their patients without routinely resorting to an expensive blood test., Although delirium is a common and serious geriatric syndrome among the elderly, it is often unrecognized. Prevalence of delirium in community-dwelling older adults over 85 years of age is approximately 14%. The goal of this pilot study was to increase knowledge of delirium in community-dwelling elderly and their caregivers. Multiple strategies were used in the aim of increasing knowledge on delirium. First, an educational pamphlet was developed and made available to elderly persons and their families. In addition, a 20-minute PowerPoint presentation was presented to small groups, with follow-up discussion. A pre and post test measuring knowledge levels was administered in order to measure impact. A brief survey was also conducted to obtain feedback on the quality and understanding of the content. A total of three presentations were given with 16 participants, mean age of 53 years. A total of 12 questions were administered in the pre and post test questionnaire. Overall, participants scored higher on the post test. Feedback from participants revealed that they found the presentation and pamphlet useful in learning about delirium, especially since many participants had no previous knowledge on the subject. The pilot study revealed that community-dwelling elders and their caregivers were not familiar with delirium. They described gaining valuable knowledge and felt the teaching methods were helpful. To further our understanding of the impact of these interventions, this pilot project will be continued in the community by 4th year pharmacy stduents with a larger group of participants. The results support the need for education among family members and caregivers in the community setting. Focus should be on the prevention, identification, and management of delirium., Our recent data have shown that eyecare services offered to older institutionalized seniors with dementia are not optimal. We present here the development of a visual acuity (VA) screening tool aimed at improving eyecare services for those individuals. Some two decades ago, the World Health Organization developed a tool to screen VA in individuals from developing countries. The tool comprised tumbling E’s presented on plastic cards. Researchers have since used this tool for screening VA in older institutionalized seniors, including those with dementia, even if it has never been validated in dementia. We have therefore developed a new tool that will be presented at this meeting. Testing is currently being performed in volunteer institutionalized seniors ≥ 65 y.o. with cognitive impairment. The tool has been developed on a retinal-display iPad to provide repeatable, high-resolution, high contrast optotypes. It contains 3 kinds of optotypes (letters, numbers, tumbling E’s), 4 symbols per optotype and 3 levels of VA. It allows testing of each eye at 2 working distances and gives the time taken for each test. Each symbol is displayed one at a time in the centre of the screen, from the largest to the smallest one, in a random sequence for each target size. This new tool is successfully being used in older institutionalized seniors with mild to severe dementia. Its application for that population has therefore been shown feasible. Within a year, we will have collected enough data to determine if the tool is valid for that population. If the tool is valid, then long-term care units will benefit from a VA screening tool to help determine those residents most needing an oculovisual examination., Neuropsychiatric symptoms (NPS) are behavioural and non-cognitive manifestations of dementia that are highly prevalent among residents in long-term care (LTC), increasing costs and burden of care for this vulnerable population. A common clinical phenomenon observed among people with dementia is “sundowning syndrome,” or the emergence or exacerbation of NPS in the late afternoon, evening, or at night. Very few studies, however, have assessed NPS prevalence in LTC residents with dementia as a function of time of day. Frequency and severity of NPS were assessed over a 2-week period using the Neuropsychiatric Inventory – Nursing Home version. NPS information for 97 LTC residents with dementia was obtained from frontline nursing staff providing their direct care during the day, evening, and night shifts. A total of 238 staff interviews were conducted, and complete triad data (across all shifts) was obtained for 59 residents. NPS prevalence was 66.1%, 71.2%, and 42.4% during day, evening, and night, respectively. Agitation/aggression and irritability were the most prevalent symptoms, even after accounting for sleep dysregulation. The percentage of residents exhibiting more than four NPS increased significantly from 13.6% (day) to 20.34% (evening) (p < .01), suggesting the presence of sundowning syndrome. Although depression was prevalent in about 15% of residents at all times of day, its presence was significantly associated with anxiety (all times), aggression/agitation (day and evening), irritability (day), and delusions and hallucinations (night). Sundowning syndrome manifests itself as an increase in the number of NPS observed within a given resident rather than as an increase in overall NPS prevalence. Depression is strongly associated with multiple NPS. Our results highlight the importance of considering time of day when evaluating NPS in LTC residents., In 2011, Alzheimer’s disease (AD) and dementia affected 747,000 Canadian seniors (65+). Estimates of the prevalence or incidence of dementia are frequently based on the Canadian Study of Health and Aging (CSHA, 1991–2001). However, administrative data are increasingly used for the surveillance of chronic diseases, including AD/dementia, and may add new insight into care trajectories. The present study identified a Quebec cohort of AD/dementia cases using linked health administrative data. This study used data linked at the Institut national de santé publique du Québec provided from 3 sources: 1) the RAMQ medical and pharmaceutical services and the registered users’ files, 2) the MED-ECHO hospital discharge file and 3) the death registry. AD/dementia cases were identified using three definitions with different combinations of ICD dementia-related diagnostic codes from physicians or hospital discharge, with or without pharmacy claims for 4 dementia medications. Two of these definitions were validated by the Public Health Agency of Canada and one will be used for further surveilance. Estimates were age-standardized. The study included 1.3 million persons aged 65+. In 2011–12, 6.8% to 10% among them were identified as cases, depending on the definition. Prevalence was 15% to 18% higher among women than men and rose exponentially in older age groups. About 1% to 2.5% of persons aged 65 to 69 years were identified as cases, compared to 27% to 35% for people 85+ years. Incidence rates varied between 16.5 and 21.7 per 1,000 person-years depending on the case definition. In this study, highest incidence rates were measured in 2006–07 for all case definitions. In Quebec data, physician claims were the main source for case ascertainment, followed by hospital data. The observed measures of prevalence and incidence are below those that can be extrapolated from the CSHA and Canadian demographics, possibly due to underreporting in administrative data. Different data sources for incidence and prevalence estimates are used in Canada and their interpretation can be challenging. Ongoing surveillance from health administrative data in Quebec is feasible and useful for research, policy, and program guidance., Certain drugs have been linked to adverse events and poor outcomes in the elderly. These drugs, called Potentially Inappropriate Medications (PIM) by the American Geriatrics Society, should be avoided in the elderly population, through treatment with safer drugs and/or nondrug approaches. In this study, we will determine the (1) prevalence of PIM use among patients referred for comprehensive geriatric assessments; (2) most common PIMs used; (3) extent comprehensive geriatric assessments addressed PIM use. Design: This was a cross-sectional study involving chart reviews of 200 patients (65 years and older) seen for Comprehensive Geriatric Assessments at the Glenrose Rehabilitation Hospital in 2012–2013. Procedure: We reviewed the use of PIMs, as defined by the 2012 American Geriatrics Society Updated Beers Criteria. Specifically, we noted the use of Medications to Avoid in Older Adults Regardless of Disease or Conditions (Group 1) and Medications Considered Potentially Inappropriate When Used in Older Adults with Certain Diseases or Syndromes (Group 2). The patients had a mean age of 79 ± 8 years. The prevalence of PIM use was 49.5% (N = 98). For Group-1 medications, 45.5% (N = 91) of patients used at least one PIM. For Group-2 medications, 31% (N = 62) of patients used at least one PIM. The most common Group-1 PIMs used were Zopiclone, Benzodiazepines, and pain medications. The most common Group-2 PIMs used were Benzodiazepines, Zopiclone and Selective Serotonin Reuptake Inhibitors. Of the 98 patients who used PIMs, 48% (N = 47) had their medications stopped, tapered, adjusted, decreased, or reviewed as a result of Comprehensive Geriatric Assessments. The 2012 Beers Criteria is a useful guideline for safe drug use and monitoring in the elderly. PIM use in the elderly is common and needs to be addressed., Long-term care (LTC) residents have high acute-care utilization rates and face elevated risks when transitioning between LTC and acute care. The objective of this study was to evaluate the initial implementation of components of the Interventions to Reduce Acute Care Transfers (INTERACT) program as part of an innovative strategy to improve the capacity of staff to handle acute change in LTC residents and reduce potentially preventable emergency department (ED) visits and hospitalizations from Baycrest. INTERACT is a quality improvement program to improve the identification, evaluation and communication of changes in LTC residents’ status. The initial implementation methods included primarily education and reminders. The evaluation used a mixed-methods approach including electronic health record reviews, audits of communication tools, tracking of ED visit and hospitalization rates, and surveys and focus groups. Preliminary findings reveal that initial implementation methods have not resulted in sustained changes in practice. Survey data collected at the onset of implementation indicated that one-third of the LTC units were in the pre-contemplation phase of change and two-thirds of the units were in the contemplation phase of change. Focus group data from point of care staff noted that the communication tools were too time-consuming and did not facilitate the preferred communication. In addition, multiple barriers have been encountered in measuring potentially preventable ED visits and hospitalizations. Our findings indicate that education and reminders alone are not sufficient for implementing sustained changes in practice related to better identifying and managing changes in status in LTC residents. To ensure greater success in implementing capacity building strategies in LTC, future efforts will focus on driving forces for change such as urgency for change, aligning with organizational systems and strategies, and committed change agents., Nursing home (NH) residents with severe dementia often receive multiple medications. With disease progression care goals shift from curative or preventive to comfort care and consequently medications have to be reviewed, adjusted, or discontinued, because of reduced life-expectancy or changes in their harm-benefit ratio. Few studies evaluated interventions to achieve this goal. The objective of this pilot study was to evaluate the feasibility of an inter-professional intervention to optimise medication use in NH residents with severe dementia. Based on a literature review and a multidisciplinary Delphi panel, lists of mostly, sometimes, or rarely appropriate medications and elements of successful interventions were identified. The lists were tailored for a NH pilot study. Between April and November 2014 a 4-month intervention was led in 3 NH in Quebec, Canada. The families of participating residents received an information leaflet on optimal medication use in severe dementia. Nurses, pharmacists, and physicians of the NH participated in two 90-minute continuous education (CE) sessions. For each participant the pharmacist performed a medication review using the lists and then discussed recommendations with nurses and physicians. A study nurse observed comfort and agitation levels of participants using the Cohen-Mansfield and the PACSLAC-F scales during the study period. 93 residents were eligible and 48 participated; 7 residents died before or during follow-up and 41 were observed over 4 months. 38 health professionals participated in the CE sessions. Medication lists were well accepted and the study nurse was present at the discussions about medication changes. Families’ and health professionals’ comments provide opportunities to improve information material and the tailored lists. Some changes in medication use were observed but levels of agitation and comfort did not change noticeably. An interdisciplinary NH intervention to optimise medication use in residents with severe dementia is feasible. The three NH in Quebec City were interested in opportunities and tools facilitating improved medication use. Results from the pilot study need to be repeated in a larger trial and education or information to families should be a focus of the study. A literature review and an expert consensus provided the elements for a feasable intervention to optimize medication use. A cluster randomized trial should validate medication outcomes, generalizability, and patient or family outcomes of this intervention., Background: Programs for preventing functional decline in the elderly hospitalized in acute care facilities are suggested in the literature and in clinical guidebooks. In general, they are poorly detailed and primarily involve physiotherapists. Rehabilitation professionals affiliated with the IUGM GAU have developed a physical reconditioning program (SPRINT) that can be adapted to the functional profile of patients admitted to GAU. This program has 4 different levels and includes ad-lib repetitions of motor activities prescribed after an evaluation of functional capabilities, ranging from transfer to a chair (level 1) to walking (level 4). The program engages the patient and enlists the contribution of medical personnel and natural caregivers with daily interactions with the patient. Purpose: Collect preliminary information on the implementation process of SPRINT in order to determine the conditions necessary for rolling out SPRINT to GAU. Methods: The project, currently under way, will last one year at the IUGM GAU and includes 4 stages: preparation, pre-intervention, intervention, and post-intervention. Results: Amongst the 47 patients admitted to the GAU to date, 18 patients (61% women) accepted to participate. They were aged 80.5 ± 8.2 years, had an MMSE score of 26.4 ± 3.4 and participated in SPRINT for 19.1 ± 9.3 days. Only SPRINT levels 2 and 3 were prescribed to recruited patients. Patients did an average of 0.1 to 4.1 exercises/day. Exercises were done with a nurse (49%), a doctor (21%), or alone by the participant (18%); natural caregivers only participated in 4% of cases. Conclustions: Qualitative data concerning factors that facilitated and perceived barriers will be collected and analysed to facilitate the successful implementation of the intervention., Although associated with adverse drug events in the elderly, prescribing cascades are often not recognized in clinical practice. The objective of this prescribing cascade game was engage students in learning how to prevent, detect, and understand prescribing cascades. This activity was part of a 3-credit course in the geriatrics pharmacotherapy course at the Faculty of Pharmacy at the University of Montreal. Four different prescribing cascades that were detected in clinical practice were used. Each cascade contained four elements (medication–side effect– medication–side effect). Students were divided into 16 groups with two students per group. Each group selected one card on which one of the elements was written: either the name of a medication, or a side effect. All 16 groups were then asked to work together to reconstruct the four different prescribing cascades. Once all four elements of the four prescribing cascades were identified, they were asked to explain how these cascades took place. A 5-point Liker scale was used to evaluate the perception of the students regarding this activity. 32 students participated in the game. It took 15 minutes for the students to get organized and reconstruct the four prescribing cascades. In general, students appreciated this activity. The majority mentioned that having to find the different element of the cascade raised their awareness concerning the detection of future cascade. This activity was used to understand, apply, and retain information on prescribing cascades. Students actively participated in this activity. They were able to discover the four different elements of their respective cascade and to explain them using ptharmacokinetics, pharmacology, and pharmacodynamics principles. The prescribing cascade game was received positively by the students. It will now be part of the geriatrics pharmacotherapy course., Internet use among older adults has the potential for significant social and health outcomes. However, few senior-focused and senior-friendly training opportunities exist. The purpose of this study was to evaluate the feasibility of delivering a senior-friendly tablet training program and its impact on tablet ownership, sustained use, and confidence over time. Twelve seniors completed the iLearn iLive Well tablet training program (six 2-hour weekly sessions) to teach participants how to operate a tablet including e-mail and internet use; availability and use of apps; and viewing, taking, and sending photographs. Participants completed pre- and post-program surveys, session reaction surveys, and 3-month follow-up interviews to assess sustained use of learned skills. All of the sessions were well received with most of the sessions being rated as “very good” or “excellent” by over 67% of participants. At follow-up 8 of 11 interviewed participants reported that they had purchased a tablet, 63% reported using it more frequently since the end of the training program, and 88% reported being more confident in their ability to use the tablet in comparison to before the program. As a result of their tablet use, participants reported being in greater contact with friends and family than they would have been otherwise, being better informed of current affairs, being able to access to information more easily, and having a great sense of satisfaction with learning new things. One-to-one mentorship, senior-friendly training manual, learning strategies, environment, and previous computer experience facilitated their tablet learning. Identified learning barriers were mostly program-specific and modifiable. This senior-focused tablet training program facilitated sustained tablet use. Future studies will examine the impact of this program on perceived social isolation, loneliness, and attitudes towards computers., Anorexia in the elderly often cause weight loss, therefore it is regarded as a important starting point of frailty syndrome, which is considered as a critical point on the pathway to disability and mortality. Korea is entering an aging society at the fastest speed in the world, but the prevalence and risk factors of anorexia in the Korean elderly have not been investigated. A total of 170 men and women (30 from nursing homes, 140 from out-patient clinics) older than 60 years were recruited in this study. We evaluated the appetite with a Simplified Nutritional Appetite Questionnaire (SNAQ) and defined the anorexia subjects as those whose SNAQ score was less than 14. We also performed a comprehensive geriatric evaluation including the measurement of anthropometric data; the medical, drug, and social history; cognitive function with the Korean version of the mini mental state examination (K-MMSE); activity of daily living (ADL); the Geriatric depression scale (GDS); and the Mini-nutritional assessment (MNA). The prevalence of anorexia was 50% in nursing home residents and 45% in ambulatory elderly patients. Comparing with non-anorexic subjects, the anorexic subjects showed lower K-MMSE score (24.7 ± 5.33 vs 26.4 ± 4.01, p = .026) and MNA score (10.2 ± 2.90 vs 11.4 ± 2.59, p = .004) and more frequently expressed gastrointestinal symptom such as diarrhea (8.0% vs 1.1%, p = .046). We could not show statistical significant relationship between the anorexia and body mass index, calf circumference, Cumulative Illness Rating Scale, the number of medications, ADL and GDS score, residual teeth number and social support factors. Logistic regression analyses showed that the MMSE score was independently related to the anorexia (p = .005). The prevalence of anorexia in our study was higher than the results in the other countries, and this result may be due to the high prevalence of polypharmacy. The average number of medications in this study was 4.9 ± 3.70. Because the study population was not selected by random sampling, the results of this study could not represent the anorexia prevalence of the general Korean elderly population. We showed a high prevalence of anorexia in the Korean elderly. Because the SNAQ is regarded as the early detection tool of malnutrition and weight loss, further prospective studies are essential to determine the long-term consequences of the anorexia assessed with SNAQ., Physicians play a key role in DMCA. However, many do not feel prepared based on their residency training. They, thus, often require additional training once in practice. To address this need, we developed and administered an interactive DMCA Workshop to familiarize physicians with a DMCA model, including concepts of capacity, the protocol, documents, and case studies. In this study, we will determine the effect of the DMCA Workshop on physicians’ confidence and comfort with decision-making capacity assessments. Design: This study used a pre-test-post-test design. We administered a questionnaire before and after the Workshop. The questionnaire asked participants to rate their agreement (4-point Likert-type scale) on 15 statements regarding awareness, confidence, and understanding of core concepts of capacity. Participants: All physicians who attended three workshops in 2014. Intervention: A 3-hour DMCA Workshop accredited by the College of Family Physicians Canada. There were 54 participants with an average age of 47 years. There was a significant improvement (p < .001, Sign Test) in the post- compared to the pre-workshop ratings for all the items. The highest positive differences were seen for awareness of legislative acts, understanding a trigger, problem-solving techniques, standardized approach, and knowledge and skill-set in regards to capacity assessments. Among the participants, those without prior DMCA training exhibited the largest change in pre- versus post-workshop ratings (p < .05). The results indicate that the information provided in the workshops is valuable for physicians regardless of years worked in the current setting. The pattern of findings provides important feedback on modifications to delivering future workshops. This study has shown that a DMCA Workshop was effective in training Family Physicians. The next step is to customize the Workshop to Family Physicians’ needs., The Regroupement des Unités de Courte Durée Gériatriques et des Services Hospitaliers de gériatrie du Québec (RUSHGQ) is a geriatric community of practice that includes health-care professionals and managers from 51 of the 61 Quebec hospitals with Geriatric Assessment Units (GAU). The RUSHGQ established a work sub-committee composed of doctors and pharmacists throughout Quebec with the purpose of establishing guidelines for medication management in GAU. Doctors and pharmacists with experience in GAU have prepared, using evidence-based data and consensus decisions, a user guide on appropriate medication management for health-care professionals in GAU. To date, the covered drug classes are: statins, antihypertensives, direct oral anticoagulants, sedatives/hypnotics, antidepressants/psychotropic drugs, as well as medications for urinary incontinence Six workgroups composed of GAU doctors and pharmacists were formed to cover each of the themes; each workgroup was headed by a doctor considered by his/her peers to be a theme expert. This iterative work lasted 12 months. The guidelines begin with a general section detailing pharmacokinetic and pharmacological changes linked to aging, specific precautions and the notion of deprescribing, which must be considered when prescribing medications to patients admitted to GAU. The typical profile of GAU patients has been described in previous work by the RUSHGQ: ≥ 80 years old with multiple acute and chronic conditions and polymedicated. Then, specific information sheets are presented which include: (1) a summary of the indications of the medication of interest; (2) usage guidelines adapted to the geriatric population; (3) clinical cases integrating the presented concepts. Appendixes provide complimentary tools. Prescribing guidelines presently covering 6 different themes were elaborated by expert clinicians in order to maintain/propagate good practices in medication management in GAU., The Geriatric Rehabilitation Program at UHN facilitates the transitions of older adults from the acute care setting to home. Participation and progress in rehabilitation is hampered at times by complications related to bowel function. The patient population includes patients with multiple co-morbidities including those with end-stage renal disease receiving hemodialysis. In order to better understand the prevalence of bowel-related concerns on the unit, a chart audit was conducted revealing approximately fifty percent of the patient population met the criteria for constipation as per the Rome III classification system. A review of current practices on the unit and existing documentation revealed opportunities for improvement. The unit leadership, consisting of the Clinical Nurse Specialist, Advance Practice Nurse Educator, and Program Service Manager, developed a multi-faceted strategy to enhance the interprofessional team’s ability to optimize the bowel health of patients. Components of our strategy included: implementing nursing interventions to enhance healthy bowel function, introducing the Bristol stool chart for assessment, patient education, evaluation of interventions, and team communication as well practice supports at the bedside. Members of the interprofessional team contributed updates on best practices and participated in educational sessions with the nurses to enrich the dialogue and assist with translation to practice. Evaluation of this important initiative included auditing documentation, communication at team rounds, and prevalence of constipation post-implementation. Optimizing Bowel Health was a significant clinical and educational initiative that improved the interprofessional team’s ability to monitor, document, and discuss priority concerns related to bowel function. This is especially important in a rehab setting where complications often lead to decreased participation, interruptions in therapy, and decreased quality of life experiences for patients. The results demonstrated enhanced documentation, interprofessional communication, and reduction in rates of constipation., Older people living in nursing homes (NH) in Hong Kong have significant mortality. Their preference of place of death and the factors affecting their decision have not been explored. This study examined the preference of place of death and the predictors in older people living in NH. A cross-sectional quantitative study by face-to-face interview in 20 NH selected by convenience sampling. A structured questionnaire was employed to collect information about attitudes of older people towards end-of-life (EOL) issues and preferences for place of death. NH residents aged ≥ 65 with Abbreviated Mental Test (AMT) Score ≥ 6 and ability to communicate in Cantonese were recruited. AMT, Barthel Index (20) and Chinese version of the European Quality of Life-5 Dimensions (EQ - 5D) for quality of life assessment were collected. The attitudes toward EOL issues (AEOLI) were examined using a validated translated questionnaire. 317 NH residents (248 women and 69 men) aged 65 to 99 (mean ± SD) 84 ± 6.6 were recruited. Most residents (N = 310, 97.8%) viewed NH as their own home. There were 216 (68.1%) who wished to pass away in NH. NH residents who preferred receiving care in hospital if they were severely ill without hope of recovery were less likely to wish to die in NH (odds 0.49, CI 0.3 to 0.81, p = .005). Those who agreed physician-assisted suicide if they were severely ill without hope of recovery were likely to wish to die in RCHE (odds 1.95, CI 1.07 to 3.56, p = .029). EOL services should be enhanced in NH in Hong Kong. Further studies are recommended to examine the attitudes towards dying in place in family members, NH staff and local public. Many older Chinese people in Hong Kong viewed NH as their own home. More than two-thirds of NH residents wished to die in NH., Suicidal ideation is a public health issue that has a significant impact at the individual, family, community, and societal levels. This study aimed to examine the association between filial piety and suicidal ideation among U.S. Chinese older adults. Guided by a community-based participatory research approach, 3,159 community-dwelling Chinese older adults in the Greater Chicago area were interviewed in person 2011–2013. Independent variables were expectations and receipt of filial piety from the older adult’s perspective. Dependent variables were suicidal ideation in the last 2 weeks and last 12 months. Logistic regression analyses were performed. Of the 3,159 participants interviewed, 58.9% were female and the mean age was 72.8 years. After adjusting for age, sex, education, income, medical comorbidities, and depressive symptoms, lower receipt of filial piety was associated with increased risk for 2-week suicidal ideation (OR 1.07, 95% CI 1.03–1.11) and 12-month suicidal ideation (OR 1.07, 95% CI 1.04–1.11). The lowest tertiles of filial piety receipt was associated with greater risk for 2-week suicidal ideation (OR 1.95, 95% CI 1.12–3.38) and 12-month suicidal ideation (OR 2.17, 95% CI 1.35–3.48). However, no statistically significant associations were found between filial piety expectations and suicidal ideation in the last 2 weeks or in the last 12 months. This study suggests that filial piety receipt is an important risk factor for suicidal ideation among U.S. Chinese older adults. However, future longitudinal studies are needed to quantify the temporal association between filial piety and suicidal ideation., Prevalence of sarcopenia increases with age. Sarcopenia is associated with higher rates of drug side effects, hospital-acquired infections and functional decline. Sarcopenia subtypes are defined by the European Working Group of Sarcopenia in Older People (EWGSOP), based on presence/absence of low muscle mass, plus/minus low muscle strength or low performance. Participants are independently mobile, community-dwelling seniors. Baseline assessments included dual energy Xray absorptiometry (DXA) body composition (BC) analysis, grip strength (dynamometer), and gait speed (10 metre walk test). BC provided appendicular lean mass/height2 (aLM/ht2) and percentage body fat. Data evaluated per EWGSOP guidelines. Low grip strength and gait speed, with normal aLM/ht2 were classified as “weak,” to differentiate them from normal. Prescaropenics had only low aLM/ht2, sarcopenics had low aLM/ht2 plus one abnormal level in one of the other parameters, and severe sarcopenics had abnormal levels in all parameters. Obesity was defined by DXA BC percentage fat of > 40% (women), > 28% (men). 39 participants were evaluated: 32 women, 7 men; average age 75.9 years (67–90); average MoCA 25.5. EWGSOP classification of the 32 women: 9 normal; 2 presarcopenia; 2 presarcopenic obesity; 1 sarcopenia; 1 severe sarcopenia; 1 severe sarcopenic obesity; 3 sarcopenic obesity; 10 obese; 1 normal “weak”; 2 obese “weak.” Of the 7 men: 2 normal; 1 sarcopenia; 3 sarcopenic obesity; and 1 obese. The subgroups were comparable for age. Baseline BMI was 27.5 (18.8–37.5) and BMI did not discriminate the body types. In these independent, highly functioning seniors, there was a surprising diversity of body composition. BMI alone was of no use in classifying body type. The EWGSOP classification is useful to stratify an outwardly homogenous group of seniors., Polypharmacy is becoming increasingly prevalent in our aging population, due to the need to treat various disease states that may develop with age. Geriatric polypharmacy has been correlated with a significant patient safety issue, due to its association with higher likelihood of nursing home placements, morbidity, hospitalization, and death. Primary care teams represent the first point of contact, and are well positioned to address this phenomenon. The purpose of this project was to develop an automated medication review process in high-risk patients (defined as those 75 years of age or older and on 7 medications or more) by optimizing collaborative process with a clinical pharmacist and taking advantage of the capabilities of the electronic medical record (EMR). Patients were identified via a search on the EMR and flagged for a medication review. An optimal process for referral and communication between providers was developed using an iterative approach, taking into consideration feedback from the team members and patient reactions. Data were also collected on the types of pharmacist interventions and the types of medications changed. We developed a process using electronic messaging and coordinated MD-pharmacist visits. The total number of medications per patient was reduced, and the medications were adjusted based on the current geriatric literature. Patients were more likely to agree to a face-to-face meeting if the idea was introduced by their regular provider. Co-ordination of pharmacist and MD appointments led to more efficient implementation of pharmacist recommendations. Inferentially, by optimizing polypharmacy, harms of negative clinical outcomes would be reduced. Using EMR capabilities, a workable and sustainable process for performing geriatric polypharmacy reviews in the primary care setting was developed, and can easily be disseminated to other sites., Case Report: 97-year-old female presented with two painful ulcers on her left foot. One of the ulcers was determined to be an osteomyelitis. 3 months into treatment of these non-healing, painful wounds, she developed a third painful wound on her left calf. Her wounds treated with topical dressings and antibiotics. Pain required multiple opiods with limited success. Seen by vascular surgery 6 months into treatment. Problem determined to be angiosomal. Treated with angioplasty. Ankle brachial ratio was increased from 0.28 to 0.57. Rapid healing over next few months ensued. Two years later, patient is walking around the nursing home. Vascular surgery consultation with computed tomography angiogram should be considered earlier in treatment to decrease morbidity, improve quality of life, and lessen pain symptoms. Advanced age is not a reason to not consider consultation., St. Mary’s General Hospital has been awarded a demonstration project for the development of a Geriatric Medically Complex Clinic (GMCC). BRIDGES, based out of the University of Toronto, has been engaged for project evaluation. Geriatric patients with conditions such as dementia, cognitive decline, delirium, falls, fractures, multiple co-morbidities (CHF, COPD and diabetes), and chronic pain can be compounded by cognitive decline, caregiver stress, frailty, and polypharmacy. When geriatric patients have suboptimal care or are unable to access traditional primary care providers, they will resort to crisis teams and emergency departments (EDs), presenting a significant cost to the health system. For the ED the GMCC specifically targets those who have suboptimal access/utilization of traditional primary care providers and sees the patient within 72 hours. The GMCC has partnered the community to ensure urgent referrals are also seen within 72 hours. The GMCC team follows patients through their point of referral (i.e., ED, community, or hospital stay), with the guidance and support of geriatric medicine specialists or primary care practitioner. The team provides a focused comprehensive assessment and targeted inter-professional intervention, intensive case management across the spectrum of care, and facilitation of successful transitional care from hospital to the community. For those who are unable to leave their homes, management of chronic diseases through partnership with Primary Care supports the patient in the community, providing patient-centered care across the continuum. Through the use of an inter-professional team, patients/caregivers will have system navigation regarding health-care options, and access to timely community supports/services to manage their health-care needs. The goal is to improve patient outcomes, access community supports to successfully manage in the community post a hospital interaction, and reduce health-care costs., The objective of this study was to evaluate the family composition of elderly caregivers that were identified in the Basic Health Unit localized in an area of high social vulnerability. Seventy-three elderly caregivers participated in the study. Collection took place from May to October 2014. The genograms were made through interviews in their homes. All ethical principles were observed. The mean age was 70.35 years (SD ± 8.5), 58 elderly women and 15 men. Mean education was 2.3 years. We found the average of three people per household and 5.53 children per individual. Most seniors reported normal bonding with family. The average income of the elderly was 0.93 minimum wage and average family income was 2.3 minimum wage. The genogram is a good tool to investigate characteristics and familial relations, revealing the interviewed’s non-verbal language; however, these relationships change over time. Most of the patients reported normal bonding with family. The genogram has proved an effective tool for assessing the family structure of the elderly in a Basic Health Unit and can be used as a mechanism to improve services planning to this population., Due to the growing number of individuals suffering from dementia, many will require acute hospital care as other indirectly related conditions appear throughout the course of the disorder. Significant concerns have been raised about the provision of quality care. Understanding their experiences is therefore essential. As part of a larger-scale study, semi-structured interviews were conducted with caregivers and people with dementia dyads after acute hospitalization. Data were analyzed using qualitative content analysis. Twenty-nine participants including 25 family caregivers and 4 caregivers/people-with-dementia dyads experienced hospitalization and commented primarily on the negative experience. Despite the importance of caregiver involvement, and evidence of caregiver burden, they commented they were rarely included in care plans and lacked support. Continuity of care was said to be affected by absent communication amongst health-care team members. The acute hospital process and environment were perceived as not supportive of dementia person-centred care principles, with reports of poor staff knowledge and recognition of the disorder. The three important themes from this study — the importance of caregivers, communication challenges, and how the processes/environment of the acute hospital is not an ideal place for a person with dementia — raise important issues about care provision. These findings are supported by prior research that states that the acute-care hospital is not adapted to care for people with dementia. Reports of acute-care hospital experiences of people with dementia and their caregivers provide insights about gaps in care delivery. These findings can influence the development of further initiatives for care improvement., The Consortium pour l’identification précoce de la Maladie d’Alzheimer – Québec (CIMA-Q) aims for earlier diagnosis of Alzheimer’s disease, before the dementia stage, and to better understand its causes, in order to develop effective therapies and identify at-risk populations. The clinical cohort group adapted or developed clinical assessment tools to evaluate both global and cognitive health status, as well as to identify health and lifestyle related risk factors, both at the start of the study and over time. This questionnaire had to be completed in under 2.5 hours, and needed to be useful to evaluate both healthy and cognitively impaired elderly individuals. Longitudinal studies of aging and Alzheimer’s were consulted as well as Cognition Clinics evaluation tools in order to determine themes that are most commonly assessed. Final selection was made by a team of experts (clinicians from memory clinics across Quebec). Within each topic, most commonly used/best questions and questionnaires were evaluated by the team of experts. When possible, a validated questionnaire was used, in order to make comparisons with other studies possible. Questions were created and adapted if a validated questionnaire could not be found. Three different tools were created, both in French and in English: (1) a telephone screening interview (15 minutes), (2) a participant evaluation (2.5 hours), and (3) an informant questionnaire (15 minutes). All were piloted in a group of elderly volunteers. Fifteen validated questionnaires are included, such as the MoCA, a telephone MMSE, functional autonomy scales, and a depression scale. The CIMA-Q clinical assessment tools can be used to evaluate both cognitively-impaired and non-impaired participants. The inclusion of validated questionnaires should permit comparisons with previous and future longitudinal studies., To provide an evidence base to support the use of safe and appropriate yoga instruction and yoga therapy for an aging population including geriatric and palliative care clients. This presentations will share the benefits of yoga postures, breath work, mindfulness, and meditation on the physiological, biochemical, psychological, and spiritual health and well-being of geriatric populations. A review of the current research on the benefits of yoga therapy practices for addressing common physical diseases and the effects of sedentary lifestyles for aging populations including geriatric and palliative care patients will be presented. Specific recommendations for health concerns & conditions such as: Alzheimer’s, dementia, COPD (Chronic Obstructive Pulmonary Disease), cardiac rehab, anxiety, depression, cardiovascular disease, chronic lower respiratory disease, diabetes, cancer, injuries from accidents, joint pain, hearing loss, vision impairmentIntegrative care for palliative care patientsBest practices for geriatric and palliative care patientsPsychological issuesSpirituality for aging The implications of this research for integrating yoga, breathing exercises, laughter yoga, spirituality, mindfulness and meditation into existing geriatric health-care programs. The current research provides a strong evidence base for incorporating yoga and yoga therapy into geriatric health and wellness programs to support the aging population in maintaining physical health, biochemical and psychological health, and well-being., The literature indicates that delirium is increasing in incidence in the acute medically ill patient. The prevalence of delirium ranges from 6% to 56% in hospital settings and costs upwards of 17 million dollars/year. There are many risk factors known to contribute to delirium, resulting in the complexity of identifying, assessing, and managing a patient that develops delirium. Hospital-acquired delirium is a concern for the geriatric population. The evidence states that the development of delirium influences a patient’s hospital course, increasing length of stay, and is associated with poor long-term physical functional and cognitive outcomes. Moreover, psychological distress to family and care givers is significant. Several studies have shown gaps in health-care professionals’ knowledge, skills, and comfort regarding management of delirium, including inconsistent use of screening instruments and poor adherence to management protocols. The management can be complex, requiring the collective expertise of the interprofessional team. To address delirium issues this poster was created to improve understanding of various types of delirium as well as to highlight prevention and management strategies. Delirium was made a focus at UHN and the poster was developed to summarize UHN’s initiatives. These included: Identifying risk factors and causes of deliriumDiscussing measures for delirium preventionExplaining assessment and management of patients with deliriumDemonstrating the use of CAM assessmentDiscussing CAM assessment and interventions documentationDelirium Prevention and ManagementResultsThe Communication StrategyTools and policiesEducation The poster promoted awareness for staff about delirium and promoted the UHN initiative (see “Conclusions”). The literature indicates that 40% of delirium can be prevented. It is clear that interprofessional education regarding identification, prevention and management is paramount to reduce the risk of delirium development and associated long-term deleterious outcomes., While most clinicians acknowledge that opioid analgesia can be an important component of ED pain management, it is well documented that ED opioid administration and prescribing is influenced by age, with older patients being less likely to receive opioids than younger patients. Retrospective char t review involving three rural emergency departments and one urban emergency department studying a total of 92 patient visits at the rural sites and 193 patient visits at the urban site. Information describing the emergency department visit and administration of analgesia in the emergency department was abstracted. 12% of rural patients and 32% of urban patients received opioid analgesia from the time of triage to discharge from the emergency department (p = .0003 for comparison). However, after adjusting for possible confounders, rurality was not associated with a decreased likelihood of opioid administration (odds ratio, 0.722; 95% CI, 0.291–1.791). 10% of rural patients and 24% of urban patients received acetaminophen (p = .0038 for comparison), while 14% of rural patients and 8% of urban patients received a non-steroidal anti-inflammatory drug (NSAID) (p = .0918 for comparison). The overall rate of opioid administration was low in both settings. Interestingly, the rate of acetaminophen administration was even lower in both settings, and the rate of NSAID administration was higher than that of opioid administration in the rural settings combined. Clinical practice guidelines for treating pain in the elderly state that acetaminophen is generally considered to be the first-line pharmacological treatment, and that NSAIDs should be used cautiously due to their side effect profile. Rurality did not influence emergency department administration of opioids to elderly patients in pain after adjusting for possible confounders., Patients with dementia and their caregivers express different needs such as coping with memory loss, information on the disease, emotional support. As a key intervention of the Alzheimer Plan of Quebec, case management (CM) has been implemented in Family Medicine Groups (FMGs) to address their needs. The purpose of this study is to identify the needs of the patient-caregiver dyad and if CM meets their expectations. A systematic mixed studies review was conducted to integrate the results from studies with diverse designs (quantitative, qualitative, mixed methods studies) on needs of the dyad and CM, published in English or French up to 2014. CM comprises case finding, assessment, care planning, and monitoring and includes a family physican working with a case manager. Two reviewers selected title/abstract, full-texts, and appraised quality (using the Mixed Methods Appraisal Tool) independently. Synthesis (a sequential explanatory design): (i) development of the categories of needs based on the deductive approach; (ii) identification of the needs that CM targets to address; (iii) juxtaposition of the needs of the dyad to the needs that CM targets to improve. 54 studies were included; 8 studies concern CM. Four main categories of needs were identified: needs for information and knowledge, needs to maintain normality, caregiver needs, and access to care. Overall CM effectively addresses the needs of the dyad living in the community. Impact of CM on access to care (e.g., access to trained family physicians) is not studied. This study highlighted a knowledge gap on the impact of CM on access to care. These results will guide the conduit of experimental study on the needs of the dyad receiving care within CM implemented in FMGs of Quebec., Patients who have sustained fragility fractures remain at high risk for future fracture without appropriate bone-protective interventions. The goal of our investigation was to examine the rate of bisphosphonate prescription within three months of discharge from hospital among patients with fragility fracture of the hip admitted to the Orthopedic Service at the Royal University Hospital, in Saskatoon. The data from this study will inform future interventions tailored to improve secondary prevention of fragility fractures in Saskatchewan. A chart review of 114 patients over the age of fifty with a fracture of the hip was completed. Patients whose mechanism of injury was not consistent with fragility fracture were excluded, along with those receiving treatment with bisphosphonates at admission, or creatinine clearance less than 35 mL/min. Data were matched with the provincial Pharmaceutical Information Program (PIP) to assess for prescription of bone protective therapy within three months of discharge. Five patients received prescriptions for bisphosphonate therapy (7%, 95% CI: [1%, 13%]), and 70 of the eligible patients did not receive treatment (93%, 95% CI [87%, 99%]). A total of 23 patients were precluded from receiving bisphosphonate therapy, and an additional 16 patients presented with fragility fracture of the hip while on bisphosphonate treatment. These findings reveal an identifiable care gap in the secondary prevention of fragility fracture of the hip in Saskatchewan. Patients who have sustained fragility fractures are at risk of adverse outcomes including loss of function and decreased quality of life. Further study to improve the management of this cohort is under way. We have begun a knowledge translation intervention, supplementing discharge summaries with information to identify patients in need of treatment and further follow-up to prevent future fragility fracture., Ambulatory care is a key component of geriatric medicine subspecialty training but currently there are no standardized core competencies in this domain. The goal of this project is to develop a set of competencies for geriatric ambulatory medicine that are essential for the geriatric subspecialty residents to master by the end of their curriculum to become independent in their professional practice, offer the best care possible, and respond to the increasing demand for the ambulatory care of older patients. We are completing a multiphase project including an environmental scan, modified Delphi, and an in-person meeting with relevant experts to develop the list of core competencies. In the first phase, we identified 151 core competencies from the current literature and lists provided by 7 geriatric program directors in Canada. They were divided into six domains (medical expert, manager, collaborator, communicator, scholar, and professional). The modified Delphi is under way and we expect 38 leaders in geriatric medicine to participate in the surveys. At the time of the 2015 CGS Annual General Meeting, data from the Delphi will be available and competencies that should definitively be included or eliminated from the final list will be identified. Competencies with discordant results will be compiled and presented for discussion during the experts meeting. The final goal of this project is to produce an exhaustive and concise list of competencies that cover the essential aspects of ambulatory care for elderly. We are hoping to create a valid and useful tool to develop ambulatory geriatrics training curricula and to emphasize skills specific to ambulatory medicine., Elderly with advancing chronic heart failure (CHF) experience high levels of morbidity and mortality, similar to patients with common cancers. There is a gap in optimal quality of care and the real experiences for these patients. Even in the terminal stages, patients and caregivers are heavily and unnecessarily burdened by health-care services that are poorly coordinated and offer fragmented care. There is evidence that these poor experiences and the lack of understanding of their preferences could be improved to a large extent by simple organizational and process improvement rather than complex clinical mechanisms. This study examines patient, carer, and professional perspectives on current management of advanced HF and barriers and facilitators to improved care. Qualitative study involving semi-structured interviews and focus groups with advanced HF patients (N = 20), carers (N = 20), and professionals (N = 30–40). Some questions are testing the knowledge, others attitude, opinion, and experience. The questionnaires for the one-on-one interviews are different from the focus group interviews. A conversational style of communication, starting the questionnaire with an introductory statement and a non-threatening and open-ended easy question to warm up is used. The literature highlights that little progress is being made to improve care experiences for those with advanced HF. Even in the terminal stages, patients and caregivers are heavily and unnecessarily burdened by health-care services that are poorly coordinated and offer fragmented care. There is evidence that these poor experiences could be improved to a large extent by simple organizational rather than complex clinical mechanisms. We will discuss the result of this study and provide recommendations., Health care has entered an era of complexity. Patients often suffer from multiple comorbidities, and the growing cohort of elderly patients present with medical, psychiatric, functional, and social complexity. There is growing recognition that the ability to handle complex cases is a critical physician competency which should be developed in trainees. We aim to explore how medical trainees conceptualize clinical complexity, how well-prepared they feel to handle complexity, and how complex encounters influence residency selection. In this qualitative study, to date, 13 participants (12 3rd-year students in their 11–12th month of clerkship and 1 4th-year elective student) engaged in a two-part interview process. First, students drew two rich pictures that represented complex clinical scenarios: one exciting, and one frustrating, overwhelming, or uncomfortable. Second, the pictures were used to guide a semi-structured interview. Interview transcripts were coded, compared, and analyzed using constructivist grounded theory principles. Preliminary emerging categories for how trainees conceptualize complexity include role certainty, perceptions of learning, and belonging. These suggest the notion of active engagement as a key process influencing how clinical complexity is perceived; when actively engaged, students described the case as complex and exciting versus complex and frustrating. Active engagement may also influence residency selection as feelings on complexity and mentorship appear to be connected when describing specialty preferences. Preliminary results suggest that the social process of learning, in relation to feelings of engagement, is a strong determinant of how medical trainees experience complex patients and the choices that result from these encounters. Medical students must be trained to handle complex cases. Future direction for this study includes recruitment of additional participants, and further exploration on trainees’ preparedness for clinical complexity and how the pre-clinical curriculum can better support the development of this competency., The recent Royal College of Physicians and Surgeons report highlighted areas of medicine that are over-serviced, but also emphasized those that are under-serviced, including geriatric medicine. The goal of this project was to develop a multimedia podcast template that would inform medical students about various career choices. Geriatric Medicine served as the prototype podcast. A needs assessment was done by surveying existing resources (CaRMS, AAMC, AFMC, CFMS) and conducting an online survey of medical students. Based on these results, a list of interview questions was developed for this video podcast. A Sony camcorder was used for recording interviews in Ottawa while Skype and ScreenFlow were used to interview and record physicians and residents nation-wide. Interviews were conducted with physicians and residents working in Geriatrics. Relevant links and resources were added to the podcast. It is now housed on the CGS website and the TOH Department of Medicine webpage. As well, the CFMS and AAMC plan to add it to their websites. The podcast was evaluated by medical students via a questionnaire. Using a podcast framework to educate trainees on career choices is a novel idea. The results from this project may be used as a template for other postgraduate training programs and this podcast may be used to raise awareness of Geriatrics as a career choice. Podcasts are a novel multimedia approach for demonstrating career opportunities to medical students, when considering residency training options., Delirium is an acute confusional state that is most commonly seen in older adults and is a predictor of poor outcomes. Despite being a quality of care indicator, evidence shows that delirium is often unrecognized. This limits the possibility of timely management. The objectives of this study are to determine the rates of delirium screening at MSH and to identify barriers and the needs of health-care professionals to better facilitate daily delirium screening. We conducted a retrospective chart review of adults 65 years or older admitted to one of four units — Acute Care for the Elderly, ICU, general medicine unit, and orthopedic surgery — between September 2010 and October 2013. The survey consists of 4 sections: Demographics, Delirium, Delirium Screening, and Education & Resources, to be administered to health-care professionals at MSH that screen for delirium in the above-mentioned study subjects. The survey was developed in 4 phases: Item Generation, Item Reduction, Question Formatting, and Validation. At the time of abstract writing (465 charts), the rate of total compliance with daily delirium screening was 60%, the rate of screening within 24 hours of hospital admission was 62%, and the rate of hospital-acquired delirium was 19%. The survey was in the validation phase and to be distributed to staff in March 2015. We hypothesize that many of the perceived barriers identified will be possible to target through the availability of resources, and that identifying the needs of health-care professionals will allow future resources to be appropriately chosen to enable improved screening rates. This approach will allow more cases of delirium to be identified and opportunely managed at MSH to reduce negative outcomes., In older adults with Mild Cognitive Impairment (MCI), a precursor to dementia, deficits in cognition can have negative impacts on well-being and quality of life. Research has shown depression increases risk of cognitive decline. Among the elderly, those who live alone are at risk of developing depressive symptoms. There is a lack of information from relevant literature on whether individuals with MCI are at risk for further cognitive deterioration depending on their relationships (marriage and/or companionship) and living arrangement (alone/with a partner). This study is to investigate the effect of relationship status and living arrangement on memory and cognition, and whether depression mediates these effects in the elderly population diagnosed with MCI. Data from the ongoing “Gait and Brain Study” cohort will be used to assess forty older adults with MCI who live alone, and forty with MCI who live with a partner. The Mini Mental State Examination (MMSE) will be used to assess cognition and depressive symptoms will be assessed using the Geriatric Depression Scale (GDS) every six months over a 2-year period. This study is in its preliminary stages; results are pending. We expect that individuals who live alone, in comparison to individuals living with a partner, will demonstrate greater declines in cognitive function, as evidenced by lower MMSE scores, and will experience greater depressive symptoms, represented by higher GDS scores. There is currently a lack of understanding whether relationship status and living arrangement, mediated by depression, affect cognitive function in individuals with MCI. This study may provide insight into possible social and psychological risk factors, further contributing to cognitive decline, that need to be addressed in the care of older adults with MCI., The McGill Centre of Excellence on Aging and Chronic Diseases (CEViMaC) aims to design a needs analysis questionnaire that can measure the performance gaps between the current situation and an ideal situation in terms of coordination of health care and services for seniors with multiple chronic diseases in the McGill Réseau Universitaire Intégré de Santé (RUIS McGill). This research project represents an important procedure as it will guide the CEViMaC in providing appropriate clinical support to health organizations within RUIS McGill. The Kaufman methodology of needs analysis at the strategic level and a conceptual framework of health-care coordination were selected to guide the questionnaire’s design process. A scoping review was performed to identify strategic plans of relevant health-care organizations: pertinent goals of coordination were analyzed and converted into items for the questionnaire. The measurement scale and the basic visual design of the questionnaire were based from similar research studies. Finally, qualitative interviews with a sample of health-care professionals were conducted to test the questionnaire. According to the interviewees, the visual design and the measurement scale were intuitive, and the items reflected broadly their professional concerns. However, some instructions and questions lacked coherence and contained inaccurate terminology. Additionally, the completion of the questions required a considerable amount of time. Reformulating the instructions and the questions, and arranging thematically the sequence of questions, are necessary to facilitate comprehension. Otherwise, the number of questions should be reduced to ensure a favorable response rate. A team of suitable experts, further interviews, and adjustments are needed to improve the measurement tool in addressing adequately the dimensions of care and service coordination. Use of incentives should be explored to boost response rate upon the questionnaire’s official launch., Low life satisfaction (LS) predicts poor outcomes and may predict dementia. We sought to determine if LS predicts dementia over a five-year period in older adults with normal cognition at baseline. Secondary analysis of a population-based cohort study of 1,751 older adults, with initial assessment in 1991 and follow-up five years later; 1,028 were cognitively intact at time 1, and alive and had complete data at time 2 when 96 were diagnosed with dementia. Measures were age, gender, and education, which were self-reported. LS was assessed using the Terrible-Delightful scale, which measures overall LS and aspects of LS (e.g., health, finances, friendships) using separate 7-point scales. Cognition was assessed using the modified Mini-mental State Examination (3MS) and a clinical exam for those scoring < 78. Cognitive status was categorized as intact, dementia, or Cognitive Impairment, No Dementia (CIND). Analyses were adjusted for age, gender and education. There were few cognitively intact people at time 1 with low LS. Overall LS predicted death, dementia, and CIND five years later. Those with low overall LS were more likely to die than to develop dementia. In logistic regression models, the unadjusted Odds Ratio (OR; 95% confidence interval) for dementia at time 2 was 0.72 (0.55, 0.95) per point on the LS scale, with the adjusted OR 0.68 (0.50, 0.93). However, no individual domain of LS predicted dementia, although the competing risk from mortality was high for some items. The risk of death exceed the risk of dementia over the five-year interval. A basic global measure of LS predicts dementia over a five-year period in older adults without cognitive impairment. No individual aspect of LS predicted dementia., Cardiovascular disease, related risk factors, and falls are all well-known predictors of cognitive decline in older adults. In a longitudinal study assessing cardiovascular health, cognition, balance, and dual-task walking, we evaluated baseline differences in balance outcomes and neuropsychological assessments to see if poor balance and poor cognition were associated with individuals who have poor cardiovascular health. The Cardiac group (CG, N = 23) included individuals with ≥ two cardiovascular risk factors and coronary patients. Healthy group (HG, N = 16) included individuals with < two risk factors. Mean age: HG 64.7 years old SD 4.3 years, CG 69.9 years old SD 4.9 years. The Montreal Cognitive Assessment (MoCA) was measured prior to balance assessment. Ten-second balance assessment were performed using a Matscan platform and included two eyes-open conditions (bipedal and unipedal). Initial comparisons of center of pressure measures between groups revealed significant differences in several measures (mean velocity [MV], mediolateral velocity [MLV]). After controlling for age and sex differences between groups, a mixed ANOVA (group by balance condition) revealed significant interactions in MV and MLV, such that CG performed more poorly than HG in the unipedal conditions (MV: p = .04, MLV: p = .02) with no significant differences in the bipedal conditions (MV: p = .86, MLV: p = .628). MLV also negatively correlated with MoCA scores in the whole sample (p = .05). This study suggests that CG have poorer balance control than HG. Simple tests with a balance platform reveal differences that identify at risk groups and relate to lower MOCA scores. Early assessments of balance status can help to identify older individuals at risk of cognitive decline, allowing early intervention to prevent falls and further cognitive decline., Speed of information processing can be affected in Mild Cognitive Impairment (MCI) and may play a role in activities such as driving. Electroencephalography (EEG) may have a role in assessing cognition, because it measures current changes to the level of milliseconds. In cognitive testing, the EEG signal is averaged to yield a waveform termed an “event-related potential” (ERP). This study compares the results of traditional cognitive testing and ERP n-back testing in patients with MCI and healthy controls (HC). Thirteen MCI patients were recruited from the Bruyère Memory Program, and 9 HCs were recruited from the general population. Cognition was tested using the MoCA, RBANS, and Trails A & B. EEGs were measured using NeuroScan NuAmps 4.3 and analysed using Brain Analyzer 2.0. Participants performed n-back cognitive tests to elicit working memory relevant ERPs. There were significant differences between clinical test results of MCI and HC groups; e.g., mean Trails B time for MCI was 173.5 seconds compared to 76.4 seconds in the HC (p < .001). In addition, the HC group had more correct responses and responded more quickly than the MCI patients in all 3 n-back conditions (p < .003). There was also a significant delay in the P200 component at midline and left hemisphere centro-posterior electrodes in MCI patients when compared to HC (p < .04). This MCI group performed less well on traditional cognitive testing, was slower, and made more mistakes in the n-back testing, and showed a significant delay in the P200 component compared to healthy older controls. Further work will be required to clarify the role of ERP in measuring decreases in speed of processing in older adults with cognitive impairment., The current practice to monitor mobility is periodic clinical assessment. Technology is now available that would allow continuous monitoring. The purpose of this study was to track mobility changes in 25 community-dwelling, frail older adults over one year, with the ultimate goal being the early detection of mobility decline. Clinical measures, including Timed Up & Go (TUG) and gait speed, were taken monthly for frail older adults living in the community. Under-mattress pressure-sensitive mat (S4 Sensors Inc.) data were collected continuously over the same time period and analyzed with custom-designed software. Among the first 15 participants, data were collected over an average period of 10 months. Of these participants, there were 8 that showed a clinically meaningful decline, 3 that showed a meaningful improvement and 4 that showed stability in mobility using the clinical measures. Data from an 85-year-old male, with a history of cerebrovascular accidents, will be presented. Over the period June 2013 to May 2014, he went from using a cane to requiring a wheeled walker, his gait speed dropped from 0.70 to 0.47 m/s and his TUG increased from 23.9 to 37.7 s. This will be compared to changes in sum of pressures and centre of pressure velocity magnitude data extracted from the mat. Distinct changes in data analyzed by the pressure-sensitive mat were associated with functional decline in the case presented. Further data analyses are ongoing to determine whether continuous monitoring of bed mobility can facilitate the early detection of mobility decline. To our knowledge, this is the first time that bed transfer data has been measured continuously over a year in frail, community-dwelling older adults., Introduction: Increasing numbers of primary care memory clinics (PCMCs) are being established in Ontario to provide much-needed system capacity for dementia care and efficient integration with specialty services. There is a need for routine integration of standardized quality indicators (QI) into PCMC care processes to ensure high-quality care. The purpose of this project was to develop consensus on the most relevant QIs for PCMCs to promote quality care and program fidelity and sustainability. Methods: A Delphi survey of PCMC clinicians and specialists was used to develop consensus on QIs for use in PCMCs. A list of QIs was identified through a systematic literature review. Survey participants were asked to rate the QIs according to their importance and feasibility in PCMCs. Mean ratings determined relative rankings of importance. Two survey rounds were conducted involving 179 and 88 participants, respectively. QIs ranked below a pre-specified threshold or not readily measurable in a primary care setting were eliminated. Results: Consensus was reached on 18 QIs. These included criteria for referrals to specialists; assessment, reassessment, and documentation requirements for diagnoses of mild cognitive impairment and dementia; criteria for diagnostic testing; medication reviews; discussing the risks and benefits of cholinesterase inhibitors and of antipsychotics; use of stroke prophylaxis in the presence of vascular risk factors; assessment for safety risks; counselling on driving risks and fitness to drive assessment; and advanced care planning, including identification of substitute-decision makers. Conclusions: A set of QIs for PCMCs has been identified. These indicators will form the basis of a quality assurance framework to enhance primary and collaborative care and that can be used in further studies to evaluate the quality of dementia care models in primary care., Vitamin D is involved in brain physiology and lower-extremity function. We investigated spectroscopy in a cohort of older adults to explore the hypothesis that lower vitamin D status was associated with impaired neuronal function in caudal primary motor cortex (cPMC) measured by proton magnetic resonance spectroscopic imaging. Twenty Caucasian community-dwellers (mean ± standard deviation, 74.6 ± 6.2 years; 35.0% female) from the “Gait and Brain Study” were included in this analysis. Ratio of N-acetyl-aspartate to creatine (NAA/Cr), a marker of neuronal function, was calculated in cPMC. Participants were categorized according to mean NAA/Cr. Lower vitamin D status was defined as serum 25-hydroxyvitamin D (25OHD) concentration < 75 nmol/L. Age, gender, number of comorbidities, vascular risk, cognition, gait performance, vitamin D supplements, undernourishment, cPMC thickness, white matter hyperintensities grade, ser um parathyroid hormone concentration, and season of evaluation were used as potential confounders. Compared to participants with high NAA/Cr (N = 11), those with low NAA/Cr (i.e., reduced neuronal function) had lower serum 25OHD concentration (p = .044) and more frequently lower vitamin D status (p = .038). Lower vitamin D status was cross-sectionally associated with a decrease in NAA/Cr after adjustment for clinical characteristics (beta = −0.41, p = .047), neuroimaging measures (beta = −0.47, p = .032) and serum measures (beta = −0.45, p = .046). Lower vitamin D status was associated with reduced neuronal function in cPMC. These novel findings need to be replicated in larger and preferably longitudinal cohorts. They contribute to explain the pathophysiology of gait disorders in older adults with lower vitamin D status, and provide a scientific base for vitamin D replacement trials., Everyday situations in which attention is divided (e.g., walking and thinking) can put older adults at risk for accidents and falls. In order to prevent falls and provide early interventions for cognitive-motor declines, additional research targeting neural contributions during dual-task walking is needed. This study assessed behavioural and neural changes during dual-task walking. Younger (YA; N = 19) and older adults (OA; N = 14) walked on a treadmill at a self-selected pace while performing an n-back task with two difficulty levels (1- & 2-back). Using a blocked design, changes in oxy- (HbO) and deoxy-hemoglobin (HbR) during single (ST: walk) and dual task (DT: walk+n-back) were acquired from 28 channels placed on the prefrontal cortex (PFC). Within each group and channel, a task by difficulty ANOVA was conducted. For HbO, a significant task effect (ST < DT) was found in 5 channels in YA and 7 channels in OA (p values < .028). For HbR, task effects (ST < DT) were found in 17/28 channels for the YA and 24/28 channels for the OA (p values < .045). In four channels (left hemisphere), a significant task by difficulty interaction was found in the YA, in which the HbR concentration change in the 2-back DT was lower than the change in the 1-back DT, a finding not present in the OA. Both groups demonstrate changes in cerebral oxygenation during dual-task walking, with OA demonstrating these effects in more channels than YA. YA may have benefited from dual-task exposure as they have less activity in the harder dual-task condition. These findings help clarify neural contributions to dual-task walking and can be used to inform intervention work on falls and cognitive-motor declines in aging., While research has demonstrated cognitive impairment is a risk factor for functional decline and may affect rehabilitation compared to the cognitively intact, the characteristics that lead to rehabilitation success in people with dementia has not been evaluated. Our objective was to determine factors associated with functional gains among older adults with dementia during inpatient geriatric rehabilitation. Retrospective cohort study: Consecutive subjects admitted to an inpatient geriatric rehabilitation unit with a dementia diagnosis (N = 175, age 83.1 ± 7.2 y, 55.4% female) had mobility, cognitive and demographic data collected at admission and discharge. The Functional Independence Measure motor function (FIM-motor) subscale was used to estimate level of mobility. Gain in motor function was the difference between FIM-motor scores at admission and discharge. Multivariable linear regression evaluated the association between cognitive and demographic factors on mobility gains. Functional gains were smaller with increasing care among pre-admission residence settings. The mean gain in mobility was 48.9% for “home without services,” 44.6% for “home with services,” 38.0% for “assisted living,” and −4.9% for “residential care.” In regression analysis, compared to “home without services,” average FIM-motor gains were lower by 4 points for “home with services” (p = .042), 5.6 points for “assisted living” (p = .029) and 23.2 points for “residential care” (p < .001). No other demographic or cognitive factors were associated with mobility gains. Only pre-admission place of residence was associated with mobility gains. More research is needed on the link between pre-admission function and loss of function on rehabilitation gains to refine positive prognostic factors associated with residence setting. Age, MMSE, gender, comorbidities, and mobility aid use were not associated with mobility gains and should not be absolute contraindications for access to inpatient rehabilitation., Speed of information processing can be affected in Mild Cognitive Impairment (MCI) and may play a role in activities such as driving. Electroencephalography (EEG) may have a role in assessing cognition, because it measures current changes to the level of milliseconds. In cognitive testing, the EEG signal is averaged to yield a waveform termed an “event-related potential” (ERP). This study compares the results of traditional cognitive testing and ERP n-back testing in patients with MCI and healthy controls (HC). Thirteen MCI patients were recruited from the Bruyère Memory Program, and 9 HCs were recruited from the general population. Cognition was tested using the MoCA, RBANS, and Trails A & B. EEGs were measured using NeuroScan NuAmps 4.3 and analysed using Brain Analyzer 2.0. Participants performed n-back cognitive tests to elicit working memory relevant ERPs. There were significant differences between clinical test results of MCI and HC groups, e.g., mean Trails B time for MCI was 173.5 seconds compared to 76.4 seconds in the HC (p < .001). In addition, the HC group had more correct responses and responded more quickly than the MCI patients in all 3 n-back conditions (p < .003). There was also a significant delay in the P200 component at midline and left hemisphere centro-posterior electrodes in MCI patients when compared to HC (p < .04).This MCI group performed less well on traditional cognitive testing, was slower and made more mistakes in the n-back testing, and showed a significant delay in the P200 component compared to healthy older controls. Further work will be required to clarify the role of ERP in measuring decreases in speed of processing in older adults with cognitive impairment., Age-normative hearing loss is linked with reduced cognitive functioning, mobility decline, and increased falls risk in older adults. This study examined age-related differences in allocation of cognitive resources between concurrent walking and listening tasks. Seventeen younger and twelve older adults with normal hearing participated. Three sentences (1 target, 2 maskers) were played simultaneously from different locations (left, center, right) in a virtual-reality street crossing scene. Target location probability (100% versus < 75%) was varied. Participants reported the number and colour in the target sentences. Gait during self-paced treadmill walking was assessed with motion capture system using active markers positioned on the head, sternum, sacrum, and feet. There were 3 conditions: walking, listening, and walking while listening. Key dependent measures were listening accuracy, head and trunk position, and stride time variability. Word recognition accuracy was significantly worse in (a) older than younger adults, (b) dual- than single-task, and (c) less predictable location probability. Preliminary kinematic analysis suggests increased peak trunk pitch, head pitch, and peak head roll rotation in older adults compared to younger adults. Older adults showed decreased head roll, peak head roll, and peak trunk pitch rotation from single-task walking to dual-task conditions but there was no such decrease in younger adults. Stride time variability (coefficient of variation) was greater in older adults under dual-task conditions than single-task walking while younger adults showed no trend. Listening performance in old age is particularly hampered when concurrently walking and when the signal location becomes less predictable. Furthermore, older adults’ gait variability worsened when simultaneously listening. The findings suggest that listening challenges affect mobility and provide early evidence to explain the link between age-related hearing loss and gait adaptations., After a mild traumatic brain injury (mTBI), individuals frequently experience balance problems associated with sensory processing disorders. Pediatric research has shown that compression vests improved anxiety in children with the disorder. However, a significant gap exists in literature regarding the application of compression vests in adult injury populations. The purpose of this study is to measure whether the vest improves gait and if it can improve mobility and aspects of cognition. Twenty-eight mTBI participants will complete the Rivermead post-concussion symptoms questionnaire (measure of anxiety) and cognitive testing, acting as their own controls performing a series of walking tests under four dual-task conditions. The dual-task conditions will consist of walking while performing a cognitive task with and without the compression vest. Cognitive testing includes the MoCA, to assess global cognition, and Trail Making to assess executive function (EF). Gait variability (GV) will be collected as a measure of gait performance. Participants will be wearing over-sized shirts to keep assessors blind to weighted vest condition. There will be a one week wash-out period. We expect that gait performance, specifically GV, under-dual task conditions will improve using the weighted compression vest — a mechanism that can be related to reducing anxiety and improving EF. This study may provide evidence that weighted compression vests can improve patients’ gait performance, allowing them to better navigate in daily environments. If gait improves using the compression vest, it may suggest that GV is sensitive to brain function. This study may contribute to recommending the use of compression vests for older adults to improve gait performance., Low executive function is associated with gait dysfunction in older adults. However, little is known about the neural basis underlying this association. We aim to investigate the relationship between regional cerebral metabolic rates of glucose (rCMRglc) and executive / gait functions in healthy community-dwelling older women. One-hundred and forty-five older women (mean age [SD], 69.6 [6.6] years) who have normal global cognitive function (MMSE > 26) underwent positron emission tomography using [F-18]fluorodeoxyglucose (FDG-PET) to assess brain activity at rest. Within 6 months before and after the FDG-PET, TMT-A, TMT-B and maximum gait indices (speed, step length, and cadence) were measured. The difference in time between TMT-A and TMT-B was calculated for a measure of executive function (ΔTMT). Associations between variables were examined using multiple linear regression analyses adjusted for demographic variables and comorbidity. Lower ΔTMT was associated with poor performance in maximum gait speed and cadence, independent of covariates. For the cerebral glucose metabolism, both lower ΔTMT and lower maximum gait indices (speed and cadence) were associated with lower rCMRglc in the posterior cingulate and the primary sensorimotor cortices. The present study in healthy older adults suggests that the known relationship between low executive function and gait dysfunction in seniors may be explained by reduced metabolic activity in the posterior cingulate and the primary sensorimotor cortices. Assessing the neural activity in these brain areas may be helpful for identifying older adults at higher risk of experiencing mobility disability, falls and progressive MCI or dementia. The posterior cingulate and the primary sensorimotor cortex may play important roles in both executive and gait controls., In Parkinson’s disease (PD), deficits in executive functions (EF) have been linked to impaired gait. Current research has suggested that exercise may be effective to treat cognitive deficits in PD. However, it remains unknown how changes in cognition might influence gait in PD. This study aimed to investigate the effects of an aerobic and a Parkinson’s-specific goal-based exercise on EF and gait in PD and whether changes in cognition and gait as a result of exercise are associated or independent. Forty-eight PD participants were randomized into an aerobic (N = 23) or a goal-based (N = 25) exercise group and attended 1-hour sessions 3×/week for 12 weeks. EF (Digit Span, Stroop Test, and Trail Making Test) and gait (single and dual tasks) were assessed pre and post exercise. A group by time interaction for the Stroop interference condition approached significance (p = .056), revealing that only the aerobic group performed better in this condition at post-test. In addition, all participants performed the Trail’s part A faster after exercise (p = .009). An interaction between time, walking task, and group for step time variability neared significance (p = .058), demonstrating that, while goal-based exercise decreased variability in the single-task, aerobic exercise decreased variability in the dual-task condition at post-test. Participants decreased step time, increased cadence and step width after exercise, only in the dual-task condition (p < .05). Negative correlations showed that more points in the digit span forward were associated with reduced step time (aerobic: r = −0.41; goal-based: r = −0.48) and double support (aerobic: r = −0.50) variability during dual-task. This is the first study to demonstrate that exercise-related changes in EF may influence gait in PD. This influence occurs primarily during dual-task and is dependent on the measure of EF., Cardiovascular disease, related risk factors, and falls are all well-known predictors of cognitive decline in older adults. In a longitudinal study assessing cardiovascular health, cognition, balance, and dual-task walking, we evaluated baseline differences in balance outcomes and neuropsychological assessments to see if poor balance and poor cognition was associated with individuals who have poor cardiovascular health. The Cardiac group (CG, N = 23) included individuals with ≥ two cardiovascular risk factors and coronary patients. The Healthy group (HG, N = 16) included individuals with < two risk factors. Mean age : HG 64.7 years old SD 4.3 years, CG 69.9 years old SD 4.9 years. The Montreal Cognitive Assessment (MoCA) was measured prior to balance assessment. Ten-second balance assessments were performed using a Matscan platform and included two eyes-open conditions (bipedal and unipedal). Initial comparisons of center of pressure measures between groups revealed significant differences in several measures (mean velocity [MV], mediolateral velocity [MLV]). After controlling for age and sex differences between groups, a mixed ANOVA (group by balance condition) revealed significant interactions in MV and MLV, such that CG performed more poorly than HG in the unipedal conditions (MV: p = .04, MLV: p = .02) with no significant differences in the bipedal conditions (MV: p =.86, MLV: p = .628). MLV also negatively correlated with MoCA scores in the whole sample (p = .05). This study suggests that CG have poorer balance control than HG. Simple tests with a balance platform reveal differences that identify at-risk groups and relate to lower MOCA scores. Early assessments of balance status can help to identify older individuals at risk of cognitive decline, allowing early intervention to prevent falls and further cognitive decline., Several studies have reported benefits of exercise interventions and cognitive training on cognitive performance in older adults, but the effect of combining both interventions has rarely been studied. 136 healthy older adults were randomly assigned to one of the 4 combinations: 1) aerobic training and dual-task training; 2) aerobic training and placebo computer; 3) stretching training and dual-task training; 4) stretching training and placebo computer. Dual-task performance benefits were assessed. Analyses compared percentage of change among groups in transfer dual-task conditions in three trial types: single-pure trials, single-mixed, and dual-task trials. Results showed larger change in dual-mixed than in single-mixed trials, but only for the groups that completed the dual-task training (vs. placebo computer), with no substantial difference between aerobic and stretching exercise. Improvement in other task conditions was equivalent among all groups. Results of this study suggest that both dual-task computer training combined with aerobic or stretching can help improve the ability to maintain multiple stimulus-response alternatives. This specific skill is essential when it comes to concurrently performing multiple tasks. Moreover, these combined interventions also lead to functional improvement in balance and gait, but do not seem to have a synergetic effect, which could be partly explained by a reduced training volume due to the combination of multiple training. These results further support the benefits of dual-task training on attentional control, and suggest equivalent effect of aerobic and stretching exercise on dual-task performance.

The flipped classroom is a reversal of conventional teaching models: learners obtain first exposure to material through independent study and then in-class time is dedicated to activities for learners to apply the knowledge. Cards are a novel method of “flipping the classroom” using adaptive multiple-choice questions with patient cases containing randomized demographic data. The purpose of this project was to implement a flipped classroom model on Geriatrics topics to determine if Cards provide an additional benefit to podcasts in learning outcomes for second-year medical students. Three distinct modalities were used: traditional lectures, podcasts, and Cards. All of the material was covered in lectures and podcasts. Half of the material was randomized to be presented in Cards. Recall and comprehension were tested as part of a formative examination. After the exam, students were asked to evaluate each teaching method based on a Likert scale: 1 (strongly disagree) to 5 (strongly agree). Students performed better on exams when faced with material covered by Cards compared to material covered by only lectures and podcasts (37.8 ± 16.5% correct responses versus 30.3 ± 14.3%; n= 131; p < 0.01). The students viewed Cards as a valuable supplement to lecture material (4.2 ± 0.56; n= 41) that helped add to their knowledge about the topics (4.2 ± 0.61). The majority would want more instructors to incorporate Cards into their teaching (4.2 ± 0.67) and preferred Cards over the traditional lectures (3.8 ± 0.92). Further studies will be required to see if Cards alone can show improved learning outcomes or if the other components of the flipped classroom are needed to supplement Cards. Cards reinforce knowledge acquisition through repetition and are a well-received teaching method., Twitter is a microblogging application utilized for medical education and communication. Twitter participation at scientific conferences enables international networking, resource sharing and critical appraisal. This study evaluates and describes the participation, content and impact of the live Twitter stream at the 2015 Canadian Geriatrics Society annual scientific meeting “(#CGS2015).” This is the first analysis of Twitter applications for Geriatric Medicine conferences. Twitter transcripts of #CGS2015 were obtained from Symplur and analyzed for content, impressions and participant demographics. The analysis began one week before the conference and extended to three days after the conference. Qualitative data on participants’ opinions were obtained by questionnaire. TweetReach provided transcripts from the 2014 CGS scientific meeting for growth analysis. There were 1491 total #CGS2015 Tweets, 40% original. Tweet content categorized as follows: conference sessions (38.8%), networking (29.2%), resource sharing (17.6%) and conference promotion (14.3%). Of the 279 participants, 60% were non-Canadian. The study authors and CGS Twitter accounts were responsible for 18% of Tweets. Through questionnaire data, participants emphasized the value of Twitter in facilitating collegial interactions and providing insight into sessions not attended live. The most cited drawback was divided attention when using personal devices. Analysis from #CGS2014 to #CGS2015 revealed increases in total participants (1057), number of Tweets (229) and impressions (788,225). Future conferences may benefit from workshops teaching Twitter basics. This study also brings into focus the need for implementing strategies to minimize stigmas when participants use handheld technology. Twitter engagement at CGS 2015 enabled international participation in online discussions of conference-specific sessions, resource sharing and networking. The efficacy of Twitter in complementing Geriatric Medicine conferences is supported by the growth of Tweeting between #CGS2014 and #CGS2015., Delirium is associated with substantial morbidity and mortality. Nurses are often first to detect delirium. When the Confusion Assessment Method (CAM) is used by nurses, a 2001 study showed that delirium is under-recognized compared to trained researchers. This study sought to understand nurses’ attitudes and perceptions regarding operationalization of CAM and barriers to its proper use. Using a thematic approach, 4 focus groups were conducted with orthopedic ward nurses at an academic hospital in Hamilton, Ontario. All participants use the CAM daily. Groups were moderated by a geriatrician using a semi-structured guide. Focus groups were continued until saturation was reached. Themes were coded by 2 independent investigators, with NVivo 11 used to facilitate analysis. Twenty nurses participated (75% female, mean age 46.5 years, mean years in practice 16.8, 50% RNs, 50% RPNs, 50% recall CAM training). Although the CAM was praised for its simplicity, some nurses wanted more flexibility for narrative descriptions of delirium episodes. Across the groups, disorientation was used to evaluate all criteria without objective testing for inattention. Reported challenges included differentiating delirium from dementia, determining baseline cognitive status, non-verbal patients, language barriers, time constraints, discrepancy with physician assessments, and pressure to diagnose delirium. Fear of precipitating delirium with opioids appeared to create an environment of undertreated post-operative pain. Our study confirms previously reported issues with nurses’ use of the CAM. Several new findings were identified, including frequent discontinuation of opioid medications in delirious patients with pain. Fifteen years after the original report on nurses’ use of CAM, significant knowledge gaps still exist in the understanding of delirium and how this popular tool is used. There is an urgent need to improve delirium detection and prevention., Seniors are the most susceptible to adverse drug events, and over 10% of seniors in 2009 were taking potentially inappropriate prescriptions (PIPs). Order sets are convenient and serve as a helpful checklist, particularly when physicians are under-slept or hurried. They do however introduce risk, as medications “checked off” may easily be prescribed without being carefully considered. The most widely-used criteria for PIPs are the Screening Tool of Older Person’s Prescriptions (STOPP), and the Revised 2015 Beers Criteria. These tools are supported by a rigorous base of evidence that have shown a reduction in the use of high-risk medications, decreasing the incidence of potential drug interactions, and improving patient outcomes. All automated order sets available to physicians in Hamilton Health Sciences (HHS) were reviewed. All order sets that could be applied to elderly patients were included in the study. Order sets specific to paediatrics or obstetrics were excluded. Order sets were screened by two independent researchers for medications on the AGS 2015 Updated Beers Criteria, or the STOPP/START Criteria. A total of 314 order sets met inclusion criteria for the study. More than half (57%) of order sets contained at least one medication that was potentially inappropriate for seniors, by STOPP/Beers criteria. Order sets with the greatest number of PIPs were from Medicine, Surgery and the Coronary Care Unit. At least one PIP was found in 65.6% of Medicine order sets (including subspecialties); 63.2% of Diagnostic Imaging order sets; 63.2% of Cardiology; 64.3% of Emergency services, and 51.0% of Surgery order sets. The most commonly available PIPs were NSAIDs, steroids, opiates, and benzodiazepines. These results highlight the wide availability of PIPs to physicians caring for seniors, who may not always be carefully considering their safety. PIPs in seniors are a preventable cause of patient harm. Approximately 50% of hospitalized seniors receive at least one inappropriate medication that can lead to falls, delirium, stroke, fracture, mortality, increased length of stay, or readmission to the hospital. More often than not, physicians in Hamilton have PIPs available to them when caring for elderly patients. Over half of all order sets contained at least 1 PIP, and the most commonly available PIPs were NSAIDs, steroids, opiates, and benzodiazepines., Ambulatory care is a key component of geriatric medicine subspecialty training but currently there are no standardized core competencies in this domain. The goal of this project is to develop a set of competencies for geriatric ambulatory medicine that are essential for geriatric subspecialty residents to master by the end of their curriculum to become independent in their professional practice, offer the best care possible and respond to the increasing demand for the ambulatory care of older patients. We completed a multi-phased project including an environmental scan, a modified Delphi and a webinar with relevant experts to develop the list of core competencies. In the first phase, we identified 108 core competencies from recent literature (2010 to 2014) as well as currently used lists that were provided by 7 Canadian geriatric medicine program directors. They were divided into the six Canmeds domains (medical expert, leader, collaborator, communicator, scholar and professional). The second phase, the Delphi process, identified 102 competencies for the final list and 6 competencies for discussion during the webinar. 2 competencies were eliminated through webinar discussion with 13 experts in geriatric medicine and education. A total of 9 new competencies were developed during the project based on suggestions from second phase participants and the opinion of experts during the webinar. 115 Geriatric Ambulatory Care Competencies for geriatric residents were identified. We produced a tool to guide the development of standardized ambulatory geriatrics training which emphasizes skills specific to ambulatory medicine. We are hoping to integrate some of the competencies into the Royal College Competency by Design initiative. The next step of this project will be to validate the tool with geriatric trainees and elderly patients., Little is known about the effects of educational intervention in mild cognitive impairment (MCI). This study assesses the effects of an intervention in a patient group setting. This prospective cohort study recruited patients through the “Living well with MCI” program at St. Paul’s Hospital, Vancouver BC. The program consisted of educational sessions led by an occupational therapist and a social worker for subjects diagnosed with MCI. Participants completed questionnaires before and after the program followed by a face to face interview, in order to quantitatively and qualitatively assess the program’s effects on patients’ knowledge and quality of life regarding MCI. A total of 13 participants were recruited. The study showed that participants perceived themselves to be more knowledgeable regarding MCI and healthy brain practices after attending the program. The study also suggested that participants may have a better understanding of MCI. There were positive correlations between self-perceived knowledge and feeling more confident to live well with MCI and lessened anxiety. There were trends which showed an increase in the number of healthy brain behaviour practiced and tasks enacted for future planning, but they were not statistically significant. The study demonstrated effectiveness of patient-centered educational intervention in patients with MCI. Patients reported less anxiety, less distress, and more confidence after attending a program. Further studies with increased sample size and longer follow-up are required to establish behavioural change with these educational interventions. Patient-centered educational intervention groups improve the quality of life in those with MCI., Institutional parental medication monographs are used to guide staff on the safe administration of medications. These documents advise how to prepare and administer the drug, but also alert the user of potential side effects and appropriate dosing regimens. Since many hospitalized patients are older, and risk of adverse drug events increases with age, these monographs should include potential hazards of use and dosing adjustments in older patients. As a quality improvement initiative, we reviewed our institution’s parenteral medication monographs for alignment with principles of safe prescribing in older adults. All parenteral medication monographs at a single acute care hospital were reviewed. Those identified as potentially inappropriate by the 2015 Beers criteria were evaluated for (a) evidence of geriatric dosing recommendations and (b) warnings about the adverse effects highlighted in the Beers recommendations. Of 226 monographs, 21 were identified as potentially inappropriate medications in the elderly. Of these, 18 (86%) were found to lack safety and dosing guidelines specific for the elderly. Risk of delirium was rarely mentioned. Cautions to use lower doses in the elderly were uncommon. At our institution, a significant proportion of parental drug monographs do not warn about common geriatric side effects or dosing adjustments. This may be of broader interest because our monographs are based on a foundational parenteral drug therapy manual that is used by other hospitals. Based on the findings, we have proposed amendments to the current monographs to alert staff of common safety concerns when these medications are prescribed to older adults. Increased attention to parenteral drug monographs is recommended to ensure that they include administration guidelines specific to elderly patients., As elderly patients are increasingly undergoing elective surgery, clinicians need to identify patients at higher risk of postoperative complications and implement interventions to mitigate this risk; however, the optimal method of assessment remains unclear. A systematic review was conducted to identify preoperative risk factors and assessment tools that predict elderly patients’ risk of postoperative complications. Studies were identified by searching electronic databases (i.e. MEDLINE, EMBASE) for articles published between 1948 and June 24, 2014, and reviewing reference lists of included studies. Prospective studies reporting risk factors for postoperative complications including delirium, functional decline, institutionalization, prolonged length of hospitalization, and mortality among elderly patients (≥ 60 years and mean age ≥ 65 years) undergoing elective surgery were included. Two independent reviewers conducted all levels of screening, data abstraction, and quality appraisal. Data analysis will be completed in February 2016. 60 cohort studies and 1 controlled before-and-after study (12411 patients) were included after screening 5165 citations. Older age, functional dependence, cognitive impairment, frailty, history of alcoholism or smoking, presence of severe preoperative pain, and a history of delirium or depression were significant predictors of delirium after elective surgery. Poor functional status at baseline, greater comorbidity, smoking status, male sex, and having a diagnosis of cancer were predictive of functional decline. Older age, frailty, functional dependence, cognitive impairment, smoking status, small arm circumference, slower Timed Up and Go (TUG) test, polypharmacy, and weight loss ≥ 10% predicted prolonged hospitalization. There are a number of identifiable risk factors that may predict postoperative complications in elderly patients. The aforementioned risk factors and complications should be integrated into a preoperative discussion when considering elective surgery in elderly patients. Further studies are needed to refine these lists of risk factors., Delirium is a common state of acute alteration in cognition among seniors admitted to hospitals. It is considered a medical emergency associated with high mortality, morbidity and healthcare costs. Melatonin is an endogenous hormone produced by the pineal gland that regulates the circadian rhythm. Supplementation of melatonin has been investigated as a mean to prevent the emergence of delirium. Literature search was performed through PubMed, Embase and Cochrane Database until Dec. 31, 2015, for randomized controlled trials (RCTs) investigating the use of melatonergic agents in the prevention of delirium. A systematic review and meta-analysis was subsequently performed. Four RCTs met our inclusion criteria. Three trials used various doses of melatonin, and one trial used ramelteon, a melatonin receptor agonist. Two trials were done in medical inpatients, while two trials were done in peri-operative patients. The most recent large trial using melatonin for the prevention of delirium post-hip fracture surgery was negative. Whereas the three earlier smaller trials showed some benefit. Taken together, a meta-analysis of these four trials showed a lack of benefit for the use of melatonergic agents in the prevention of delirium (Risk ratio 0.34, Confidence Interval 0.10–1.13). Overall, there is insufficient evidence to support the use of melatonergic agents in the prevention of delirium at this time. Further studies are needed to answer this question. It is possible that melatonergic agents are more helpful in the prevention of delirium in medical inpatients rather than peri-operative patients., High levels of sedentary behaviour and low levels of physical activity are present in older adults with mobility impairment. Hip fracture is a life changing event that can result in long-term mobility impairment; it is therefore important to understand the ways in which sedentary behaviour and physical activity affects health outcomes, especially the fracture recovery process. We conducted a systematic review to answer our research questions. Our objectives were: 1. Describe the patterns of sedentary behaviour and physical activity in older adults after hip fracture; 2. Explore associations between sedentary behaviour and physical activity patterns with overall health and fracture recovery. Our review questions were: For older adults with hip fracture: 1. How much waking time is spent in sedentary behaviour and physical activity?; 2. Is there an association between time spent in sedentary behaviour and health outcomes? We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for conducting and reporting systematic reviews. We searched nine different databases. We included experimental and observational studies that objectively measured sedentary behaviour or physical activity in older adults (65 years+) after hip fracture. We reviewed 404 papers at the title and abstract level and 33 papers at full text level. Ten papers met the inclusion and inclusion criteria for data synthesis. There are ten studies that have objectively evaluated (accelerometers, pedometers etc.) sedentary behaviour and physical activity patterns in older adults after hip fracture. Older adults with hip fracture often spend prolonged periods of their waking hours sedentary or in light physical activity. There is limited research describing activity following hip fracture. The evidence indicates high levels of sedentary behaviour that may cause increased morbidity., Multi-morbidity, the coexistence of multiple chronic diseases, is a significant burden for older patients and primary health care (PHC) providers alike. The objectives of this research are to: 1) Determine prevalence and characteristics of older PHC patients with multi-morbidity in Canada; and 2) Examine patterns and progression of multi-morbidity among these patients over time. Data were derived from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) electronic medical record (EMR) database, which collects longitudinal, de-identified data from PHC practices across Canada. Chronic disease diagnoses were identified using the ICD-9 classification system and a list of 20 chronic disease categories identified older patients with multi-morbidity. Computational and statistical analyses were conducted using JAVA programming and Stata 13.1 software. Overall, 69.2% of older PHC patients were living with ≥ 2 chronic diseases. These patients had an average age of 74.6 years (SD: 7.0) and majority were female (57.9%). The majority of older patients with multi-morbidity had ≥ 3 chronic diseases (70.4%). The most frequently occurring combinations of chronic diseases were: 1) diabetes and hypertension; 2) hypertension and hyperlipidemia; 3) hypertension and cancer; and 4) hypertension and cardiovascular disease. Preliminary survival analyses demonstrate quicker accumulation of subsequent chronic diseases over time. The majority of older PHC patients in Canada are living with multi-morbidity. Insight into the most frequently occurring clusters of chronic diseases and the rate of disease accumulation indicate a need for more proactive clinical care delivery. This research explores the prevalence and clinical profiles of older PHC patients with multi-morbidity. This information can be used strategically to inform more effective health care policy and clinical practice guideline redevelopment for older adults living with multi-morbidity in Canada., It is common to see post-menopausal women with low spinal bone mineral density (BMD) without spinal fractures. Whether these patients are in the early stages of osteoporosis, or whether the low BMD is an artifact is unknown. We hypothesized that low BMD may be an artifact as BMD is an areal density, influenced by vertebral body shape. Wider vertebrae have a greater surface area and may be calculated to have a lower BMD than vertebrae which are deeper and narrower, but of similar mass and strength. Post-menopausal women attending the osteoporosis clinic with a BMD T-score ≤ −3.0 at L2–L4 sites, with and without spinal fractures, were studied. Patient height, weight, age, bone mineral content (BMC), vertebral area, BMD for the spine, and BMD at 3 standard hip sites—total, neck and intertrochanteric—were collected. Lateral thoracic and lumbar radiographs were assessed for compression fractures. Of 112 women assessed, 39 patients had vertebral fractures. The patients did not differ in terms of vertebral morphometry, refuting the primary hypothesis. Fracture patients were significantly older (71.3±10.6 vs. 64.2±8.5, p, Age and injury severity alone are inadequate at predicting outcomes in the geriatric trauma population because they fail to consider physiologic age and frailty state. The Canadian Study of Health and Aging Clinical Frailty Scale is a validated judgement-based scale that assigns a frailty score based on clinical data. We hypothesized that the Clinical Frailty Scale will predict outcomes following injury in geriatric patients. We performed a retrospective cohort study of geriatric patients (aged ≥ 65 years) admitted to a level 1 trauma centre between 2011 and 2014. The pre-admission Clinical Frailty Scale score was assigned to each patient by a geriatrician in their initial assessment or was abstracted by manual chart review. The primary outcome of interest was discharge destination, either adverse (death or discharge to a long term, chronic care or another acute care facility) or favourable (home or rehabilitation). Logistic regression was used to evaluate the relationship between these outcomes and the Clinical Frailty Scale. 260 patients met inclusion criteria. The mean age was 77 and mean Injury Severity Score was 19. Moderate or severe frailty (CFS 6 or 7) was strongly associated with adverse discharge destination (OR=5.3; 95% CI 2.1–13.5), compared to age (OR=1.1; 95% CI 1.0–1.1) and total number of comorbidities (OR=2.8; 95% 1.1–7.3). Frailty independently predicts adverse discharge destination in geriatric trauma patients. This may be because frailty comes from a detailed assessment of the loss of physiologic reserves, unlike age or total number of comorbidities, which fail to consider the multi-factorial nature of geriatric trauma patients. The Clinical Frailty Scale can be used as a clinical tool to triage resources and expertise to mitigate adverse outcomes in this population., Cholinesterase inhibitors (ChEI) are the primary pharmacologic treatment for dementia. Their efficacy in patients of Chinese descent is not well described. The aim of this systematic review is to gauge the overall efficacy of ChEI in Chinese patients with Alzheimer’s disease (AD), vascular dementia (VaD), or mixed dementia. MEDLINE, PsycINFO, EMBASE and CINAHL were systematically searched for controlled trials of ChEI, including donepezil, galantamine and rivastigmine, for Chinese patients with AD, VaD, or mixed dementia. 54 relevant articles published from 1 Mar 2000 to 1 Mar 2015 were retrieved: 48 were excluded due to issues in study design or methodology, leaving six articles in this review. Outcomes for cognition, function, behavioural/psychological symptoms of dementia, and overall dementia rating were assessed. Dementia patients of Chinese descent treated with ChEI (n = 180) had significantly higher mean Mini-Mental State Examination (MMSE) score than patients not treated with ChEI (standard mean score difference of 0.65, 95% confidence interval 0.34, 0.96). There was a trend favouring ChEI treatment measured by Alzheimer’s Disease Assessment Scale–Cognitive (ADAS-Cog) scale, Activities of Daily Living scale, and Clinical Dementia Rating scale. However, there was no observed ChEI benefit in behavioural/psychological symptoms of dementia measured by the Neuropsychiatric Inventory. The cognitive benefit of ChEI in Chinese patients was similar to previous reports in other ethnicities. It remains unclear if ChEI treatment had different effects on functional and behavioural outcomes in Chinese patients compared to other ethnicities. Cholinesterase inhibitors are effective in improving cognition among patients of Chinese descent with AD, VaD, or mixed dementia. Further studies are needed to examine the potential benefits in the non-cognitive, clinically relevant outcomes in Chinese patients with dementia., Physical frailty is a prevalent syndrome in older adults that increases vulnerability for a range of adverse outcomes including death and increased dependency. Caregivers of older adults experience significant physical, emotional, and financial burden, which is associated with physical and psychiatric morbidity. Our systematic review examined the state of the evidence regarding the relationship between these two prominent concepts in the geriatric literature. We searched key databases to identify original English-language articles. Screening was based on a priori inclusion criteria, including discussion of physical frailty, caregiver burden, and a population of community-dwelling older adults. Included studies were critically appraised using the Cochrane Risk of Bias Tool or the Newcastle-Ottawa Scale (for RCTs or cross-sectional studies respectively). Two researchers screened titles and abstracts of 1,205 retrieved studies, followed by the full-text 265 retained studies. Nine included studies underwent abstraction and appraisal. Heterogeneity of included studies precluded meta-analysis. Five studies had the same author and drew from the same population. Three studies were of limited value since they did not include a validated measure of frailty. While caregivers of frail older adults experience burden, the scarce available evidence and lack of normative comparisons does not allow conclusions to be drawn about the strength or nature of the relationship. Excluded studies suggested that the term “frailty” is often used without clear definition, or is treated as synonymous with functional impairment or advanced age. Our review suggests that caregivers of frail older adults experience burden which may differ from that of other caregiver populations. The scarce evidence does not allow conclusions to be drawn or to inform clinical practice. Given the salience of physical frailty and burden, there is ample space for further research., Geriatric patients present with medical, psychiatric, functional and social complexity. With the anticipated demographic shift, there is a greater need for clinicians who can manage such complexity. Training future physicians to navigate the complexity of clinical decision-making is in fact a newly recognized aspect of the CanMEDS Medical Expert Role. This study explores how medical trainees conceptualize clinical complexity, how well-prepared they feel to handle complexity and how complex encounters influence residency selection. In this qualitative study, 20 third and fourth-year medical students engaged in a 2-part interview process. First, students drew 2 rich pictures which represented complex patient scenarios: 1 exciting and 1 frustrating scenario. Second, the pictures were used to guide a semi-structured interview. Interview transcripts were analyzed using constructivist grounded theory principles. Descriptions of complexity fall under 3 categories: systemic/institutional complexity, medical complexity and complexity of the patient’s social history. Categories for systemic/institutional complexity include active engagement and navigating the system. These are key processes which distinguish how clinical complexity is perceived; when actively engaged and able to successfully navigate the system, students perceived the case to be complex and exciting versus complex frustrating. These processes also influence residency selection, as feelings on complexity and systemic pressures are connected to students’ specialty preferences. The social process of learning, in relation to systemic/institutional complexity, appears to surpass medical complexity in how strongly it affects trainees, from how they experience complex patients to the choices that result from these encounters. Complexity is a multi-faceted phenomenon. Ensuring that students feel engaged and supported in their encounters with geriatric patients is important for motivating trainees to pursue care of the elderly. These insights may benefit medical educators, as they strive to build a workforce capable of managing the aging population., The global aging population is increasing annually. However, the interest in a career involving geriatrics care is not keeping up with the increase in population. The lack of geriatrics interest leads to a decrease in willingness and quality of care for the elderly. Geriatrics knowledge, geriatrics experience, and personal demographics have been found to be associated with geriatrics attitudes in health care professionals. In Canada, personal demographics is an important factor because 20% of Canadian Medical student identify as Chinese or South Asian. The purpose of the study is to analyze medical student attitudes and compare the factors that affect these attitudes. In our study, we compared the attitudes of medical students at University of British Columbia in Canada and National Taiwan University in Taiwan. The similarity between these two countries in its elderly population and health care system provides them as two countries for comparison. We utilized a 5–10 minutes online questionnaire to obtain data on pre- medical factors (demographics and experiences), career choice factors, current geriatrics attitudes, and geriatrics knowledge. The study results will be presented comparing positive attitude scores between UBC students of Taiwanese and non-Taiwanese descent vs. Taiwanese students. Statistical differences in attitudes will be presented from analyzing geriatrics experiences and geriatrics knowledge. Western individualist values lower chances for intergenerational interaction whereas Eastern collectivist culture promotes duty of caring for older family members. Asians have a more negative geriatrics attitude whereas those more assimilated into Canadian culture will exhibit a more positive attitude towards geriatrics. By understanding the attitudes that UBC medical students have throughout the four years of medical school and comparing this with medical students in Taiwan, we can better dissociate the influences pre-medical and medical experiences have on attitudes., Frail patients are at high risk for morbidity and mortality following cardiac surgery. Low muscle mass is a core component of the frailty syndrome that is neglected by frailty scales. Psoas, lumbar and thoracic muscle areas (PMA, LMA, TMA) are radiographic correlates of muscle mass that can be measured from routine computed tomography (CT) images. The objective of this study was to evaluate the association between muscle mass derived from CT scans and postoperative length of stay (LOS) after cardiac surgery. The perioperative clinically-indicated CT scans of cardiac surgery patients were analyzed to measure cross-sectional lean muscle areas on axial slices at the level of the L4 vertebra (PMA, LMA) and T4 vertebra (TMA) using the CoreSlicer.com software. Linear regression and correlations were used to measure the association of PMA, LMA and TMA with the Short Physical Performance Battery (SPPB) and postoperative LOS adjusted for the predicted risk of prolonged LOS determined by a composite variable from the Society of Thoracic Surgeons risk model. Eighty patients were included with a mean age of 69.2 ± 10.0 years. SPPB was correlated with PMA (r=0.66, p, This study aimed at evaluating the effectiveness of the TIME (This Is ME) Questionnaire in eliciting personhood and enhancing dignity; specifically investigating the residents’ and health-care providers’ perspectives in the nursing home setting. Six nursing homes in a Canadian urban center were involved in the study, including both for-profit and not-for-profit organizations. Residents completed both the TIME Questionnaire and a feedback response questionnaire; health-care providers offered feedback both through a questionnaire or participation in a focus group. Cognitively well residents (n=41) and nursing home health-care providers (n=22) participated. 100% of the residents indicated the summary was accurate. 94% stated that they wanted to receive a copy of the summary, 92% indicated they would recommend the questionnaire to others, 72% wanted a copy of the summary to be placed into their medical chart. Overall HCPs’ agreed that they have learned something new from TIME, and that TIME influenced their attitude, care, respect, empathy/compassion, sense of connectedness, as well as personal satisfaction in providing care. A descriptive prospective study of the TIME questionnaire using both quantitative and qualitative methods. While residents endorsed the value of TIME as a dignity enhancing intervention, their feedback suggested that these responses were less uniformly held than among HCPs. The TIME Questionnaire is a viable tool for HCPs to elicit personhood and enhance dignity centered care., Studies are warranted to examine innovative solutions that instill a patient centric healthcare model for physically disable patients. Alternatives such as telehealth are available to address the needs of an ageing Canadian population through enhancing collaboration, accessibility and timely delivery. In this two-phase study, several peer reviewed articles were assessed to evaluate risks and opportunities related to Telehealth. The findings were then corroborated through an online survey to assess geriatricians’ perceptions of telehealth. In phase 1, studies highlighted disparity in healthcare accessibility with 40% of Canadian rural emergency departments located more than 300 km from a major tertiary care centre. Findings from a recent survey conducted by Telehealth Canada found a 45.7% aggregate growth in clinical telehealth session across Canada with 60% utilization rate in Ontario. Barriers included risk of information loss, technology implementation and policy development. In phase 2, surveys were distributed to Ontario geriatricians (N = 26) of which 78% expressed an interest in offering telehealth services. Consultations and follow-up were among the most popular telehealth services offered. Key barriers to telehealth implementation entailed communication and scheduling constraints. Rural EDs and Royal Flying Doctor Service continue to present costs and accessibility barriers. With 120% increase in facility endpoints since 2010, telehealth deems further exploring. Common perceptions of telehealth’s importance and limitations highlight the level of interest expressed by geriatricians. Technology and nursing support are also identified as important implementation factors when enabling telehealth in Canada. The findings can be used to highlight numerous benefits presented by telehealth, address challenges related to its implementation and confer common perceptions of geriatricians and their respective patients., Warfarin remains the mainstay therapy for stroke prevention and venous thromboembolism, accounting for over three-quarters of the anticoagulants prescribed in Canada. However, warfarin has multiple drug interactions including with antibiotics, which increase the risk of major hemorrhage. Currently, most drug compendia on warfarin interactions are primarily informed by case series and reports. To date, no meta-analysis has systematically quantified the risks of hemorrhage and supratherapeutic anticoagulation using population-based studies. Database searches of MEDLINE and EMBASE (1980–2016) were conducted without language restriction. Studies were included if they were randomized controlled trials, cohort or case-control studies that examined the risks of major hemorrhages requiring hospitalization or supratherapeutic International Normalized Ratio ≥ 5.0 among individuals over age 65 concurrently taking antibiotics and warfarin. The most adjusted effect estimates were pooled using Dersimonian-Laird random effects models. Eight cohort studies (n=260,842) and five case-control studies (n=124,200) were included. The antibiotics significantly associated with hemorrhages included cotrimoxazole (RR=3.18, 95%CI: 2.64–3.83), quinolones (RR=2.22, 95%CI: 1.64–3.00), macrolides (RR=1.87, 95%CI: 1.54–2.26), amoxicillin (RR=1.77, 95%CI: 1.53–2.04), but not nitrofurantoin (RR=1.26, 95%CI: 0.69–2.31). The few studies that reported INR excursions were limited by heterogeneity. However, cotrimoxazole (RR=8.11, 95%CI: 1.56–42.19) and macrolides (RR=2.62, 95%CI: 1.01–6.84) were consistently associated with supratherapeutic anticoagulation. Antibiotics vary in their risk of major hemorrhage among warfarin users, and judicious selection of antibiotics during acute illness coupled with close monitoring for bleeding is necessary. Greater research is needed regarding the effects of antibiotics on INR because early detection and intervention for over-anticoagulation can prevent hemorrhages. Older adults are at increased risk for adverse drug interactions, and a better understanding of warfarin interactions with common antibiotics will enable safer prescribing practices., Effective teachers are better learners and have improved clinical competency. Formal teaching curriculum improve residents’ teaching skills and confidence. This paper looks at how residents are taught to teach and how these methods can be applied to Family Medicine Care of the Elderly (CoE) programs. A Medline search was performed using the terms “teaching” and “internship and residency”. The search was limited to English papers, studies with an intervention and excluded participants who were medical students, fellow or faculty. Studies newer than 2009–2014 were the focus as recent reviews looked at articles up to 2009. 2,450 articles were reviewed and 33 were relevant. Teaching curriculum was heterogeneous in delivery, duration of curriculum and frequency of pedagogy delivery. All the programs included a didactic teaching session, readings and taught residents specific microskills. Six studies reviewed principles of adult education. 3 studies had relapse or maintenance strategies, using spaced education handouts, reminder pocket cards or guided sessions. One study evaluated a teaching elective rotation. All the teaching methods were evaluated, however few evaluated whether the program improved student learning (Kilpatrick level 4). It is unlikely that one program will fit the needs of all residents. Ideal programs would be greater than 2 hours in length, include principles of adult learning, microskills and feedback from faculty and learners. CoE programs are 12 months in duration, so time is a limiting factor in delivering resident as teacher programs. At Queen’s University, CoE residents are given the junior attending role on several rotations and provided with feedback from faculty and learners. Teaching interventions in CoE setting warrant further study., With the growing aging population, the complexity of medical problems and chronic diseases, including dementia and physical disabilities, has increased. GCP was developed as a quality improvement program to offer practicing health care providers an opportunity to develop knowledge, skills and attitudes in geriatrics-specific areas including assessment, behaviour management, and geriatric best practices. This study provides a preliminary program evaluation, examining the impact on self-reported changes in knowledge, skills, and competence. GCP graduates completed online evaluation surveys upon successfully completing program-specific requirements, which included multiple choice examination. 292 individuals have registered in GCP, including nurses (36%), non-regulated health professionals (34%), regulated health professionals (16%), students/residents (6%), educators (4%), physicians (3%), and pharmacists (1%). 56 individuals have graduated to date; 55 completed a survey. Mean ratings (5-point scale) indicate the program is perceived as highly relevant (4.1 ± .61) and useful in enhancing clinical practice (4.2 ± .58). A large majority of graduates (98%) sustained or improved self-perceived competence in providing geriatric care after participating in GCP. 100% of GCP graduates reported gaining new knowledge (n=55) and skills (n=54). Graduates reported feeling more informed on how to better serve geriatric populations, and indicated use of learned skills including application of standardized assessment tools, supportive evidence-based strategies for persons with responsive behaviours, therapeutic communication skills, and comprehensive care planning. Program and travel costs in absence of financial employer support were identified as a barrier. This program provides a significant and valuable opportunity for capacity building in geriatric workers, using core competencies to advance interdisciplinary best practice use. This program will develop a workforce that is better prepared, supported, and can more confidently and competently meet the needs of the aging population., Residents receive minimal education on formal communication techniques throughout their training. However, many studies indicate that the way in which information is presented to patients significantly impacts their perception of risks and benefits. ReCoM uses tangible examples, personal experience, and evidence-based methods such as the shared decision making model to address the common communication problems faced by residents in their everyday practice. Using a real life example of the dramatic influence presentation of statistics can have, we address how statistics can be used to practice evidence-based medicine and preserve patient autonomy based on individualized goals. The evidence behind the shared decision making model is presented, as well as a practical approach to using it in everyday practice. Using code-status discussions as a familiar geriatric example, a mock conversation is presented, both in text and in video, to demonstrate how this approach can help to facilitate a difficult discussion with patients. The conversation is then reflected upon, along with common patient responses, in order to facilitate understanding its relevance to a multitude of situations a resident encounters. The manual also addresses some of the common knowledge gaps around survival, outcomes and the process of resuscitation itself. Results surrounding the efficacy and readability of the manual are currently being compiled. Surveys have been distributed to key staff physicians and residents. Final results of the survey should be available by March 2016. The objective of this project was to produce a manual that will provide guidance to junior residents on communication strategies in order to improve their skills during difficult conversations. Written in colloquial language, ReCoM is a functional reference for residents., The ratio of geriatricians to older adults in Canada stands at 1:20,914. This, however, does not accurately reflect the significant lack of access to culturally safe and appropriate geriatric care in rural areas and in particular remote First Nations Communities. Our objective is to inform the development of a new Geriatric Outreach Model of Care for remote First Nations populations, we performed a systematic review of the existing evidence around the development of geriatric models of care in rural and remote populations Articles indexed in MEDLINE, CINAHL, and EMBASE describing geriatric models of care for rural or remote populations were identified. A qualitative approach identified key components of each model, while their inclusion and reported subjective value were used to postulate their relative importance and impact within each model. Nine of 704 initially identified studies were included. Our analysis identified 7 distinctive model components: community investment, local model oversight, environmental awareness, provider education, continued patient-provider contact, and model integration. Provider education and frequent patient-provider contact were most frequent (7/9 models). Only 2/9 models included in-person contact between a geriatrician and patient. Our review has helped to identify 7 essential components of existing geriatric outreach models of care for rural and remote populations and provided additional insight on the value each appears to contribute towards the success of these models. These findings will help inform the creation of an evidence-informed Geriatric Outreach Model of Care for Remote Canadian First Nations Populations., The purpose of this study was to examine how the CGS core competencies (GCCs) are addressed in the undergraduate medical education (UME) curriculum at the Schulich School of Medicine & Dentistry (SSMD). This was a quality assurance project, including quantitative and qualitative components. Geriatric objectives in the curriculum from the 2014–15 year at SSMD were mapped to the GCCs. Lecture materials were reviewed, to determine whether each objective was “not covered”, “somewhat covered” or “well covered”. In the UME curriculum at SSMD, 19 out of the 20 GCCs appeared in the objectives. Of these, 17 were covered in didactic lectures, while two were addressed only in clinical rotations. As there is no dedicated geriatric block, the GCCs were distributed across the first three years. However, 11 of the 20 competencies were covered in didactic lectures during the first block of medical school. Additional geriatric objectives, not part of the GCCs, (fitness to drive, elder abuse, and geriatric psychiatry) were recurrent themes in didactic lectures. Of the 19 core competencies identified in the curriculum, 17 were covered in didactic lectures. The objectives were reviewed and each competency had objectives that were “well covered” or “somewhat covered” in lectures. Two competencies were identified only in core clerkship rotations. Extent of coverage would be subject to variations in patient exposure and preceptor teaching, and may therefore not be reliably covered. Nineteen of the 20 GCCs appeared in the undergraduate medicine curriculum at SSMD. Seventeen of those were reliably covered through didactic lectures, while the remaining two depended on exposure during clerkship rotations. Next steps include evaluation of student knowledge regarding the GCCs at completion of medical school., In long term care, previous research has shown that 30 to 50% of the elderly consume benzodiazepines. However, it is well known that this type of drug has numerous adverse effects, especially in older patients (cognitive impairment, falls, fractures, delirium, etc). Many organizations have published pharmacology guidelines stating the dangers of these drugs and encouraging physicians to limit their use. In 2014, a rapid survey of the benzodiazepine use in IUGM (Institut Universitaire de Gériatrie de Montréal) have shown that 28% of its residents use these drugs for insomnia. A more detailed study was needed to describe the pattern of use of these psychoactive substances in our facility. We conducted a quality control study in early autumn 2015 at IUGM. The file of every patient in long term care that had at least one active prescription of benzodiazepine in the pharmacy records on June 1st of 2015 was analyzed for the study. A total of 140 patients were included. Every file was reviewed for medical conditions, demographic information, patterns of use as well as the side effects of the investigated drugs. We discovered that 44% of the residents consume benzodiazepines. The majority was prescribed on as needed basis. The main reasons for the prescriptions were: agitation, anxiety, insomnia and resistance to care. These results showed us that many prescriptions of these drugs are potentially inappropriate. Many residents in our long-term care facility consume benzodiazepines without proper indication. An educational intervention for the physicians and staff must be made to help them choose more appropriate treatments for the indications noted above., It has been shown that medical students feel less prepared to look after older adults in long term care than in the acute setting. Students also have trouble individualizing their medical conduct to each patient in the nursing home context. A survey conducted locally with senior family medicine residents, supported these findings. Individualizing medical reasoning to choose proportionate means is the daily work of physicians treating patients in nursing homes, we chose to call this process the proportionate approach. Since this skill is a requirement of the family medicine residency program we believed that it should be taught in a more explicit way as opposed to the current implicit (informal) learning methods. We chose to create a workshop to answer this need. First, the literature was reviewed to characterize the decision-making process involved in the proportionate approach. Since literature in this field is lacking we worked with a long term care multidisciplinary team (including doctors and pharmacists) to reflect on their daily work to complete the theory on this competency. Second, we created the workshop based on the best teaching practices. Once our work finalized, it was presented to medical educators of the University of Montreal for comments. A 45 minutes group activity and an observation chart were created. We think that the workshop and the chart will help residents to achieve a higher level of competency (“knows how” level of the Miller pyramid) to better prepare them for their work in long-term care. Medical residents need explicit guidance to achieve a higher level of competency in using a proportionate approach in long term care. Research and teaching on this topic is lacking and should be pursued., In long term care, 30 to 50% of older people consume benzodiazepines. In a quality control study conducted in the previous year at IUGM (Institut de Gériatrie de Montréal), we observed that 44% of our residents have this kind of prescription. Many were receiving these drugs for inappropriate indication in elderly (anxiety, agitation and insomnia). We decided to take action on this problem by conceiving an educational intervention aimed at the orderlies, nurses, pharmacist and the physicians at our facility. We are conducting and evaluative research on a program to reduce the use of benzodiazepines in our establishment. First, we reviewed the literature on benzodiazepine withdrawal in the elderly to create an educational clinical intervention with a multidisciplinary approach. We will give a formal course to the physicians on February 11th 2016, followed by on-site teaching capsules for the nurses and orderlies. We also created cue cards to help the physicians determine the appropriate and alternative treatments to the symptoms the benzodiazepine were treating. A data collection has already been made on the patients using benzodiazepines earlier in 2015 at our facility. In March 2016, these patient file will be reanalyzed to measure the impact of our intervention at one month. The process will be done again 2 months later to evaluate the long term results of the program. The preliminary results (from the 1 month follow-up) will be presented at the convention. The preliminary results will be discussed at the conference., Primary Progressive Aphasia (PPA) is a clinical syndrome with speech deficits as initial presentation. With increasing prevalence of dementia in the aging population, the diagnosis of PPA may be missed. We will describe 2 cases of Primary Progressive Aphasia in older adults and review relevant literature. This is a report of 2 cases of Primary Progressive Aphasia. Case 1. An 83-year-old lady had a 3-year history of progressive language difficulties with no behaviour symptoms. Her speech was fluent but had pauses and difficulty in word finding. On examination, the MMSE was 7/30, GDS was 4/15, and there was a mild deficit in short-term memory and a mild impairment in visual-spatial abilities. She had diabetes and hypertension. The CT scan showed cortical and medial-temporal atrophy. Case 2. A 65-year-old male had a 2-year history of dysphasia: he had difficulty expressing himself and needed cueing. This progressed to difficulties in memory and calculation. He could write short notes but struggled with paragraphs. The PET Scan showed an advanced neurodegenerative disorder with preservation of metabolism at the posterior cingulate gyrus. Both cases were managed with cholinesterase inhibitors, speech therapy, referral to geriatric psychiatry, and caregiver support. Primary Progressive Aphasia is diagnosed using Mesulam’s criteria (2001: Language difficulty as the most prominent clinical feature; language deficits as the principal cause of impaired daily living activities; and aphasia as the most prominent deficit at the symptom outset. There are 3 variants described by Gorno-Tempini et al. (2011): Nonfluent/agrammatic variant, semantic variant, and logopenic variant. Diagnosis is made clinically with imaging support or definite-pathologic-diagnosis. Primary Progressive Aphasia is a syndrome that needs to be differentiated from other geriatric syndromes to ensure appropriate and supportive care., Frailty and chronic complex conditions have the biggest impact on our health care system. However, the current health care system is fragmented and not senior friendly. Coordinated, comprehensive interventions are needed to better manage frailty and multiple co-morbidities. We will develop and implement an interdisciplinary, integrated geriatric program targeting frail seniors within a primary care network. The Seniors Community Hub (SCH) has: (1) Community-based, inter-professional, team-based care with family physicians working along-side with specialists; (2) Joint care planning and assessment of care needs; (3) Case managers; (4) Clinical records that are shared with interdisciplinary teams. We will identify frailty using the Clinical Frailty Scale, support family physicians in providing team-based care, enable chronic disease management nurses to act as navigators, and enhance geriatric skills among allied health professionals through workshops. Caregivers will be supported by tapping into existing community programs. We will describe the characteristics of the patients served in terms of demographics, frailty levels, and interventions and services provided. We will evaluate the impact of educational workshops on knowledge, attitudes, skills, and practices of healthcare professionals attending the workshops. Further, we will explore the impact of the SCH on hospital admission rates, emergency department visits, and patient-caregiver satisfaction. The goal of SCH is to promote a collaborative relationship between family physicians, specialists, interprofessional multidisciplinary teams and community support services with active involvement of patients and their caregivers. SCH will be guided by the concept of the Patient-Centred Medical Home and, as such, align with current primary care reform. The development and implementation of an interdisciplinary, integrated SCH is central to the provision of quality, efficient, and coordinated care for frail seniors in community., Poor self-management contributes to seniors’ risk for poor outcomes following an Emergency Department (ED) visit. The purpose of this study was to identify the factors that contribute to seniors’ ability to self-manage their health following an ED visit. Interviews were conducted with 26 seniors and 25 caregivers of seniors who were discharged from the ED of a large urban hospital, Hamilton, Ontario. Questions were asked about their ability to follow through on treatment recommendations (enablers, barriers) and needed supports. Inductive analysis was used to identify reoccurring themes in the data. Six major themes were identified as factors contributing to seniors’ ability to self-manage: understanding of post-discharge expectations, understanding of the health condition(s), caregiver availability, support for caregivers, patient resistance to accept treatment recommendations, and external factors (transportation, affordable housing, weather). Age differences and differences between patients and caregivers were evident. Patients were less likely than caregivers to indicate challenges with self-management and to identify needed supports. Older (>81 years) patients and caregivers were less likely to raise concerns about self-management. Needs for community-based services (home exercise programs, seniors groups) and advocacy support for caregivers to facilitate recommendation compliance were identified. Both seniors and caregivers require greater community-based support following an ED visit to ensure they understand the health condition and understand and follow through on recommendations made in the ED. Identified needs for services currently available suggest there may be a lack of knowledge of available services and need for system navigation support. The use of senior-friendly strategies in the ED (recommendations in writing, confirmed understanding of recommendations, including follow up) and greater access to community supports may enhance self-management following an ED visit., Seniors account for a high number of Emergency Department (ED) visits, yet little is known about how they decide to visit the ED. The purpose of this study was to determine what seniors do prior going the ED and how they decide to visit the ED. Adults over 65years of age visiting a large urban hospital ED (Ontario) over a three-month period completed a survey prior to discharge in which they were asked to identify what they did to manage their health prior to visiting the ED and whether someone had suggested the visit. Follow-up telephone interviews were conducted with a subsample to learn how they decided to visit the ED Surveys were completed by 264 patients, 116 caregivers (N=392; N=12 unspecified). The mean age of patients was 79 years; over half were female (53%). While 40% of patients consulted with friends or family, and 24% called 911, fewer consulted their primary care provider (20%), specialist (5%), home care provider (12%), Telehealth nurse (3.1%) or walk-in clinic (1%) before visiting the ED. For 85% of patients it was suggested by at least one person that they visit the ED, 35% of whom were health care providers; 25% of patients decided on their own. Interviews (with 26 patients, 25 caregivers) revealed that patients often go to the ED when unsure whether symptoms are emergent or they cannot access primary care. While older adults rely on others to help them decide whether to visit the ED, only a small proportion consult with health care providers in doing so. Opportunities exist enhancing senior’s decision-making process regarding ED visits and access to community-based health care to avoid ED visits., Syncope is common in both younger adults and the elderly. Arrhythmia as a cause of syncope can be detected using implantable cardiac monitors (ICM), which allow for long term rhythm monitoring to try to achieve symptom-rhythm correlation. Our purpose was to compare the diagnostic yield of ICMs in patients ≥ 65 years of age to patients < 65 years. We did a retrospective database review of all patients who received an ICM and were followed at a tertiary cardiac device clinic between 2005 and 2015. A total of 98 patients were included, 65 patients ≥ 65 years (33 female and median age 79.9 years) and 33 patients < 65 years (13 female and median age 48.8 years). Of the patients ≥ 65 years, 29 patients (44.6%) had a rhythm recorded during symptoms. Bradycardia treated with a permanent pacemaker was the attributable rhythm in 83%. Of the patients < 65 years, 18 patients (54.5%) had a rhythm recorded during symptoms; 50% had bradycardia needing a permanent pacemaker. The diagnostic yield of ICMs in older patients with suspected arrhythmic syncope is high and comparable to younger patients. Permanent pacemaker implantation is higher in older patients. Long-term rhythm monitoring should be considered in older patients with unexplained syncope as it frequently impacts patient management., Little is known about admissions to hospital for residents of assisted living facilities such as special care homes (SCHs). These facilities provide assistance with activities of daily living but not regular nursing or medical care. The purpose of this study was to evaluate the reasons for hospital admission of SCH residents in a tertiary emergency department (ED) with 56,000 annual visits. The community of reference had a population of 30,000 aged 65 years and older and 785 SCH beds. We performed a retrospective chart review of SCH residents seen in the ED and who were admitted to hospital over a one year period. Reasons for ED visit and hospital admission were analyzed using descriptive statistics. There were 785 SCH residents (mean age 78.4 years), 111 (14%) of whom visited the ED 344 times (3.1 times per resident). Over one third (36.6%) of SCH ED visits resulted in admission, compared to the overall ED admission rate of 13.4%. The most common presenting complaints resulting in admission were shortness of breath (21.9%), weakness (10.9%) and abdominal pain (7.0%). The average length of stay was 17.4 days. SCH residents seen in the ED were admitted to hospital at a rate three times higher than the total ED admission rate. Almost 40% of SCH admissions were due to complaints of shortness of breath, weakness, or abdominal pain. Residents of assisted living facilities are admitted to hospital more often from the ED than the general population. Further study may determine if improved community health care in the SCH environment would lead to decreased hospital admission rates. Focus on the most common complaints may provide the best opportunity for improved outcomes., The management of aortic stenosis by transcatheter aortic valve replacement has well documented medical outcomes. However, there is limited data on functional outcomes. Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure that avoids sternotomy and cardiopulmonary bypass. TAVR is the standard of care in higher surgical risk patients. The TAVR population is primarily elderly, more frail than surgical patients, and burdened with multiple other comorbidities. Our hypothesis is that TAVR procedure is not associated with significant functional decline and that preoperative frailty will be a predictor of functional and medical outcomes at one month and one year post-operatively. Our study is a retrospective data review of patients with symptomatic, severe aortic stenosis with prohibitive or very high surgical risk who were selected to undergo TAVR between June 2012 and November 2015 at Vancouver General Hospital and Saint Paul’s Hospital. Data was recorded in an administrative data base. Pre-morbid status, intraoperative events, and post-operative outcomes have been collected as part of usual care. Our primary endpoint is functional stability following TAVR procedure, based on post-operative activities of daily living and gait speed recorded at 30 days and 12 months. Secondary outcomes are hospital re-admissions and mortality at 12 months post-operatively. Subjects serve as their own controls with their pre-operative measures. Preoperative indices and peri-procedure characteristics will be investigated as predictors of postoperative outcomes. Our results are pending. This study will add to the growing body of literature on the impact of frailty on surgical outcomes. Our conclusions will depend on our results., By 2036 likely one in five Albertans will be 65 years or older. Alberta’s Continuing Care Strategy focuses on the concept of seniors “Aging in Place” and recognizes the medical system needs to focus on chronic community care rather than acute care. While this model aligns with the desires of senior Albertans and makes fiscal sense, there are unique implications to the 23% of rural Alberta seniors. This projects aim was to identify barriers to successful “Aging in place” for rural southern Alberta seniors as well solutions to these barriers. A critical review of Keating et al in 2011 which summarized the social barriers to aging in rural Canada was compared with reports of eleven key healthcare stakeholders in rural Southern Alberta. An EMBASE MEDLINE search was performed September 17 2014, followed by a Grey Literature review between October 30th to November 6th 2014 to identify solutions to these barriers. Nine barriers were identified from interviews: transportation/geographic isolation, social isolation, compulsory volunteerism, lack of services (health care and non-health care), housing, caregiver burnout, community uniqueness and communication. Nine papers met inclusion criteria and purposed solutions yet addressed only three of the identified barriers. The Grey Literature search revealed multiple small solutions to all identified barriers. Many solutions exist to mitigate barriers to successful “Aging in place” in rural southern Alberta, however, the services are often small, fragmented, lack supporting evidence and funding leaving them vulnerable to collapse. Without a platform to streamline services, critically examine strategies and share successful pilot projects it is unlikely they will grow meet the demands of the future. Without a platform to streamline services, critically examine strategies and share successful pilot projects it is unlikely they will grow meet the demands of seniors the future., An integrated home program incorporating an existing Falls risk Management team and the Geriatric Consult service (GCT) was developed to provide care to complex home care clients. The objectives of this program was to provide in home comprehensive geriatric assessment in addition to a focussed falls risk assessment for high risk patients with the goal of reducing acute care utilization and support functional independence at home for patients and their caregivers. In the first year of the program 601 referrals were received of which 546 were seen. An evaluative study of the Integrated home care geriatric consult team using data from acute care utilization of enrolled clients over a 1 year period and qualitative data from semi structured interviews of integrated home care case mangers and caregivers 50 % of referrals to the GCT were falls specific; There was a 51% decreases in ED visits post referral; 17% decreased ED utilization 6 month post referral; 7% decrease Acute Care admission 3 months post referral. Caregiver reports suggest improved overall quality of life and satisfaction with program. The GCT service provides a unique service in the healthcare system. The ability to provide in home assessment to frail elderly patients who are home bound enables access to comprehensive geriatric care. Continuity of care is achieved by bridging communication between the home care case managers, who attend GCT rounds and community based physicians. Successful components for implementing this model include: interdisciplinary fall risk in-home assessment with a comprehensive geriatric assessment; timely and effective communication of client recommendations; and facilitation of fall risk strategies to ensure client safety and quality of life., Driving is a marker of independence and an important aspect of quality of life for older adults. Driving decision-making is a significant challenge facing persons with dementia, their family, caregivers, and healthcare providers. This review aimed to identify specific strategies that facilitate the transition to non-driving. We conducted a scoping review to inform the design of an intervention that supports drivers with dementia and their caregivers make decisions about driving, and transition to non-driving. A literature search was performed using the databases MEDLINE, CINAHL, Cochrane Central, Embase and PsycINFO, from 1994–2014 to identify articles pertaining to driving cessation (DC). Data were extracted and findings were synthesized across qualitative and quantitative papers. The initial search yielded 476 records. Of these, 110 pertained to DC in older adults. Following exclusion of non-research related records, 93 papers were included in the review; 42 quantitative, 31 qualitative and 3 review papers. Evidence from these studies was complemented by 17 editorials. Broad themes include the importance of: advanced planning, acceptance and adaptation; control, autonomy and shared decision-making; social support for drivers and their families; and the promotion of community access and diverse approaches to mobility. There is a dearth of findings specific to persons with dementia, but existing studies suggest that approaches should target challenges associated with the illness, including reduced insight which impacts the decision-making process, and the increased need for social and other supports given new dependencies. The findings suggest that interventions that normalize DC and promote advanced consideration of supports required by drivers and their families can ease the transition to non-driving. The review also calls for greater attention to factors that frame variations in experiences of decision-making and adaptation to non-driving., Acute care transfers present risks of adverse effects on long-term care (LTC) residents and increased healthcare resource usage. As part of an ongoing capacity building initiative to reduce potentially preventable emergency department (ED) visits, Baycrest examined circumstances surrounding unplanned, short-stay ED visits of its LTC residents. We conducted retrospective chart reviews of 35 unplanned ED visits less than 24 hours by 35 residents of Baycrest’s 472-bed LTC home. These visits were randomly sampled from 108 visits that occurred between April 2014 and March 2015. We examined the 7 days prior to and the 3 days following the transfer. Collected data included: presenting symptoms, clinical evaluations, diagnostic inquiries and therapeutic interventions at Baycrest, as well as hospital investigations and diagnoses. Symptoms precipitating the transfer and their accompanying assessment occurred, on average, 2.4 days prior to transfer, with the median time for residents experiencing symptoms and assessment being the day prior to transfer. Registered practical nurses, registered nurses and physicians conducted evaluations in 83%, 60% and 20% of residents before transfer, respectively. Before transfer, at least one diagnostic test or intervention was conducted in 34% of residents; 63% of residents received at least one ED investigation (other than blood work) or intervention. Falls (21%), respiratory (15%), cardiovascular (15%) and urinary (18%) issues accounted for 69% of hospital diagnoses. Transfers occurred soon after the symptoms arose, suggesting that earlier detection of changes in status may be helpful in reducing ED transfers. The findings from this initial study of ED visits by LTC residents help inform topic areas for education of point-of-care staff as well as considerations for making specific interventions (e.g., suturing) available in LTC, which may help reduce subsequent ED transfers., Older adults are at great risk of functional decline during hospitalization. The purpose of this study was to investigate how long older patients spend sedentary per day during hospitalization and how sedentary time is associated with mortality. Currently 104 patients (82±8 years, 57% women) have been recruited within 48 hours of admission to the QEII Health Sciences centre in Halifax, NS either through the Emergency Department, under the care of Internal Medicine, or at the Geriatric Assessment Unit. Time spent sedentary (lying down and sitting) was objectively measured 24 hours per day until hospital discharge or for a maximum of 2 week using ActivPAL inclinometers. On average, patients remained in the hospital 17.3 (SD 18) days and 14 patients died during their hospital stay. On admission 35 could walk independently. Across all days, patients were sedentary an average of 22.7 (SD 22.5) hours per day and there were no differences in sedentary time by day of the week. Patients were the most sedentary during the evening and night time. Sedentary time was a significant predictor of mortality even after controlling for age, sex, frailty, and mobility status at admission. Among those participants who died, sedentary time did not change during the first five days of hospitalization. Among those who were discharged from hospital, a gradual decline in sedentary time was noted with the largest decline observed during the first 3 days of hospitalization. Hospitalized older patients spend most of their day sedentary even when they can walk independently. Sedentary time during hospitalization increases risk for mortality. Future studies need to investigate whether using devices to track sedentary time in routine practice will improve clinical care for older patients., Background/Purpose: Case-study regarding an older adult with proven HSP had a recurrent episode a year later. Methods: Interview of the patient, case file review. Results: Pathology confirmation of recurrent HSP, photographic evidence of the evolution of the episode, treatment regimen and final fatal outcome of the episode. Discussions: Exploring the impact of recurrent HSP within the older adult population, specifically upon the changes inherent in the immune system associated with older age, and the impact of HSP upon the frailty of the patient. Conclusions: HSP presentation in the older adult has profound implications of patient’s immunity, frailty, mobility and overall affect., Alzheimer’s disease (AD) is associated with changes in selective attention and response inhibition, commonly measured using the Stroop task. While increases in neural activity have been reported in healthy aging as a means of compensation, whether AD results in increased activity remains unclear. The goal is to elucidate the relationship between inhibitory control and the brain in AD using fMRI and Stroop interference. 34 controls (mean age 67.1 ± 9) and 16 mild AD participants (mean age 74.6 ± 7.6) completed a rapid event-related version of the Stroop task. We contrasted incongruent minus congruent conditions at stimulus onset to investigate neural activity related to Stroop interference within each group. Verbal responses were recorded, and Stroop interference (incongruent RT – congruent RT), and number of errors were calculated. Behavioural: The AD group had significantly greater Stroop interference t(−5.52) p < 0.05, with an average of 296.76 ± 102.32 ms compared to 138.83 ± 73.50 ms in the controls. The AD group also made more incongruent errors compared to controls t(−4.38) p < 0.05. fMRI: Controls had increased activity relating to the incongruent condition than AD in areas including the anterior cingulate cortex, dorsolateral prefrontal cortex, orbitofrontal cortex, precuneus, and inferior frontal gyrus. The controls had activity related to areas involved in inhibition, while the AD group had less activity, suggesting the ability to compensate is altered with the disease. This is in line with the behavioural data, which revealed a significantly greater Stroop interference in AD. Controls seem to have a compensatory mechanism by which to maintain cognitive function on a task of inhibition, whereas AD has reduced neural activity and altered behaviour (greater Stroop interference and more errors), suggesting altered inhibition., Frail older adults have complex geriatric needs that make assessment and management in the Emergency Department (ED) challenging. In addition, geriatric issues often go unrecognized in the ED setting leaving underlying factors unaddressed. The Geriatric Evaluation and Management in the ED (GEM-ED) project aims to develop and assess a geriatric intervention designed to improve the care of older adults presenting to the ED. The GEM-ED service is a novel intervention providing geriatric assessments to older adults in a community hospital ED setting. The GEM-ED service is being evaluated through collection of demographic data of assessed patients, reasons for referral, identified geriatric syndromes, and recommended community interventions. Patient/caregiver surveys during ED visit and at two weeks assess patient experiences in the ED and follow through with recommendations. To date, the GEM-ED service has assessed 360 older adults, 49% of which are 85 years or older. 76% live in independent home living and 22% in some form of supportive living. The most common referral reasons have been falls/mobility issues, cognition, and assessment of home supports. Older adults presenting to the ED are often medically complex, requiring increased supports in the community. This project aims to target this challenging population and, through its evaluation, direct future interventions. The GEM-ED service is filling a need for geriatric assessment and intervention of older adults in the ED, identifying geriatric issues and establishing links to community supports and services., It is critically important to identify older adults who are at risk for functional decline. Placing a focus on prevention allows older adults to live longer, healthier lives in their homes free of disability. Resistance training (RT) has the potential to slow the rate of functional decline linked to aging. Higher training intensities have been used with healthy older adults to achieve greater gains in strength, but the feasibility and effectiveness is less established in at-risk, older adults with preclinical disability where conservative protocols are typically employed. Higher intensity RT may be an innovative and effective strategy to reduce the risk and impact of future disability and falls that threaten the independence of older adults in Canada. This protocol will outline a current pilot single-blind randomized controlled trial being conducted at two sites (Mississauga and Collingwood, ON). It will compare two arms of RT, high (HI) and low intensity (LOW), with respect to strength, balance, falls risk and quality of life in adults 60+ identified as having preclinical disability. Both arms are 12-week, twice-weekly programs supervised by a physiotherapist. The HI group will focus on compound multi-joint movements (e.g. squats, step ups) at 85%+ of their estimated 1 repetition maximum (1RM). The LOW group will employ single-joint exercises at an intensity of 60–70% of 1RM. With a focus on preventative care, determining optimal dosage of RT to prevent functional decline in at risk older adults could lead to improved quality of life and disability-free years in community dwelling older Canadians. Higher intensity training could result in greater gains in strength balance and quality of life thereby providing health professionals with an effective strategy for prevention of disability., Identifying and responding to frailty should begin in primary care where health professionals can consider both the medical and social context of their patients. The purpose of this study was to examine the feasibility of first measuring and then mitigating frailty in community-dwelling older adults. Fifty-one community-dwelling people (82.0±7 years, 64.7% females) from two sites participated: 33 from Fraser Health (Vancouver) and 18 from Capital Health (Halifax). A goal-oriented, multidisciplinary primary care plan was employed and frailty was assessed before and after the intervention. A 56-item frailty index was constructed based on a comprehensive geriatric assessment (CGA) at both time points. Analysis was stratified by age (younger group ≤ 81 years, older group 81+ years old) and sex. Frailty status was identified for all patients except for one who was missing more than 30% of the CGA items. Ten patients were not followed up and for two patients we were unable to identify their frailty status due to CGA missing data. The mean frailty score at baseline was 0.26 (SD=0.10, 0.07–0.52); 70% (N=34) were identified as frail (0.21+ score). On average patients’ frailty score decreased by 0.032, which is equivalent to having 1.8 deficits less at the follow up; frailty levels were reduced for 79% of the patients. Frailty levels were reduced significantly for both the younger and the older group but when analysis was stratified by sex the change was significant only for females. This pilot study showed that it is feasible to assess frailty within the primary care setting by using a CGA and that a goal-oriented multidisciplinary primary care plan could mitigate the effects of frailty. Future research should test this intervention in a controlled clinical trial., There is much support for collaborative models of dementia care to ensure well integrated and coordinated quality care. The purpose of this study was to explore the clinicians’ perception of collaboration among health care providers (HCP) providing dementia care. Prior to participation in a dementia training program, participants completed an online survey in which they were asked to rate their level of collaboration (5-point scale; 1=not at all to 5=extremely collaborative) with various HCP and community-based dementia services and the extent to which these collaborations have been challenging (5-point scale; 1=not at all, 5=extremely challenging). Surveys were completed by 200 HCPs; 38 physicians, 75 nurses, and 87 allied health professionals (AHP). On average, clinicians had been in practice for 11.5 years. Collaboration ratings were highest in working with nurses (M=3.9), family physicians (M=3.8), and social workers (M=3.7) and lowest for home care managers (M=2.9), geriatric specialists (M=2.7), and community responsive behaviour resources (M=2.6). AHPs had significantly (p=.004) higher ratings (M=3.4) of the collaborations with the Alzheimer Society than physicians (M=2.8) and nurses (M=3.2); other ratings did not vary by discipline or by years in practice. Mean ratings reflected that clinicians perceived their experiences in working collaboratively with other health care professionals (M=2.5) and with community agencies (M=2.6) as somewhat challenging. HCP tend to perceive collaboration among colleagues in primary care as moderately collaborative, but less so with specialist and community-based services; collaborations were perceived as somewhat challenging suggesting an opportunity to enhance collaborative care. Further study to identify why collaboration is perceived as suboptimal can inform the development of strategies to improve collaborative dementia care., To examine the effects of different exercise interventions on sarcopenia and frailty indices among community-dwelling older adults with high osteoporotic fracture risks. One hundred and thirty-nine high risk subjects on osteoporotic fractures or fall were enrolled. Among them, 30 from Chang Gung Health and Culture Village (CGHCV) were assigned into video game exercise group (XBOX) and 109 from National Taiwan University Beihu Branch (NTUH-BB) were randomized into integrated care group (IC, n=55) and muscle extremity exercise group (MEE, n=54). Major outcomes included muscle mass, grip strength, walking speed, lower leg extension power, and frailty indicators by Dr. Fried and colleague at baseline and after 12-weeks of intervention. Mean age was 74.8±7.8 years for the entire cohort. After 12-weeks of training, walking speed (1.3±0.3 m/s vs. 1.4±0.3 m/s, p, This study is to describe the process for developing reliable and valid measurement instruments that can be used in age-friendly health care institution. The scale is effectively and conveniently for assessment of elderly inpatients’ opinion about the hospital’s age-friendly policies. We enrolled 330 elderly inpatients with the age of 65 y/s and older from a regional teaching hospital. A structured questionnaire was used to conduct the face-to-face interview by a trained nurse case management. Description, content validity, test-retest reliability and regression analyses were performed for the reliability and validity of scale construction. The CVI value is 1.0 in surface validity and the expert’s validity CVI is 0.97. We performed the test-retest reliability for scale stability and ranged from 0.707 to 0.963, an average of 0.824. The correlation coefficient between the four dimensions of questionnaire about age-friendly health care institute, ranged from 0.58 to 0.75; high positive correlation (p, The needs of elderly health care increase with age, particularly in elderly inpatients. The study is to evaluate the satisfaction of elderly inpatients for aged-friendly healthcare institution, there is four dimensions include “management policy”, “communication & services”, “medical care procedure” and “physical environment”. The study employed a questionnaire and enrolled 330 elderly inpatients (> 65 years) from a regional teaching hospital in the eastern Taiwan. Description, functional assessment, GDS, Mini-cog and regressive analyses were performed to predict the impact on age-friendly institution satisfaction. The results showed: young-old (65∼74): 166(50.3%), old-old (75∼84): 102(30.9%) and oldest-old (85+): 62(18.8%). Mean age is 75.4±7.8 years, male of 53.3%; ADL: disability 113(43.3%); IADL: disability 195(59.1%); GDS: GDS, Aging is a global trend, and Taiwan is one of the world’s fastest aging nations. Meanwhile our country will be reached the aged-society in 2017. This study aims to explore the factors influencing the self-rated health status of elderly inpatient. This study collected from August 2014 to March 2015 elderly residents of a regional teaching hospital of a total of 330 patients were recruited. These factors include age, sex, education, occupation, work status, number of chronic diseases, ADL, IADL function, cognitive function, depression symptoms and the various family factors include marital status, religion, residence status, living alone and perceived economic status. 53.6% had poor perceived health status. Aged 65 to 74 years (50.3%), 75 to 84 years (30.9%) and the mean age was 75.4±7.8 years. Sex: Men (53.3%), education level revealed 78.1% were elementary school and 56.7% were ADL intact, 40.9% were IADL intact, 32.1% had poor perceived economic status, 53.8% of participants were impaired cognition by Mini-Cog assessment. The mean GDS score was 3.4±3.9; 8.4% had depression, and 29.9% were at high risk of depression at baseline. Functional deterioration was noted in most of the elderly inpatients. The correlation analyses between perceived health status and economic status, ADL, IADL have significantly positive correlation and cognitive function; depressive symptoms have significantly negative correlation with perceived health status. The perceived economic status and depressive symptoms can predict the perceived health status of elderly inpatients. Improving the economic situation, supply related-social resources and early started with rehabilitation program intervention, assessment of cognitive function and depressive symptoms with good management could improved the perceived health status of elderly inpatient., The End of Life Clinical Plan for Inpatients (EOL-CPi) was developed to foster dignified deaths in older patients admitted to a geriatric step-down hospital. We performed a study to evaluate its effectiveness in enhancing dignified deaths. A retrospective study in which all in-patients with age ≥ 65 who were under EOL-CPi between 4 June 2012 and 3 June 2014 were reviewed. 128 patients with an average age of (mean ± SD) 87.7 ± 7.6 were studied. The average duration of EOL-CPi was 4.15 ± 6.5 days. Their chief diagnoses were advanced dementia (49.2%), active cancers (26.5%), neurodegenerative diseases (11.7%), organ failure (8.6%) and stroke (4%). In the last 24 hours before deaths, 99.2% of patients were pain free, not agitated and without excessive secretion. After EOL-CPi, there were significant reductions (pre-EOL-CPi vs. post-EOL-CPi) in intravenous antibiotics: 87.5% vs. 55%, p, Whereas health status and a higher risk of death have been associated to prolonged length of hospital stay (LHS), the effects of Mobile Geriatric Teams (MGT) recommendations on risk of death remain to determine. Because of a significant geriatric and gerontological recommendations-related decrease of LHS previously reported, we hypothesized that these recommendations could also decrease the risk of death in geriatric patients visiting emergency department (ED). The aim of this study was to examine the effects of geriatric and gerontological recommendations visiting an ED on risk of death in the first year following the ED visit. A total of 131 geriatric patients who visited Angers University hospital ED were prospectively included in this pre/post quasi-experimental study. They were separated in three groups matched on age and gender: two intervention groups (11 patients with geriatric recommendations and 23 patients with gerontological recommendations) and one control group (97 patients without any recommendations). Intervention was provided upon the participant’s ED admission. Incident mortality was collected via the administrative registry of Hospital before patients’ discharge and via a systematic phone call 12 months after the ED visit. Age, gender, place of living, number of daily drugs taken, cognitive decline, and reason for ED admission were used as co-variables. Multiple Cox regression model showed that gerontological recommendations were associated with a lower rate of mortality (adjusted Hazard Ratio [HR] = 0.12, p=0.038) but not geriatric recommendations (adjusted HR=9.94, p=0.905). Living at home was associated with a greater risk of death (adjusted HR=2.55 with p=0.020). Kaplan-Meier distributions of mortality confirmed that patients who received gerontological recommendations had a lower mortality rate compared to those who did no received recommendations (p=0.005) and those who received geriatric recommendations (p=0.015). Our findings show that gerontological but not geriatric recommendations were associated with a lower risk of mortality. This finding is consistent with previous published studies. Indeed, recently a systematic review, which examined the effects of interventions performed in geriatric patients visiting ED, reported that greater intensive interventions lead to greater reduction of adverse outcomes compared to simple interventions. In our case, we can consider that gerontological recommendations are more intensive than geriatric because these recommendations involve a combination of medical (i.e., the same as geriatric recommendations) and social recommendations corresponding to the establishment of formal and appropriate home-help services. Gerontological recommendations for the management of geriatric patients visiting ED reduced the risk of death during the year following the hospital discharge. Further research is required to confirm the result of this pilot study and should be based on multicentre randomized controlled trial., With the rapid growth of visits to the ED in elderly individuals, hospitalization after an ED visit is expected to be even greater in the future. Hospitals need to confront this new issue. To examine the age effect on the performance criteria (i.e., sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], likelihood ratios [LR], area under receiver operating characteristic curve [AUROC]) of the 10-item brief geriatric assessment (BGA) for the prolonged length of hospital stay (LHS) using artificial neural networks (ANNs) analysis. Design: Observational prospective cohort study. Setting: Angers University Hospital, France. Subjects: A total of 1117 geriatric ED visitors hospitalized in acute care wards after ED discharge. Methods: The 10 items of BGA were recorded during the ED visit and before the discharge to acute care wards. The top third of LHS defined the prolonged LHS. Analysis was successively performed on participants categorized in 4 age groups: aged >70, >75, >80 and >85 years. The ANNs analysis method was conducted using the modified multilayer perceptron. There was a trend for older inpatients (p=0.0699) and a significant greater prevalence of temporal disorientation (p89%, specificity>96%, PPV>87%, NPV>96%, LR+>22; LR−93), with the best balance performance being reported amongst participants aged 75 and over (sensitivity=89.7 %, specificity=97.8%, PPV=93.4, NPV=96.5, LR+=41.0; LR−=0.1 and AUROC=93.7). The findings show that age effect on criteria performance of the 10-item BGA for the prediction of prolonged LHS was minimal. Whatever the age group, prolonged LHS was accurately predicted with high values and good balance between criteria. These findings suggest that the 10-item BGA combined with ANNs analysis may be used as a screening tool as well as a diagnostic tool to detect early older ED visitors at greater risk of prolonged LHS after their ED discharge to acute care wards, regardless of their age. Age effect on the performance criteria of the 10-item BGA for the prediction of prolonged LHS using MLP was minimal; in all cases, prolonged LHS was accurately predicted with a good balance between criteria, suggesting that this tool may be used as a screening as well as a diagnostic tool of prolonged LHS regardless of age of older ED users., Long wait times in emergency departments (ED) and poor patient flow is a critical health system issue. ALC patients, those who do not require the intensity of care an acute care bed unit can provide, have a significant impact on patient flow. Currently, the ALC data consists of mainly the % of beds that are ALC, but lack information about the patient characteristics and unmet needs of these patients. Data is also lacking on the inefficiencies in the ALC process Saskatchewan Health partnered with eHealth, Health Quality Council, and CIHI to address this problem using lean methodology. A group of clinicians, health records personnel and health information technologists from every region was assembled for a Rapid Process Improvement Week (RPIW). An ALC form was developed which collected ALC patient characteristics, the various factors contributing to why they were ALC, as well as process measures. The pilot found over 50% (CIHI estimated 30%) underreporting since only Long Term Care (LTC) patients were being captured as ALC. Almost 2/3 of the medicine unit was ALC patients, of which ½ were waiting for LTC. Most patients had on average 5 reasons to be ALC, in particular reduced mobility (70%), unable to manage personal care (40%), and cognitive impairment (40%). Process metrics revealed that of the entire inpatient LOS, only 1/3 was for active care and 2/3 was ALC LOS. After several adjustments, ALC data collection is next being rolled out in 5 health regions. The original region used the ALC data to develop an ALC reduction strategy with clear gaps identified and the use of dynamic modeling to determine which initiatives will have the most impact on patient flow. The key to the success of the project was the high level of collaboration., Baycrest Centre for Geriatric Care delivers care in a hospital based program of 250 beds including rehabilitation, behavioural neurology, mental health, complex continuing care, palliative care and transitional care, as well as long-term care home of 472 beds. The main types of ulcers treated include pressure ulcers, diabetic foot ulcers, arterial ulcers and arterial ulcers. At this site, the main ulcers treated are pressure ulcers which have impact on quality of life and significant health system expenditures. In 2011, a Pressure Ulcer Prevention, Assessment, and Management program was launched to develop an evidence-based approach to preserving skin integrity and wound management. Prevalence and Incidence studies were undertaken yearly. Education towards ward staff took place—“Wound Warriors” for nursing, “Wound Whisperers” for personal support workers. Continuing education meeting for family physicians. Wound Care rounds occurred up to 2x/week involving teaching at the bedside. Product lines were streamlined but not removed. Intent was to build competency among the health-care workers involved. Our prevalence rates were 10.17–12.65% for years 2011, 2012, 2013 and 2014 in both the long term care and hospital for stage II and greater ulcers. The prevalence rates for hospital 14.73 to 19.63% whereas in the long-term care they were 8.54–9.81%. In 2010 wound care supply expenditure for both the hospital and long-term care was $147, 858.83. In 2013 it had decreased to $82,039.62. In 2014 it had decreased even further to $65,319.38. The wound are prevalence rates themselves did not change much meaning that we were treating about the same number of wounds. This approach could be trialed at other healthcare sites. Other areas of possible savings have also been identified in this process which may lead to further processes. By implementing an evidence-based education, we were able to reduce the costs of wound care supplies by 55.82%., The majority of older adults seek treatment in the emergency department (ED) within 48 hours of having a fall therefore the implementation of falls risk screening and initiation of falls-related interventions for this population is essential (Miller et al., 2009). Falls Risk Screening was implemented in the ED of one of three Ontario acute care community hospitals serving a population of over 525,000 people. An average of over 130 patients are seen and treated each day in this ED. The ED patients are screened for falls risk by the triage nurse using a tool that was developed from the guideline created by the American Geriatric Society, American Academy of Orthopaedic Surgeons and British Geriatric Society (2001). Over 20% of the patients who presented to the ED of this hospital were found to be ≥ 70 years of age and of this population, 43% screened positive for falls risk. In a sample of 145 ED patients who were ≥ 70 years of age and screened positive for falls risk, 96% were discharged home and only 26% had documented evidence of any actions taken as a result of the screening. This information was used to enhance existing documentation and processes and to educate staff regarding potential actions that could be taken to help reduce the risk of falls for older adults upon ED discharge. Falls are a major concern in the older adult population. Opportunities exist to help and support ED patients who are ≥ 70 years of age and at risk for falls as well as the ED staff who care for them., In Canada’s aging population, over half of all clients living in long-term care (LTC) facilities have a diagnosis of dementia. Most of this population will experience behavioural and psychological symptoms of dementia. A lack of understanding of responsive behaviours (RB) results in escalation of behaviours reduced quality of life, negative health outcomes and increased caregiver burnout. In 2012, the Long Term Care Behaviour Support Outreach Team (LTC BSOT) was created to facilitate capacity building among front line LTC workers caring for residents with responsive behaviours. The goal of LTC BSOT is to coach LTC staff and collaborate with other resources to build a sustainable behavioural support model in each LTC home, which subsequently improves the quality of life of seniors with responsive behaviours. This evaluation project looked at capturing the current assessment and follow-up processes that constitute the work of the LTC BSOT team with the goal of process improvement. Three methods of data collection were used: Semi-structured interviewsGo, Look, See – “Gemba” WalkFocus group with LTC BSOT team The results were organized into a detailed process map with variables collected from registered nurses, personal support workers, physicians and clinical educators that make up the LTC BSOT. While the data collection is still ongoing, this model of responsive behaviour intervention has never been evaluated before. The quality improvement focus of this evaluation will lend to further education of the front line care staff to understand common responsive behaviours, how to adapt in future situations, and to reduce responsive behaviours in clients., Pressure ulcers develop when ongoing pressure is applied to skin, causing capillary compression, decreased oxygenation, and skin breakdown. They typically occur in cases of reduced mobility, and pre-existing vascular and skin conditions, and cause significant morbidity/mortality. New pressure mat technology provides the ability to monitor pressure continuously. Infra-red (IR) cameras can help identify micro-circulation patterns. Data from a 64-year-old female Complex Continuing Care in-patient with stroke, dialysis, and high risk of developing an ulcer (MDS 2.0 – Pressure Ulcer Risk Scale score: 6) was collected over some 120 days. A fiber-optic based, pressure- sensitive mat (S4 Sensors Inc.) was placed under the mattress below the feet. An IR camera (FLIR Systems Inc.) was used to capture morning skin temperature at the heels. Thermal contours were formed for each IR image using custom software (SB). The mat data was converted to mean sum of pressures (SoP) and the standard deviation (StDev). The SoP represents the amount of pressure and the StDev the amount of limb movement. The morning of August 12th, 2015 this patient showed a significantly lower skin temperature over the L heel than the R (26 C vs. 28 C). Corresponding mat data showed a larger SoP and lower StDev. This project found a correlation between reduced mobility (mat pressure) and reduced skin temperature (IR images). We believe that this is the first time these 2 sensors have been combined to show the link between limb mobility and micro- vascular circulation. If replicated, mat sensors may provide a novel, automated way of measuring pressure ulcer risk., Limited knowledge of dementia care in primary care is a well-documented barrier to optimal care. This study aimed to identify the learning needs of clinicians participating in an Ontario training program aimed at establishing primary care memory clinics. In a pre-training online needs assessment, respondents were asked to rate the extent to which their professional training prepared them for dementia care (5-point scale: not at all - extremely well). They rated their interest in learning (5-point scale: not at all – very much so) various dementia related topics (clinic development, differentiation of dementia from delirium and depression, normal aging and mild cognitive impairment, assessment of executive functioning, differentiation of dementia types, drug and nondrug therapies, driving, communication) and were asked to identify additional topics of interest. Surveys were completed by 134 physicians, 208 nurses, and 210 allied health professionals (AHP); N=552. Average time in practice was 12.9 years. Mean ratings of the extent to which formal education prepared them for dementia care were moderately low (M=2.8); ratings did not vary significantly by discipline but was negatively correlated with years in practice (r=−.150, p=.001). Mean ratings of interest in the dementia topics were all high, ranging from 3.9 for memory clinic development to 4.4 for differentiation of dementia types; ratings did not vary by years in practice but did vary by discipline, with nurses have higher ratings for most topics than physicians and AHPs. Additional topic areas were generated. Clinicians reported that their formal education did not prepare them well for dementia care; they wanted greater knowledge in all areas related to dementia care. Ongoing professional education should focus on all aspects of dementia care., Psychological literature supports a strong relationship between mental and physical health. With aging comes increases in physical issues that are not reflected in similarly increased mental health concerns. This raises questions about how psychological and physical health are related in older adults. We qualitatively investigated psychological concerns and their associations with medical concerns among adults 50 years and over attending mental health clinics. This research utilized archival data from 142 individuals who attended clinics in Portland and Hillsboro, Oregon. We collected demographic and clinical data including physical concerns for each client. We also transcribed initial phone screen conversations between clients and clinicians and applied qualitative analytic techniques to code presenting complaints. Overall, 61% of clients had physical concerns. By far the most frequent complaint theme among these individuals was depression whereas individuals with no physical concerns expressed anxiety, depression, and relational difficulty themes with similar frequency (48, 31 and 28% vs. 40, 40 and 41%). We also examined complaints within the most common physical concern types (pain 30%, cardiovascular 25%). Compared to those without the disorder, individuals with pain disorders reported more complaint themes of abuse and trauma (24 vs. 13%) while individuals with cardiovascular concerns reported more complaint themes of depression and anxiety (51 and 40 vs. 33 and 42%). We did not find similar associations between physical concerns and clinical diagnoses. This research suggests there is a relationship between physiological conditions and the nature of psychological concerns among older adults. Our findings highlight the importance of considering both physical and mental health when caring for older adults. Mental health professionals should be aware of their older clients’ medical problems and of how these contribute to specific psychological experiences., With Canada’s senior population increasing, there is a greater demand for family physicians with enhanced skills and added competency in care of the elderly (COE). The College of Family Physicians Canada has introduced Certificates of Added Competence (CACs) in five domains, one being COE. CAC awards will be based on the demonstration of specific competencies. The first steps of defining these competencies are a determination of the Priority Topics. A modified Delphi technique was used with on-line surveys and face-to-face meetings. The Working Group (WG) of six physicians, with enhanced skills in COE, acted as the nominal group, and a larger group of randomly selected practitioners from across Canada acted as the Validation Group (VG). The WG, and then the VG, completed electronic write-in surveys that asked them to identify the Priority Topics. Responses were compiled, coded and tabulated to calculate the frequencies of selection of topics. The WG used face-to-face meetings and iterative discussion to decide on the final topics. There was as 19% response rate (41 of 212) from the VG. Most respondents from the VG are involved in teaching, and about one quarter are Program Directors. Half of them have more than 10 years of experience, and 45% have a focused practice. The correlation between the specific Priority Topic list identified by the VG and that identified by the WG is 0.68. The final list has 18 Priority Topics. There is an even higher correlation (0.89) for the generic skills of competence that were independently identified by the VG and the WG. Defining the required competencies is a first step to establishing national standards in COE. The methodology used and the high correlation between the lists generated by the WG and the VG suggest that this Priority Topic list is valid for COE. These 18 Priority Topics will be expanded with Key Features and will be the basis for awarding CACs., Family caregivers are an integral, yet increasingly overburdened, part of the healthcare system. In Canada, there is an estimated 3.8 million family caregivers caring for seniors. We have successfully held a CIHR-funded conference in 2014 on Supporting Family Caregivers of Seniors. Knowledge users and researchers from Alberta and across Canada, and various stakeholders, including those from the World Health Organization, discussed the state of family caregiver support and initiated research plans. We developed a Discovery Toolkit from learnings and resources in the Conference. (1) Each speaker’s slide deck was presented in a page containing six representative slides and a hyperlink to the full slide deck. (2) Evidence Summaries were shortened to a page. (3) Notes from discussions were subjected to thematic analysis and summarized. (4) A caregiver’s account was presented as a personal communication to a government official. (5) Relevant articles, web pages, and organizations were collated and listed. The toolkit is 44 pages long and designed for online viewing. It contains an executive summary and five parts: (1) Supporting Family Caregivers of Seniors with Complex Needs; (2) Voices of Family Caregivers: A Window into their Experiences; (3) Online Support for Caregivers of Seniors; (4) Support for Caregivers in End-of-Life Care; and (5) Research and Resources. The toolkit is free and is accessible to family caregivers, patients, and various stakeholders. We will disseminate the toolkit to family caregivers, seniors, health-care providers, researchers, healthcare organizations and community organizations, and other stakeholders. Also, we will use parts of the toolkit to create an academic module for family physicians, health-care providers, and trainees. This Toolkit is a timely resource on family caregivers., The Canadian Collaboration on Neurodegeneration and Aging (CCNA) is a national research study of people with cognitive impairment or dementia funded by CIHR and study partners engaging over 360 dementia researchers. Across the 3 themes of prevention, treatment, and quality of life are 20 teams with specific research questions. The 8 platforms supporting the teams include the Clinical Cohorts Platform; COMPASS-ND study. To recruit participants with various cognitive conditionsIntegrate experimental, clinical, 3 Tesla MRI imaging and genetic expertiseAddress the causes, identification, management, treatment, and prevention of cognitive conditionsCollect biospecimens, imaging, genetics, and brain donation to support the 20 national research teams Since July 2014, the Clinical Cohorts working group and Platform Implementation Team have worked between regular teleconference calls to confirm the clinical questionnaires and neuropsychological test battery. This has included collaborative alignment with two provincial cognitive impairment studies, one in Ontario (ONDRI) and one in Quebec (CIMA-Q) and also with the Canadian Longitudinal study of Aging. Inclusion/exclusion criteria for the 7 cohorts are defined and multiple research ethics board submissions have begun. Final selection and purchase of the laptop computers and recording technologies and distribution to the 40 recruitment sites is proceeding. Recruitment of the 1,600 participants by diagnostic group include: subjective cognitive impairment [54 Canada-wide, 156 in Toronto and 90 in Montreal, for a substudy of diet and exercise and a substudy of cognitive intervention] (total 300); amnestic mild cognitive impairment (MCI) (400); MCI with subcortical vascular lesions (200); mixed dementia (200); Alzheimer’s Disease (100); Parkinson’s Disease/dementia/LBD spectrum (200); fronto-temporal (FTD), 5 variants (200). Competitive enrollment, funded on a per patient recruitment basis, will begin spring 2016., Idiopathic basal ganglia calcification or Fahr’s disease is an uncommon cause of wide array of symptoms including movement disorders and neuropsychiatric disorders. It is characterized by brain calcinosis in many areas of the brain, most notably, basal ganglia. It is either familial autosomal dominant or sporadic condition and etiology is still yet to be fully elucidated. Treatment is limited to symptom management and prognosis is guarded. We present a case of Down syndrome patient with new onset dementia, ataxia and orthostatic hypotention with CT findings of basal ganglia calcification. We further discuss diagnostic challenge to rule out Alzeheimer disease. A case report is presented and literature search of pubmed, ovid and embase using search term “Fahr’s disease, Fahr’s syndrome, idiopathic basal ganglia calcification, down syndrome and dementia, down syndrome and alzeheimer disease” Case report presents a 59 year old man with Down syndrome with new onset of dementia, orthostatic hypotension and ataxia with CT head findings of diffuse bilateral calcification of basal ganglia. Literature search returned 165 articles relevant 8 articles are selected for the case report. Cognitive assessment in Down syndrome is challenging. Fahr’s disease was diagnosed based on his functional decline, neurological findings and imaging while ruling out secondary causes of calcinosis. While this diagnosis is academic in nature, in other patients, implication of the diagnosis may impact family planning and genetic counseling. Current active research in genetic basis of the pathophysiology may offer treatment in the future. Fahr’s disease is a rare cause of dementia. No effective treatment is available currently. A further systematic review of reported cases and treatment tried to date combined with genetics research can help learn more about this entity., In working age adults, sudden unexplained cardiac death may be more common on Mondays than on other days, but there is less evidence for this association in older populations. Objective: To determine if sudden unexplained cardiac death is more common on Monday than other days, and to determine if there is an effect of age on this association. We updated a previous analysis of a prospective cohort study—the Manitoba Follow-up Study (MFUS), an ongoing cohort study. In 1948, a cohort of 3,983 male aircrew who served in the Royal Canadian Airforce in World War Two was closed. These men live across Canada and have been followed since then with routine medical examinations conducted by each man’s personal physician. We considered death on Monday compared to other days of the week. We stratified analyses on age at death. Sudden unexpected cardiac death was coded in the same manner over the course of the study based on chart and death certificate review. Sudden unexpected death was more common on Monday in men under the age of 60, but not in men over the age of 60. There was a strong gradient in the risk of sudden unexpected death on Monday across the age range: 44% of those who experienced sudden unexpected cardiac death before age 50, died on a Monday, compared to 26% of those between 50 and 60; 20% of those between 60 and 70; 24% of those between 70 and 80; and 10% of those over 80 years old (p =0.01, chisquare test for trend). Younger men were also more likely to die from Ischemic Heart Disease on a Monday than older men. All cause mortality, and death from other causes on Monday did not show any differences between age groups. The reason for this is not clear. Younger men may be more likely to experience sudden unexpected cardiac death on a Monday, while older men are not., Elder abuse is defined as an act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust that causes harm or distress to an older person. The prevalence of reported elder abuse in the general Canadian population is approximately 10 percent. Public perceptions of elder abuse have been documented for the Canadian population, however limited research has focused upon immigrant populations, particularly immigrant Muslims. Due to differing cultural practices, the prevalence of extended family systems, and other factors, immigrant Muslim perceptions about elder abuse may differ from the larger Canadian population and require further study. An online survey was adapted from a collection of published surveys and elder abuse screening tools, including the Elder Abuse Suspicion Index (EASI). This adapted survey is to be disseminated among the Muslim population in Southwestern Ontario electronically and in person at local religious community centres. The results of the surveys are expected in early 2016 and will be available to present at the CGS Annual Meeting in April. The results of this study will provide a better understanding of the prevalence and awareness of elder abuse in immigrant Muslim communities residing in Southwestern Ontario. This study aims to fill the gap that is present in elder abuse literature regarding elder abuse in immigrant Muslim communities, which may lead to further research regarding elder abuse in other immigrant communities across Canada. The results of this study will be beneficial in that they will influence the practice of health care workers to improve the care of vulnerable seniors within this population., Social networks, social support, social participation and loneliness are important determinants of health in older adults. Hearing and vision loss are highly prevalent and may be modifiable risk factors for decreased social engagement since they interfere with communication and mobility. The objective of our study was to determine whether sensory losses were associated with social function in a nationally representative survey of Canadians aged 45–85 years. A cross-sectional analysis of a nationally representative sample of adults aged 45–85 was performed. Data was obtained from the Canadian Longitudinal Study on Aging. Hearing and vision ability were determined from self report. Outcome measures included the Social Network Index, Medical Outcomes Study Social Support Survey, a composite measure of social participation derived from the Canadian Community Health Survey, and a single item pertaining to loneliness. Univariate and multivariate regression models were used to determine associations between hearing loss, vision loss, dual hearing/vision loss and the social outcomes. Dual sensory loss and vision loss were independently and significantly associated with smaller social networks, low social support, reduced participation in social activities, and loneliness. Hearing loss was independently and significantly associated with low social support and loneliness. Hearing aid use moderated the association between dual sensory loss and lower social support. The demonstrated associations may be mediated through reduced communication, mobility, or cognitive declines. The results corroborate previous cross sectional and longitudinal studies from other countries. Limitations include the cross sectional design, subjective exposure variables and possibility of unmeasured confounders. Sensory losses were independently associated poorer social function. Future research is necessary to determine whether treatments for sensory loss improve social function and associated health consequences., Quality of life (QoL) predicts death, but it is not clear if the trajectory of QoL over a long time frame predicts death. Objectives: 1. To determine if a decline in QoL over a decade predicts death; and 2. To determine if any effect is due to declines in mental or physical QoL. In 1948, a cohort of 3983 RCAF airmen was sealed. In 1996, there were 2,043 surviving participants, whose mean age was 76 years. At this time, a successful aging questionnaire was added, including the Short Form – 36 (SF-36), and administered regularly thereafter. Trajectories were determined for both the mental component (MCS) and the physical component (PCS). These were categorized as high, medium and low function based upon the trajectory of decline from 1996 to 2006, with high being those who maintained function. These categories were then used to predict death. Kaplan-Meier plots and Cox proportional hazards models were constructed. After four years, the probability of survival for men in the high MCS group was 77% vs. 58% in the low group. The age adjusted hazard ratio (HR) was for mortality was 1.75 (95%CI 1.28, 2.39) for the low MCS group and 1.55 (95%CI 1.28, 1,88) for the moderate group. The four-year probability of survival for men in the high PCS group was 81% vs. 61% for the low group. The HR for mortality for the low PCS group was 1.89 (95%CI 1.47, 2.43) and 1.33 (95%CI 1.11, 1.60) for the moderate group. Both mental health and physical health trajectories were independent predictors of death. A decline in QoL is a predictor of subsequent mortality., Both unhealthy eating and lack of activity have been associated with a higher cardiovascular risk. Personal motivation tends to follow a seasonal pattern, usually in the form of New Year’s resolutions. Using Google Trends search data for the US, we examined how state-by-state interest in both weight loss and increasing physical activity predicted rates of cardiovascular death, obesity, diabetes and stroke. Internet search query data was obtained from Google Trends (2005 to 2014), after a standardized keyword search. Heart death, obesity prevalence, diabetes prevalence and stroke death were obtained from Center for Disease Control datasets. Time series analysis (every 2 weeks) was performed on search query data to determine both search volume (normalized to overall search intensity) and seasonality (cosinor analysis). As expected, the seasonality of both weight loss and exercise searches showed a peak near the start each year. Strong seasonality for exercise searches was associated with a lower state-by-state diabetes prevalence (Standardized β −0.33±0.15, p=0.030), while strong seasonality for weight loss searches showed no association with any cardiovascular outcome. Overall state-by-state search volume for both weight loss and exercise was associated with higher rates of all outcomes. Overall interest in both weight loss and exercise is associated with higher rates of negative cardiovascular outcomes, suggesting that interest in health promotion (at least as measured by Google search data) does not necessarily translate into reduced risk. Cyclic increases in interest in exercise, however was associated with a lower statewide rate of diabetes., Background/AIMS: Suicidal ideation is a significant public health issue that may lead to suicide attempts and completed suicide in older adults. Very few studies have explored the cultural determinants of suicidal ideation among minority older adults. This study aimed to examine the association between filial piety expectation and receipt and suicidal ideation among U.S. Chinese older adults. Method: Guided by the community-based participatory research approach, 3,159 community-dwelling Chinese older adults in the greater Chicago area were interviewed in person from 2011–2013. Independent variables are expectations and receipts of filial piety from older adult’s perspective. Dependent variables were suicidal thoughts in the last 2 weeks and last year. Logistic regression analyses were performed. Result: Of the 3,159 participants, 58.9% were female and the mean age was 72.8 years. After adjusting for age, sex, education, income, medical conditions, and depressive symptoms, every 1 point lower in filial piety receipt was associated with increased risk for 2-week suicidal ideation (OR 1.07, 95% CI 1.03–1.11) and 12-month suicidal ideation (OR 1.07, 95% CI 1.04–1.11). Lowest tertiles of filial piety receipt was associated with greater risk for 2-week suicidal ideation (OR 1.95, 95% CI 1.12–3.38) and 12-month suicidal ideation (OR 2.17, 95% CI 1.35–3.48). However, no statistically significant associations were found between filial piety expectations and 2-week and 12-month suicidal ideation. Discussion: This study suggests filial piety receipt to be an important risk factor for suicidal ideation among U.S. Chinese older adults. Future longitudinal studies should be carried out to understand the temporal association between filial piety and suicidal ideation. Future longitudinal studies should be carried out to understand the temporal association between filial piety and suicidal ideation., This tractography study aimed to assess the diffusion characteristics of white matter tracts in Alzheimer’s disease and their cognitive correlates. Diffusion tensor 3T MRI scans were acquired in twenty-four cognitively normal controls and sixteen participants with Alzheimer’s disease. Participants completed neuropsychological testing including the Montreal Cognitive Assessment, Mini-Mental State Exam, Stroop test, Trail Making Test B, Letter Number Sequencing and Wechsler Memory Scale-III Longest span forward and Longest span backward. Tractography was performed by the Fiber Assignment by Continuous Tracking method. The superficial white matter, corpus callosum, cingulum, long association fibers, corticospinal/bulbar tracts, thalamic fibers, and cerebellar fibers were manually segmented. The fractional anisotropy (FA) and mean diffusivity (MD) of these tracts were quantified and compared between cognitively normal controls and participants with Alzheimer’s disease. In participants with Alzheimer’s disease we correlated cognitive test scores and the MD and FA of tracts. Alzheimer’s disease was associated with greater MD in the superficial white matter tracts (AD: 0.001168±0.000218, controls: 0.001018±0.000150, p=0.011), cingulum (AD: 0.000848±0.000098, controls: 0.000794±0.000072, p=0.045) and association fibers (AD: 0.000824±0.000052, controls: 0.000774±0.000049, p=0.003) and decreased FA in the corpus callosum (AD: 0.560±0.043, controls: 0.593±0.048, p=0.031). In the cingulum, increased MD was associated with worse performance on Trail Making Test B (p=0.034) and Longest span backward (p=0.021) and decreased FA was associated with worse performance on the Mini-Mental State Exam (p=0.042). In the corpus callosum, increased MD was associated with worse performance on Longest span forward (p=0.013). Quantitative tractography can detect abnormalities in the superficial white matter, cingulum, corpus callosum and association fibers. In Alzheimer’s disease, quantitative tractography can detect abnormalities white matter tracts and its measures can relate to cognitive function., In Central East [Ontario] Local Health Integration Network (CE-LHIN), Seniors Care Network (SCN) is responsible for improving the organization, coordination and governance of specialized geriatric services (SGS) for frail seniors. There are 5 core programs spanning hospital, community and long-term care. Since its inception, SCN has enabled all teams to utilize evidence-informed practices, facilitating knowledge translation and process standardization. This has positively impacted quality of care, patient volumes and transitions. Seniors Care Network, created in 2011 as part of a newly funded comprehensive strategy, enhances outcomes and promotes better care for frail seniors. Establishment of Seniors Care Network has led to: A significant increase in dedicated funding for SGS (annual budget $17M)An increased synergy between SGS teams due to joint planning180 clinicians providing care to frail seniors in SGS>27,000 direct patient encounters in 2014–15; consistently high patient satisfaction ratings;Emerging impact data showing ED diversion, change in treatment plans and appropriateness of admissionsHigh recruitment and retention ratesEmerging leadership roles on a provincial level The regional structure has enabled system partnerships, growth in SGS programs, standardization of practice and increasing demand for affiliation with Seniors Care Network. This demand has been leveraged to create Primary Care Memory Clinics and new linkages with Primary Care. It has also enabled the identification of emerging priorities, enhancing the ability to advocate for vulnerable populations such as those experiencing substance misuse or mental health issues, aging with developmental delay, experiencing elder abuse. Regional specialized geriatric service coordination enabled through SCN is an effective approach to planning, integrating, monitoring, quality improvement and evaluating services for frail seniors in CE-LHIN., The Canadian Consortium on Neurodegeneration in Aging (CCNA) is pan-Canadian response to a global health priority. This submission provides a high-level overview of the consortium and how it functions. Supported by the CIHR and a variety of international national, and provincial partners (see: http://ccna-ccnv.ca/en/partner-organizations/) the CCNA unites 350+ experts in age-related neurodegenerative conditions including Alzheimer’s disease, vascular cognitive impairment, frontotemporal dementia, and Lewy body dementia. The primary objectives of the CCNA are to accelerate our understanding of how these diseases develop, their impact (on individuals, families, and the community as a whole), and what can be done to slow their progression and cope with them, if not prevent these diseases altogether. This team of investigators is supported by a culture of collaboration and a facilitating central administrative core. Based on their area of research interest, CCNA researchers from across Canada are working in one of 20 teams grouped within 3 themes. Eight national platforms, 4 cross cutting programs, and central administration support these themes, teams, and researchers. Details on these components are available at http://ccna-ccnv.ca/en/. The CCNA was launched in the fall of 2014. The first year has been spent in getting the enterprise launched. Each team is working hard on implementing their program of research. Among other accomplishments, a national cohort study, the COMPASS-ND (which will consist of individuals with multiple morbidities, as well as mixed dementias) will shortly be launched. The long-term criteria on which CCNA will be evaluated is how it has improved both the quality of life and the quality of services provided to individuals living with neurodegenerative diseases. The CCNA is a national initiative for “the” public health crisis of the 21st century., In 2011, the Ontario Senior Friendly Hospital (SFH) Strategy was launched by the Local Health Integration Networks (LHINs) and Regional Geriatric Programs (RGPs). An environmental scan based on the five-domain Ontario SFH Framework highlighted promising practices and identified delirium and functional decline as priorities. Hospitals responded by addressing gaps and implementing strategies to improve care. In late 2014, we conducted a refresh of the SFH environmental scan to identify system-wide progress in SFH commitment and care. A modified version of the original 2011 self-assessment survey was sent to 143 hospitals. Quantitative responses were aggregated and summarized and qualitative responses were clustered into themes by 3 reviewers. The 2014 environmental scan was completed by 135 hospitals. Key findings include: 80% of hospitals have SFH strategic plan commitments (39% in 2011)87% of hospitals have a committee/champion to coordinate SFH initiatives (31% in 2011)94% of hospitals provide geriatrics training to their workforce (55% in 2011)92% of hospitals have practices related to delirium (62% in 2011)89% of hospitals have practices related to functional decline (49% in 2011)64% of hospitals use senior-friendly design resources in physical environment audits (34% in 2011) There has been significant progress in SFH care since 2011, though many areas for improvement remain. A hospital system committed to becoming senior-friendly needs to embrace this as a long-term quality improvement journey. Monitoring progress in SFH care using a self-assessment environmental scan can empower providers, organizations and decision-makers by validating the long-term nature of this work, highlighting successes and innovation, supporting knowledge exchange and collaboration, and sustaining the engagement of organizations to support further improvement across the system., Injuries resulting from falls are the leading cause of hospitalization among Canadian seniors. A multi-factorial falls prevention approach including exercise for balance and strength has been shown to reduce falls. This study investigates the impact of a Falls Prevention Program for frail older adults. The Baycrest Day Treatment Centre ran a multi-factorial Falls Prevention Program from 2011–2014, including exercise, education and individualized therapy based upon patient identified goals. A retrospective chart review was carried out to review prospectively collected outcome measures. The program was too short to collect meaningful falls data so substitute primary outcome measures were changes in the Berg Balance Scale Score and the 2 Minute Walk Test. Secondary outcomes include number of risk factors addressed, and percent goals met. A preliminary analysis of 45 of approximately 100 participants revealed the mean age of the participants was 80 years, 76% were females and 89% were vulnerable-moderately frail. On average, participants experienced 2 falls in the 6 months prior to the program’s initiation. On admission to the program, baseline data revealed an average Berg Balance Score of 46 and a 2 Minute Walk Test score of 96 m. At the program’s completion, the average Berg Balance Score was 48 and the 2 Minute Walk Test was 105 m. Chart review is ongoing and further analysis will be available. Falls Prevention Programs in a day hospital setting can improve balance, endurance and reduce the overall risk factors for falling in community-dwelling older adults. We hope to identify factors that predict which patients benefited the most in order to be able to target future interventions., Hip fractures in the elderly population are associated with adverse post-operative outcomes like delirium. Risk factors for post-operative delirium include cognitive disorders. In addition to adverse bone effects, hypovitaminosis D is associated with adverse effects such as gait and cognitive disorders. Therefore, vitamin D supplementation may prevent adverse effects such as post-operative delirium. The purpose of this study was to examine whether pre-operative Vitamin D consumption was associated with post-operative delirium in patients with hip fractures. We hypothesized that patients with who were not taking vitamin D pre-operatively were at increased risk of developing post-operative delirium This study was a retrospective cohort design of 106 elderly patients (i.e., >65) admitted to an orthopedic surgery ward for hip fracture after an accidental fall. Baseline mobility, cognitive impairment, functional status, number of medications, vitamin D consumption, psychotropic medication use and comorbidities were recorded. Postoperative complications, post-operative delirium and in-hospital psychotropic medication intake, were also assessed. Pre-operative cognitive impairment (OR = 5.1 p < 0.04) and pre-operative functional status (OR = 3.6 p < 0.04) were both predictors of post-operative delirium. However, preoperative Vitamin D consumption (OR = 0.48, p = 0.23) and baseline mobility status (OR = 2.6 p = 0.17) were not. A significant association was demonstrated between pre-operative cognitive and functional impairment and postoperative delirium, but was minimally affected by vitamin D consumption. This study supports the association between preoperative functional and cognitive status and post-operative delirium. However, because cognitive impairment has been strongly linked to vitamin D levels, future prospective studies should investigate specifically whether pre-operative serum vitamin D levels have an association with acute postoperative delirium, as well as chronic outcome measures., Short-acting injectable antipsychotics are sometimes used to manage acute behavioural and psychological symptoms in hospitalized elderly patients with dementia or delirium when the oral route is not feasible. Although intramuscular (IM) haloperidol has frequently been used, IM olanzapine has recently become an alternative. The purpose of this study was to compare the effectiveness and safety of IM olanzapine and haloperidol prescribed to older adults in a community teaching hospital. We conducted a retrospective chart review of all inpatients aged 65 years or older who received at least one dose of IM olanzapine or IM haloperidol between November 2010 and December 2012. Information on patient demographics, comorbidities, concurrent medications, treatment and adverse effects were collected. The two groups of patients were matched using the propensity score matching method. Treatment effects and adverse outcomes of the two groups were compared. There were 397 and 72 patients who received IM haloperidol and IM olanzapine respectively. Effectiveness and safety parameters were not consistently documented, which limited the number of patients that could be matched. Desired treatment effect was achieved similarly (OR 1.34, p=0.587) in patients treated with olanzapine (71.0%) compared to those who received haloperidol (64.5%). There was a marginal trend of increase in the odds of adverse effects in patients who received olanzapine (23.3%) compared to those in the haloperidol group (11.6%), which barely escapes being significant at the conventional 5% level (OR 2.3, p=0.0946). Results of this study indicate that IM olanzapine has similar effectiveness as IM haloperidol in the treatment of behavioural symptoms in hospitalized older adults. The trend in increased odds of adverse effects in the olanzapine group suggests that vigilant monitoring is warranted., The European Working Group of Sarcopenia in Older People (EWGSOP) classifies people as normal, presarcopenia, sarcopenia and severe sarcopenia depending on lean muscle mass, grip strength and gait speed. The Clinical Frailty Scale (CFS) classifies people into 9 possible levels. Prevalence of both increases with age. Some authors have implied that sarcopenia and frailty are two sides of the same coin. Purpose: To compare Sarcopenic and Frailty classifications in a group of community dwelling elderly. Seniors participating in an exercise intervention study were evaluated for their sarcopenic status. Blinded to this information, they were evaluated using the CFS and classified accordingly. Data was obtained from 39 participants (6 men), average age 75.7 years (67–90). Average MMSE 29.1 (22–30), MoCA 26.4 (18–30). 11 were normal, 11 were obese, the remainder various stages of sarcopenia. 24 were CFS 3 or higher. Poor correlation was found between EWGSOP sarcopenic status and CFS (R=0.43), lean muscle mass (appendicular lean mass/height2) and CFS (R=0.21 in women), EWGSOP grip strength cut-offs and CFS (R=0.46). However, good correlation was found between CFS and 6m absolute walk time (R=0.82) and gait speed (R=−0.61). This study is limited by fewer individuals in the sarcopenic or frail spectrum. This study suggests there is poor correlation between sarcopenic status (as defined by EWGSOP criteria), absolute muscle mass or grip strength and CFS. However, there was good correlation with gait time and speed, suggesting that functional measures of muscle are more important than absolute muscle mass in the development of frailty. Sarcopenia, as defined by EWGSOP does not equate to frailty as defined by CFS. The use of standardized definitions has important implications for research into potential therapeutic interventions., De-prescribing is the process of titration/weaning and discontinuation of potentially inappropriate medications. The objectives of this study were to determine if an electronic module would be an effective tool to increase knowledge and confidence in de-prescribing and decrease perceived barriers in de-prescribing. All Family Medicine residents at the Michael Garron Hospital were invited to participate in an anonymous survey and electronic module that presented principles of de-prescribing. Multiple choice questions based on the content were presented before and after the module to assess a change in score. Subjects were also asked to qualify their experiences using Likert scales. Statistical analysis was performed using SPSS. 26 of 37 residents participated in the study. The mean increase in scores after the module was 12% ((5.2%–18.9%), p=0.001). Of those who did not have confidence in de-prescribing, 93% versus 7% endorsed an increase in confidence after the module (p=0.012). Fewer residents cited “fear of harming the patient” (22 versus 14, p=0.021) and “medication started by a specialist” (25 versus 14, p=0.003) as barriers to de-prescribing after the module and 100% of subjects stated they would use the Beers Criteria in the future (p, Heart failure (HF) is the most common cause of hospitalization in elderly patients. Understanding the patient and care provider’s perspectives on the provision of optimal care is essential to quality improvement. Our objective was to determine the patient and caregivers’ perspectives on HF care at the Geriatric Medical Unit to assist with the organizational and process changes needed to enable optimal HF care. Nineteen consenting patients and their caregivers were interviewed (once in hospital and once post-discharge) in a semi-structured manner about their experiences & preferences. Chart reviews were used to collect demographics. Difficulties experienced with interviewing patients: High refusal rate (due to fatigue, hearing issues, recovery, lack of appreciation of research, and family disinterest)Patients talked out of boredom and frequently went off topicEven well-established questionnaires were met with comprehension difficultiesAlmost all patients required hearing assistanceQuality interaction with participants needed multiple attempts due to interruptionsSelecting the appropriate environmentInterview length pushed their capabilitiesPhone interviews were compounded with forgetfulness It is crucial to plan strategies to conduct this research in frail elderly patients. Allow time for patients to adjust to environment Be patientEnsure optimized sensory (e.g., hearing aid)Engage the familyUse visual cues and repetition to assist patients with cognitive impairmentConduct interviews in appropriate setting, stress the importance of research, make it personal, and tailor it to the patient’s abilities and desiresAttempt pilot study firstMake interviews short and questions specific Research in the elderly is not impossible but does present its unique challenges that must be met with the appropriate solutions., Falls remain the leading cause of injury-related hospitalization among Canadian seniors. Both mild cognitive impairment (MCI) and gait variability have been shown to be independent predictors of falls in community-dwelling older people. In addition, individuals at risk for falls have been shown to possess white-matter (WM) abnormalities. Dual-task gait analysis (walking while talking tests) has been shown to be sensitive to identify fall risk in MCI individuals. Therefore in this study we investigate the WM abnormalities localization and correlation with dual-task gait decline to further elucidate their role in the risk of falling. Sixteen patients with MCI, 50% with history of falls, received diffusion weighted imaging (DTI) on a 3T Siemens MRI scanner, comprehensive neuropsychological and neurological evaluation, and single-and dual-task gait testing using an electronic walkway (GAITrite systems). Analysis was performed using FSL analysis tool (Analysis Group, FMRIB, Oxford, UK) on baseline imaging data and gait parameters measured over a 3 years follow-up. Low WM integrity in the corpus callosum (fractional anisotropy (FA)=−0.664; p=0.026), predicted poor dual-task stride velocity. Furthermore, the corpus callosum FA values significantly correlated with Stride velocity (0.629; p=0.038), counting gait velocity (0.696; p=0.017) and counting stride velocity (0.689; p=0.019). There was no significant correlation between aforementioned gait parameters and BMI, age and cognitive status. Poor WM integrity in the corpus callosum predicted a 3 year decline in several gait parameters which are valid markers of fall risk. DTI measurements are affected early in older individuals experiencing gait decline. Our findings and on-going research will help explain the high risk of falls recently described in older adults with MCI and aim to provide predictive power to detect patients more prone for falls and injury.

Background/Purpose: The 85+-year-old population – the “oldest old” – is now the fastest growing age segment in Canada. Although existing research demonstrates high health services utilization and prescribed medications in this population, little epidemiological evidence is available to guide care for this age group. Objective: To describe the epidemiological characteristics of common health conditions and medication prescriptions in the “oldest old”. Methods: We conducted a retrospective chart review of all family practice patients aged ≥ 85 (N = 564; 209M:355F) at Sunnybrook Health Sciences Centre, Toronto. Electronic medical records were reviewed for all current chronic conditions and medication prescriptions, and then stratified by sex and age subgroup (85–−89, 90–94, 95+) for descriptive analysis. Results: On average, patients experienced 6.4 concurrent chronic conditions and took 6.8 medications. Most conditions were related to cardiovascular (79%) and bone health (65%). Hypertension (65%) was the most common condition. Bone-related conditions (e.g., osteoarthritis, osteoporosis) and hypothyroidism predominantly affected women (p < .001), while coronary artery disease and T2DM were more prevalent in men (p < .05). The top two prescribed medications were Atorvastatin (33%) and ASA 81 mg (33%). Males were more likely to be prescribed lipid-lowering medications, while females were more likely to receive osteoporosis therapy (p < .001). Patients received less lipid-lowering therapy with increasing age (p < .001). Discussion & Conclusion: Multimorbidity and polypharmacy are highly prevalent in patients over 85. Most clinical concerns in this population relate to cardiovascular and bone health; medications predominantly treat risk factors. In the absence of epidemiological data to guide clinical decision-making, this study provides a first look at the common health concerns and medication profiles in this population., Background/Purpose: Although a serious public health concern, very little is known about the neurocognitive basis of suicidal behaviour in the elderly. Here we aimed at: 1) assessing alterations in cognitive inhibition in suicidal depressed elderly people, and 2) reviewing the literature on cognitive inhibition and decision-making in elderly suicidal behaviour. Methods: First, we compared 20 currently depressed patients, aged 65 and older, who had recently attempted suicide to 20 elderly subjects with a current depression but no personal history of suicide attempts and 20 elderly controls. Different aspects of cognitive inhibition were examined: access to relevant information (reading with distraction task), suppression of no longer relevant information (Trail Making Test, Rule Shift Cards), and restraint of cognitive resources to relevant information (Stroop Test, Hayling Sentence Completion Test, Go/No-Go task). Second, systematic MEDLINE literature search was performed on neurocognitive deficits in suicidal behaviour. References from our research group’s online database were also selected (http://www.bdsuicide.disten.com). Results: After adjustment for age, depression intensity, Mini-Mental Status Examination score, and speed of information processing, suicidal depressed elderly people showed significant impairments in all three domains of cognitive inhibition in comparison to the affective and healthy control groups. Moreover, the results of a meta-analysis study will also be presented. Discussion & Conclusion: Cognitive inhibition deficits and impaired decision-making appear to be part of a series of cognitive deficits and may impair the patient’s capacity to respond adequately to stressful situations, which could subsequently lead to an increased risk of suicidal behaviour during late-life depression. Suicide prevention interventions may be developed to specifically target cognitive impairment in depressed elderly people., Background/Purpose: Anticholinergic drugs may induce cognitive decline in older adults, but data are conflicting. One research challenge is ascertaining the effect of different exposure & outcome definitions on measures of association. Methods: Using baseline and 1-year follow-up data from 131 community patients aged 60+, we applied 4 measures of anticholinergic drug exposure (the Anticholinergic Drug Burden Index (DBI), ACB, ADS & ARS, and 4 definitions of cognitive decline (neuropsychological test raw change scores, the RCI, the standardized regression based change score (SRB), and the clinical diagnosis of a new mild neurocognitive disorder according to DSM-5 criteria). The frequency of classification for each patient and the number needed to harm (NNH) was calculated according to each exposure & outcome definition. The consistency of associations between drug exposure & cognitive decline was examined using logistic regression models for each definition. Results: The Anticholinergic DBI identified the smallest number of patients with an increase in anticholinergic exposure (n = 18) and the ACB identified the largest number (n = 23). The RCI identified cognitive decline in only 6 patients; 12 patients were diagnosed with a new mild neurocognitive disorder, 44 had changes in raw neuropsychological test scores, and 99 had changes on the SRB measure. The NNH ranged from 0–100. A significant association between increased anticholinergic drug exposure & cognitive decline was found in only one model that used the Anticholinergic DBI and the SRB measure of cognitive decline on the Trail B test (OR 2.2; 95% CI −1.1–8.06). Discussion & Conclusion: The choice of definition by which to classify drug exposure and cognitive decline has a significant effect on the results of causal association studies., Background/Purpose: Few studies in long-term care (LTC) have examined the feasibility and acceptability of knowledge translation (KT) programs. We conducted a qualitative evaluation of LTC professionals’ experience with a multifaceted, interdisciplinary KT intervention. Methods: We invited Medical Directors, Directors of Care (Nursing), and Consultant Pharmacists who participated in the Vitamin D and Osteoporosis Study (ViDOS), a randomized controlled trial conducted in 40 Ontario LTC homes (19 intervention, 21 control). ViDOS objectives were to evaluate the feasibility and effectiveness of a KT model to increase the use of osteoporosis/fracture prevention strategies. Multifaceted components included: 3 webinar presentations by expert opinion leaders, audit & feedback, point-of-care tools, internal champions, and action planning for quality assurance. In this qualitative evaluation study, we conducted individual, semi-structured telephone interviews and analyzed transcripts using thematic framework analysis. Results: Overall, 4 Directors of Care, 7 Consultant Pharmacists, and 2 Medical Directors participated. Medical Directors were not included in group comparisons due to the limited sample size. Most respondents (10/13) attended all sessions and thought it was a valuable experience. The on-site involvement of an expert opinion leader was seen as most useful by all participant groups. Perceived utility of the other KT components varied by group: Directors of Care highly valued audit & feedback, whereas Consultant Pharmacists highly valued small-group learning and internally nominated champions. Common themes for improvement were ready-touse educational fact sheets and having expert opinion leaders attend in person or via video conference. Discussion & Conclusion: The ViDOS intervention was well-received by study participants we interviewed. Lessons learned in this study can inform future KT initiatives in LTC., Background/Purpose: Older men receiving ADT for prostate cancer have a 5–10 fold increased rate of bone loss and up to 20% fracture risk by 5 years of treatment. Guidelines exist for bone-loss management in this population, but adherence is poor. We assessed the knowledge and current practices regarding bone-loss management in a sample of Canadian prostate cancer (PC) specialists. Methods: Using Dillman’s tailored design method, a questionnaire was distributed to Canadian PC specialists through three major specialty organizations. Results: 156 PC specialists completed the questionnaire. Awareness of recommendations for frequency of repeat bone mineral density (BMD) scans (76.3%) and vitamin D use (70.3%) was relatively high, but lower for calcium intake (53.2%) and amount of weekly exercise (20.7%). A minority were aware of the true prevalence of osteoporosis in otherwise healthy 60-year-old males (27.3%), the risk of developing osteoporosis after 1 year of continuous ADT (37.8%), and the excess fracture risk after 5 years on ADT (14.7%). 34.4% of respondents reported routinely ordering BMD tests pre-ADT treatment and 36.6% ordered routine BMD tests after initiating ADT. Most reported routinely recommending exercise, calcium, and supplemental vitamin D. The most significant barriers to implementing the recommendations were lack of time to counsel patients and lack of supporting structures (e.g., patient education). Discussion & Conclusion: Participants were fairly knowledgeable regarding recommendations for managing bone loss in men on ADT. However, there were gaps in knowledge regarding risk of developing osteoporosis and in clinical surveillance and risk assessment. These findings suggest the need for knowledge translation strategies and tools to address this gap between evidence and clinical practice., Background/Purpose: An audit was conducted on the recorded reason for invasive treatments in older patients. According to the British Geriatric Society and NICE guidelines catheterisation and regular sedation should be avoided in elderly patients especially those with delirium. Additionally, many studies have been conducted showing a link between sedation and delirium. The aim of the study was to discern whether invasive treatments such as the use of catheters, cannulas, intravenous antibiotics, and the provision of sedatives is justified, as these procedures have associated risks including delirium. Methods: Data were collected data from three Geriatric Medicine wards, looking at the first 48 hours of care. Data were assembled on patient demographics, patient’s AMT score, invasive procedures conducted, and the reason for the procedure. The gold standard for this audit is that 100% of procedures are provided with a reason in the notes. Results: 72% of patients were Caucasians, the mean age 84.6 ± 8.0 (SD), and 50% of patients in the audit were classed as delirious. The findings show that 98% of invasive procedures were not clearly justified in the notes, regardless of whether the patient was suffering from delirium. 97% of cannulas inserted were not justified in the notes and was the most common invasive procedure. Discussion & Conclusion: These results are in agreement with the hypothesis that the majority of procedures will not have a clear justification in the notes. A justification column could be added in order to make doctors think twice about their reasoning for providing these treatments and thus prompt doctors to provide a reason for these invasive procedures., Background/ Purpose: The management of multimorbidity in the oldest old (aged ≥ 85) is recognized as one of the most pressing challenges facing clinicians. Given the increasing prevalence of T2DM in this population, a more precise understanding of the epidemiology of co-existing chronic illnesses is necessary to guide therapy. Objective: To characterize co-morbidity in T2DM patients aged ≥ 85 in primary care. Methods: We conducted a retrospective chart review of family practice patients aged ≥ 85 at Sunnybrook Health Sciences Centre, Toronto. Electronic medical records were reviewed for all chronic conditions. For all T2DM patients, each condition was coded as “concordant/discordant” with diabetic care (whether it is related to its pathophysiologic risk profile or management complications), “symptomatic/ asymptomatic” (whether it causes symptoms noticeable to the patient), and “clinically dominant/not dominant” (complex or serious enough to eclipse the management of all other health conditions). We recorded the total number of co-morbid conditions (other than diabetes) in each category for each patient. Results: T2DM patients comprised 16% (n = 91; 42M:49F) of all patients aged ≥ 85. On average, each patient experienced 6.8 co-morbid conditions other than diabetes (range: 2–16); patients generally had discordant and symptomatic co-morbidities (p < .001). 47% (n = 43) of our sample had at least one clinically dominant condition. Discussion & Conclusion: Co-morbidity is highly prevalent in very old type 2 diabetic patients. Most co-morbid chronic conditions are symptomatic and discordant with diabetes care. A significant proportion of these patients also suffer from clinically dominant conditions. In the absence of evidence-based care guidelines for this age group, it may be beneficial to focus therapy on the management of symptoms and functional limitations rather than aggressively pursuing risk factor modification., Background/Purpose: Men receiving androgen deprivation therapy for prostate cancer have low knowledge of osteoporosis (OP) and are engaging in few healthy bone behaviours (HBBs). A multi-component intervention was piloted in this population, and changes in OP knowledge, self-efficacy, health beliefs, and engagement in HBBs were evaluated. Methods: A pre–post pilot study was performed in a convenience sample of men recruited from the genitourinary clinics at Princess Margaret Hospital. Men were sent personalized letters explaining their dual X-ray absorptiometry (DXA) results and fracture risk assessment with an OP-related education booklet. Participants completed questionnaires assessing OP knowledge, self-efficacy, health beliefs, and current engagement in HBBs at baseline (T1) and 3 months post-intervention (T2). Paired t-tests and McNemar’s test were used to assess changes in outcomes. Results: A total of 148 men (median age 72) completed the study. There was an increase in OP knowledge (9.7 ± 4.3 to 11.4 ± 3.3, p < .0001) and feelings of susceptibility (16.5 ± 4.3 to 17.4 ± 4.7, p = .015), but a decrease in total self-efficacy (86.3 ± 22.9 to 81.0 ± 27.6, p = .007) from baseline to post-intervention. Men made appropriate changes in their overall daily calcium intake (p ≤ .001), and there was uptake of vitamin D supplementation from 44% (n = 65) to 68% (n = 99) (χ2 = 24.6, p < .0001). Men with bone loss (osteopenia or OP) had a greater change in susceptibility (1.9 ± 4.3 vs. −0.22 ± 4.2, p = .005) compared to men with normal bone density. Discussion & Conclusion: Our results provide preliminary evidence that a multi-component intervention such as the one described can lead to increased knowledge, feelings of susceptibility regarding OP, and uptake of some HBBs., Background/Purpose: Fitness-to-drive guidelines recommend employing the Trailmaking B test (a.k.a. Trails B), but do not provide guidance regarding cut-off scores. There is ongoing debate regarding the optimal cut-off score on the Trails B test. Objective: To address this controversy by systematically reviewing the evidence for specific Trails B cut-off scores (e.g., cut-offs in both time to completion and number of errors) with respect to fitness-to-drive. Methods: Systematic review of all prospective cohort, retrospective cohort, case-control, correlation, and cross-sectional studies reporting the ability of the Trails B to predict driving safety that were published in English-language, peer reviewed journals. Results: 47 articles were reviewed. None of the articles justified sample sizes via formal calculations. Cut-off scores reported based on research include: 90 seconds, 147 seconds, 180 seconds, and < 3 errors. Discussion & Conclusion: There is support for the previously published Trails B cut-offs of 3 minutes or 3 errors (the ‘3 or 3 rule’). Major methodological limitations of this body of research were uncovered including: 1) lack of justification of sample size leaving studies open to Type II error (i.e., false-negative findings), and 2) excessive focus on associations rather than clinically useful cut-off scores., Background/Purpose: The Geriatric Medicine (GM) academic half-day (AHD) at the University of Toronto is targeted to structured teaching of the CanMEDS roles. This seminar series must fulfill learners’ needs, GM program mandates, and the RCPSC standards for structured education. Given that the University of Toronto has the largest GM program in Canada, the aim is to produce a competency-based AHD framework that can be translated to other Canadian GM programs. Methods: The RCPSC CanMEDS framework for educational design was utilized. A literature review and a national needs assessment surveying the trainees were conducted. Subsequently, an audit and blueprint of the current AHD curriculum at the University of Toronto were completed. Those domains that were less emphasized were the focus of improvement. Suggestions were made through an educational consultation to improve the structured teaching. Results: The literature review found no publications related to a Canadian GM AHD curriculum. The needs assessment demonstrated satisfaction in training of all domains, but lesser satisfaction in three areas: the sciences of aging, ethical and legal issues, and formal teaching of the Manager role. The four most formally taught GM specific enabling competencies were Medical Expert 2.1, Manager 1.3, Scholar 3.2, and Medical Expert 3.1. An educational consultation provided practical suggestions for improvement. Discussion & Conclusion: The AHD at the University of Toronto is one example of structured teaching, but as a 2-year, weekly seminar series, GM residents invest a great amount of time in this formal education. Peer-reviewed educational tools are available to further enhance the AHD teaching. Improvements to meet the needs of the learner, program, and RCPSC are currently being implemented., Background/Purpose: Medication-related problems are common, costly, associated with poor outcomes, and are potentially preventable in older adults. Older adults with cognitive impairment are at higher risk of adverse drug reactions. The retirement home (RH) setting is a prime opportunity to intervene to screen for cognitive impairment and for medication review. Methods: This project is a two-phase project taking place in a RH setting. The first phase included resident chart review for diagnosis of dementia or MCI, then cognitive screening using the Dementia Quick Screen (Mini-Cog & animal fluency). Screen failure lead to full assessment. The second phase included an intervention with Medchecks by pharmacist using the anticholinergic load scale and the Ottawa Top Ten Tool (OTTT). OTTT was developed after a thorough review of the literature/available tools with subsequent geriatrician panel review for the Top 10 higher risk drug classes with practical recommendations. All were sent to the treating physician for review. 3-month follow-up was done to identify physician acceptance of recommendations. Barriers to acceptance will be reviewed. Results: 75 residents were included in study. Per chart, 45 had normal cognition so were included in the memory screen: 32 (71%) failed screening. Medchecks were done on 48 residents (16 with dementia). Total of 78 recommendations (range 0–5 & mean 1.6 per resident) were made. 11 (14%) anticholinergic-related, 11 (14%) OTTT-related, and 56(72%) were other pharmacist recommendations. 31(40%) recommendations were accepted by treating physician; 4 (5%) were rejected; 43 (55%) pending. Discussion & Conclusion: Cognitive screen and Med-checks using the new OTTT & anticholinergic load scale should be incorporated in RH setting to improve care of this aging population., Background/Purpose: The loss of muscle mass, sarcopenia, in older adults is an important marker of frailty due to the association with mobility decline, falls, fractures, and mortality. However, dynapenia, the loss of muscle strength, has been shown to manifest earlier than sarcopenia, and is more consistently associated with disability and mortality. It is unknown whether dynapenia is associated with early gait disturbances, specifically gait variability. Gait variability is a measure of gait regulation, and high gait variability has been proposed as an early marker of mobility decline and a predictor of falls. Therefore, our aim was to determine if dynapenia in community older adults is associated with poorer gait performance, specifically high gait variability. Methods: In 184 community-dwelling older adults (aged ≥ 75), muscle weakness was assessed by measuring the average grip strength in the dominant hand using a handheld dynamometer. Gait variables were assessed under “usual” and “fast” pace conditions using an electronic walkway. Relative risk analysis evaluated the association of muscle weakness to each of the gait parameters. Results: Older male adults in the lowest quartile of grip strength (< 20.67 kg) had slower gait velocity [mean %CoV (SD) = 82.93 (34.51)] [RR (95% CI) = 1.53(0.58,4.06)], and increased stride time variability [mean %CoV (SD) = 5.81(1.94)] [RR (95%CI) = 1.71(0.82,3.57)], then those in the highest quartile of grip strength (≥ 32.33 kg). Results were similar in female participants. Discussion & Conclusion: Our findings have interesting clinical implications because muscle strength assessments can be used in the clinic as an early screening tool to detect those with high gait instability, risk of falls, and mobility decline., Background/Purpose: The purpose of this study is to investigate the integration of two non-intrusive approaches to monitoring home care clients’ activity level, along with access to best practice guidelines for clinicians at the point of care. A prototype Remote Activity Monitoring and Guidelines System has been developed that uses a GPS-equipped Blackberry to monitor an elderly client’s mobility outside the home. The System includes a pressure-sensitive mat that is placed under a regular bed mattress and can monitor sleep disturbances, and how long it takes to enter and exit the bed. Methods: A proxy client who is over the age of 65 with chronic health issues was invited to carry a Blackberry and to use a pressure sensitive mat to collect data about the client’s physical activity. After a period of 7 days, 4 different nurses made home visits to the proxy client, where a research member observed clinicians interacting with the prototype System in the client’s home. Results: The findings indicated the value of the mobility-related data to gerontological clinicians when they plan care to address the aging needs of their home care clients. The results also suggested the usefulness and placement of the Best Practice Guidelines in the electronic user interface. The observational data generated information about the clinicians’ needs and interaction with the prototype in actual home care setting. Discussion & Conclusion: This study provides important implications about the value of remote monitoring technology in providing clinical support to assist gerontological clinicians’ decision-making process when planning care for seniors in home care settings., Background/Purpose: Receiving rehabilitation enables geriatric patients to regain their function prior to return home. However, long waiting times associated with access to rehabilitation are detrimental to the quality of care for geriatric patients. Methods: Geriatrics consults at the Royal Victoria Hospital and the Montreal General Hospital for 1 year were examined. Relevant information in the consultations was extracted. OACIS was consulted to determine the date of discharge to rehabilitation or home and the number of medications prescribed. The admission/discharge logbooks of the Geriatrics Units were also examined to determine the date of transfer to these units. Statistical analysis was performed on these data using SPSS. A survey of geriatric health professionals determined the reasonable waiting time. Results: The mean waiting time was 11.4 days for outside rehabilitation or home and 4.3 days for the Geriatrics Units. A theoretical reasonable waiting time of 48 hours was defined from a survey of health professionals. Only 7.5% of patients were admitted within this theoretical time frame to outside facilities or home and 44% to a Geriatrics Unit. We didn’t find any patient characteristics (age and number of medications) that contributed to explain the waiting time for rehabilitation. Discussion & Conclusion: This study documents the long waiting time for patients who were recommended for rehabilitation by the Geriatric Consultation Team. The percentage of patients whose waiting time was lower or equal to the reasonable waiting time set by geriatrics health professionals was quite low. However, the waiting times for the Geriatrics Units were significantly lower than those for outside facilities or home. Discharging efficiently to rehabilitation could decrease length of stay and improve patient turnover., Background/Purpose: Hip fracture is the leading cause of transfer to acute care for long-term care (LTC) residents. Osteoporosis and falls put LTC residents at a high risk for fractures that lead to pain, loss of mobility, heavy costs to patients their families and to the health-care system, and increased mortality. Effective prevention includes pharmaceutical and non-pharmacological interventions to decrease fractures. Methods: We conducted a pilot telephone survey of LTC residents’ family members to inform investigators who are adapting the 2010 Clinical Practice Guidelines for the Diagnosis and Management of Osteoporosis for use in LTC. The 10 questions addressed awareness of and preference for falls and fracture prevention interventions available in LTC. Data were analyzed using frequency counts for closed-ended questions and Thematic Framework Analysis for the open-ended ones. Results: 91% of the 11 respondents supported osteoporosis medication use if indicated, while expressing concerns about potential side effects and polypharmacy issues. All respondents supported Vitamin D supplements without any concerns; 82% supported calcium + vitamin D use, but worried about swallowing difficulties. Participants felt pain prevention and preserving quality of life were among the most important outcomes for their family members, and extending life was among the least important outcomes. Discussion & Conclusion: Results from this pilot survey indicate family members support pharmaceutical interventions, per recommendations in the 2010 Clinical Practice Guidelines for reducing the risk of fractures and falls in LTC residents. Many of them believe pain prevention and quality of life are more important than extending life, which should be considered in guideline development for this population., Background/Purpose: Inappropriate prescribing in the elderly population is associated with adverse drug events and increased hospitalization, ultimately reducing quality of life and increasing mortality rates. The aim was to measure the prevalence of inappropriate prescribing in elderly patients with dementia at Ayrfield Medical Practice in Kilkenny, Ireland. The 2012 Beers Criteria was the standard used for comparison. The Beers Criteria was developed to improve the quality of care for elderly patients and provide physicians with a guideline for safe prescribing. Methods: Medical charts of 80 patients ≥ 65 years old with documented dementia at a primary care centre were studied. The range of age was between 65 and 98 years of age, the mean age was 83.5 years (± SD 9.3). Of the patients studied, 67.5% were female. Patients’ current diagnoses and medications were documented and the Beers Criteria was applied to measure the prevalence of inappropriate prescribing. Results: The mean number of diagnoses per patient was 3.3 (± SD 1.8) and the mean number of medications prescribed per patient was 9.3, ranging from 0–22. Beer’s criteria identified a total of 129 inappropriate medications in 72.5% (58) of patients. Medications with strong anticholinergic properties (antidepressants, antihistamines, anti-parkinson agents, skeletal muscle relaxants, antipsychotics, antimuscarinics, and antispasmodics) accounted for the majority of inappropriate medications and were prescribed to 66.3% (53) of patients. Discussion & Conclusion: Potentially inappropriate drug prescribing is widespread among elderly patients. Regular review of medications by a primary care team and cessation of inappropriate medications should be incorporated into intervention strategies to reduce the number of inappropriately prescribed medications and associated adverse outcomes., Background/Purpose: Medication-related adverse events are a significant cause of morbidity and mortality in the geriatric population. With the percentage of Canadians over age 65 expected to double within the next 20 years, educating medical trainees about appropriate prescribing of medications for geriatric patients is becoming increasingly important. Using the internal medicine teaching ward, this study explored the teaching discussions that occur with respect to prescribing, and the use of potentially inappropriate medications (PIMs). Methods: Four admission histories for elderly patients were scripted to include learning opportunities regarding geriatric prescribing. A simulated student orally presented 1–3 admission histories to each of 24 internal medicine ward attending physicians (12 geriatricians and 12 internists) who were instructed to respond as they normally would during morning rounds. Semi-structured interviews following the case discussions explored how attending physicians chose the topics they talked about. Transcribed audio-recordings of 66 case review discussions were analyzed using template and inductive analysis for teaching scripts pertaining to PIMs. Results: Twenty of 24 interviews involving the review of 54 patient cases have been completed. Geriatrician and non-geriatrician attendings varied in terms of their degree of uptake of the geriatric prescribing teaching and learning opportunities built into the cases. Preliminary analysis of 20 completed interviews will be presented. Discussion & Conclusion: Teaching about geriatric prescribing and PIMs on the internal medicine clinical teaching wards can play a crucial role for the care of geriatric patients. Our study is the first to examine the teaching discussions around the prescription of medications for older adults in the context of the general medicine ward., Background/Purpose: Children born to mothers of advanced or adolescent ages face increased risk for multiple health problems. In this study, we investigated whether individuals born to mothers of these ages were more likely to experience frailty later in life. Methods: This was a retrospective cohort study of the Health and Retirement Survey, including 3,080 Americans age 50+ (mean = 58.2 ± 5.5 years, 54% women) for whom maternal age data were collected. Frailty was assessed using a 33-item frailty index; participants with scores 0.25 were considered frail. Maternal age at participants’ time of birth was categorized as older (35 years) or younger (< 20 years), compared to a reference group (20–34 years). Results: Mean maternal age was 22.7 ± 6.5 years. After controlling for participants’ age, gender, and education level, being born to an older mother was associated with higher risk for frailty compared to the reference group (OR = 1.61, 95% CI = 1.05–2.48), as was being born to a younger mother (OR = 1.40, 95% CI = 1.15–1.71). When maternal education level was added to the regression model, being born to an older mother was no longer associated with higher risk for frailty (OR = 1.52, 95% CI = 0.98–2.34), but being born to a younger mother remained associated with higher risk, at a similar level (OR = 1.41, 95% CI = 1.15–1.72). Discussion & Conclusion: Among middle-aged and older Americans, being born to an older mother is not associated with greater risk for frailty once maternal education is taken into account. However, being born to an adolescent mother is associated with higher risk for frailty later in life, regardless of maternal education level., Background/Purpose: Social vulnerability has been shown to be associated with mortality in Canadian populations. The purpose of this study was to investigate whether social vulnerability can predict mortality in middle-aged and older Europeans, after considering frailty. Methods: This was a secondary analysis of the first wave of SHARE (Survey of Health and Retirement in Europe), which began in 2004 and included a probability-based sample of non-institutionalized participants aged 50+ from 11 European countries. We used the deficit accumulation approach to create a frailty index and a social vulnerability index. The frailty index included 70 health deficits from the physical health, behavioural risks, cognitive function, and mental health sections of the main questionnaire. The social vulnerability index included 29 social factors from the drop-off questionnaire. For each index, an individual’s score reflects the proportion of deficits present out of the total possible deficits. Results: 18,289 participants were included in the analysis (age 65.0 ± 9.67, 45.9% male). The mean frailty index score was 0.15 ± 0.11 and the mean social vulnerability index score was 0.32 ± 0.09. Social vulnerability significantly predicted 5-year mortality when controlling for age and sex (adjusted hazard ratio = 1.33, confidence interval 1.25–1.42, p < .001). This association remained significant when additionally controlling for frailty (adj. HR = 1.09, CI 1.01–1.17, p = .02). Discussion & Conclusion: Similarly to Canadian populations, social vulnerability appears to be an important component for mortality risk stratification in middle-aged and older Europeans. Future investigations are needed to focus on the clinical implications of social vulnerability in older patients., Background/Purpose: The relationship between increased arterial stiffness and cardiovascular mortality is well-established in older adults. Short-term vigorous exercise interventions have been shown to reduce arterial stiffness in older adults with T2DM. We examined whether training type (aerobic training versus strength training) influences the improvement in arterial compliance in older adults with Type 2 diabetes complicated by co-morbid hypertension and hyperlipidemia. Methods: A total of 45 older adults (mean age 72.3 ± 0.7 years) with diet-controlled or oral hypoglycemic-controlled T2DM, hypertension, and hypercholesterolemia were recruited. Subjects were randomly assigned to one of three groups: an aerobic group (6 months vigorous aerobic exercise, AT group, n = 20), a strength training group (6 months strength training, ST group, n = 15), and a control group (no training, C group, n = 10). Exercise sessions were supervised by a certified exercise trainer three times per week. Arterial stiffness was measured as pulse-wave velocity (PWV) using the Complior device. Results: There was a significant difference in the response to training (group × time) between the AT and NA groups for both radial (p = .011) and femoral (p = .017) PWV. This was primarily due to an improvement in the AT group after 3 months training as compared to control (p < .001 radial PWV; p < .001 femoral PWV), that was not maintained at the 6-month mark for either radial or femoral PWV. Discussion & Conclusion: Our findings indicate that in older adults with T2DM, long-term strength training resulted in no improvement in measures of arterial stiffness, while aerobic exercise resulted in short-term improvements in arterial stiffness that became attenuated over the long term., Background/Purpose: Our program aims to provide physicians with Enhanced Skills in Care of the Elderly training. The program has undergone significant educational changes in the last year. Methods: The COE Program was established at the University of Alberta in 1993. To date, 51 residents have completed the program. Program description: 6 months to 1 year Enhanced Skills Diploma Program with core program requirements including geriatric inpatient, geriatric psychiatry, ambulatory, continuing care, and outreach. There is a longitudinal clinic component and a research project requirement. The program is designed to cover 85 core competencies encompassing the CanMEDS-Family Medicine Roles. Results: With the increased complexity of the frail elderly we are expanding the program to a 1-year program for the majority of residents, with an exit exam upon completion. This exit exam is comprised of MCQ and geriatric assessment observation with patient encounter. We have been able to increase our positions to four 1-year positions from four 6-month positions. With the increase of the program to 1 year, we have added new rotations in Palliative Care and significantly developed the community experience with rotations in Continuing Care which includes Supportive Living and a Home Living rotation. We have also introduced the electronic Competency Based Achievement System to give formative feedback to our residents. Discussion & Conclusion: There is a need for Care of the Elderly physicians to provide clinical care, as well as educational, administrative, and research roles to meet the health-care needs of medically complex seniors. We have made changes to our program to prepare residents for these roles., Background/Purpose: Post-operative delirium is associated with pain but also from the use of analgesics. Gabapentin has an opioid sparing effect and reduces pain in the acute post-operative period. The study objective was to determine the treatment effect of perioperative gabapentin on the incidence of post-operative delirium among elective total knee arthroplasty (TKA) patients. Methods: 161 patients with American Society of Anesthesiology (ASA) physical status class I–III scheduled for elective total knee arthroplasty at an orthopedic centre were randomized to receive gabapentin 200 mg (n = 83) or placebo (n = 78) before surgery and up to 3 days post-operatively. Incident delirium in the post-operative period was determined by a validated chart abstraction tool. A subset of charts was abstracted by two independent reviewers to determine inter-rater reliability. Data abstractors and patients were blinded to the study drug allocation. Results: Inter–rater agreement was good (κ = 0.83). Baseline characteristics, co-morbidities, type of anesthesia and analgesia, and previous exposure to gabapentin between the 2 groups were similar. Incident delirium in gabapentin (12%) and placebo (9%) groups was not significantly different (p = .53; absolute risk reduction −3.1%, 95% CI −12.5 to 6.4%). The mean duration of delirium in both groups was 1 day. Discussion & Conclusion: Perioperative gabapentin was not effective for the prevention of post-operative delirium in elective TKA patients nor did gabapentin have an effect on delirium duration., Background/Purpose: The objectives are: to describe factors associated with multi-morbidity in community-dwelling older adults; and to determine if a simple measure of multi-morbidity predicts death over 5 years. Methods: Analysis of an existing population-based cohort study. Population: 1751 community-dwelling adults, aged 65+, were interviewed and followed over 5 years. Measures: Age, gender, marital status, living arrangement, and education were all self-reported; the Mini-Mental Status Examination (MMSE), the Center for Epidemiologic Studies—Depression (CES-D), and the Older Americans Resource Survey (OARS). The measure of multi-morbidity was a simple list of common health complaints and diseases, followed by an open-ended question of other problems. These were summed and the score ranged from 0 to 16. Death and time of death were determined over the 5-year interval by death certificate, administrative data, and proxy report. Analysis: Cox proportional hazards models were constructed for time to death. Results: Multi-morbidity was more prevalent in women, older age groups, those with lower education levels, lower MMSE scores, more depressive symptoms, and higher levels of disability. Multi-morbidity was a strong predictor of mortality in unadjusted models—the Hazard Ratio (HR) and 95% confidence interval (95% CI) was 1.09 (1.05, 1.12). In models adjusting for age, gender, education, marital status, living arrangement, the CES-D, and the MMSE, this effect persisted: the HR and 95% CI was 1.04 (1.00, 1.08). However, after adjusting for functional status, the effect of multi-morbidity was no longer significant. Discussion & Conclusion: Multi-morbidity strongly predicts 5-year mortality, and the effect may be mediated by disability. The cumulative effect of health problems, however minor, is associated with poor outcomes. Guidelines and clinical care models must consider multi-morbidity., Background/Purpose: Older patients often pose a challenge to physicians who must determine which patients are good candidates for invasive cardiac procedures, a decision often left to clinical gestalt. The concept of frailty, a multidimensional approach to stratify older patients by physiology and function rather than age, has been associated with poor outcomes. However, due to the lack of consensus on significant measures and the increased time and personnel required, routine frailty assessments are not often used. Methods: A retrospective chart review was completed on 171 consecutive patients over the age of 85 who underwent PCI between 2007 and 2010. Four outcomes were evaluated: major adverse cardiac event, in-hospital death, increase in creatinine by > 25%, or any in-hospital complication. Sixteen demographic, clinical and frailty variables were studied. Results: The univariate analysis, using chi square for categorical and t-test for continuous variables, found that patients presenting with cardiogenic shock or urgent PCI had an increased risk for each of the four outcomes. A logistic regression with the outcome “any in-hospital complication”, found that the “inability to walk without an aid or assistance” (OR 3.9 (95% CI 1.8, 8.5)) was associated with in-hospital complications. Discussion & Conclusion: Our study found that patients over the age of 85, who were unable to walk without an aid or assistance, were 3.9 times more likely to have a post-PCI in-hospital complication. Asking a patient this simple question about their mobility is both quick and straightforward. A larger prospective study will need to assess whether this type of question could be used as a bedside screening tool to predict poor outcomes in older adults undergoing PCI., Background/Purpose: There is paucity of information concerning the epidemiology of multimorbidity in the frail elderly in Alberta. Four rehabilitation wards at a Rehabilitation Hospital have collected data from 2003–2012 for each admission. The de-identified data include ICD-10 diagnosis codes, length of stay (LOS), admission and discharge dates, admission and discharge Functional Independence Measure (FIM) scores, and age of patients. The objective is to begin analyzing and characterizing multi-morbidity in the geriatric population of Alberta. Methods: Data for 2010–12 were separated. A list of all present ICD-10 codes was formed. ICD-10 codes were put into diagnosis groups, which were then counted. The number of ICD-10 codes per patient was counted. The rate of FIM change (FIM efficiency) was calculated according to the equation: (Discharge FIM-Admission FIM)/Length of Stay). Regression analysis was performed to compare the relatedness between FIM Efficiency and Admit FIM, Length of Stay, and Number of Diagnosis Codes. Results: Initial analysis of codes of interest showed that 0% of this geriatric population had a code for chronic obstructive pulmonary disease, congestive heart failure, or urinary tract infection. Regression analysis revealed that Admission FIM and LOS are significant with FIM Efficiency, but Number of Diagnosis Codes is not. Discussion & Conclusion: The ICD-10 codes do not reflect expected prevalence for major chronic diseases. This may be a result of codes forming a present problem/treatment list, rather than a list of all diagnoses. There is a need for another study to fully describe the epidemiology of multi-morbidity in this population., Background/Purpose: Wounds, such as diabetic, venous ulcers, pressure ulcers, and surgical wounds, present a significant economic burden on health-care systems. High-quality cost-effectiveness evidence may play a role in considering resource allocation. We conducted a systematic review of cost-effectiveness analyses (CEAs) of wound care interventions to evaluate the methodological quality and cost-effectiveness of this evidence-base. Methods: Potentially relevant material was identified through searching MEDLINE, EMBASE and the Cochrane Library. Inclusion criteria included CEAs assessing any type of intervention for treating wounds in adults. Two reviewers independently screened search results and abstracted data from relevant articles in duplicate. The methodological quality of the included CEAs was appraised using the Drummond tool. Results: 6199 titles and abstracts and 421 full-text articles were screened for inclusion. Of these, 35 CEAs (including 12 cost-utility analyses) were included. The majority of the included CEAs (69%) focused on elderly patients. Only 12 CEAs were deemed to be high-quality (including one from Canada). Seven high-quality CEAs found the following interventions were cost-effective: pentoxifylline plus usual care versus standard compression with external treatment, 4-layer high-compression bandages versus short-stretch high-compression bandages, multi-disciplinary community wound care teams versus usual nursing care, hyperbaric oxygen therapy plus standard care versus standard care alone, becaplermin gel containing recombinant human platelet-derived growth factor plus standard care versus usual wound care alone, and ertapenem versus piperacillin/tazobactam. Discussion & Conclusion: We identified a large research gap in CEAs of wound care interventions, and the quality of the evidence is limited., Background/Purpose: Older adults have multiple chronic health and social conditions, requiring expertise from different health-care professionals. With the proportion of older adults increasing, it’s important for these professionals to work together effectively. Interprofessional education (IPE) (when two or more professionals learn with, from, and about each other to improve collaboration and quality of care) has been incorporated into policy, systems, and curricula globally. However, the impact of IPE remains unclear. An updated systematic review was performed to assess the effectiveness of IPE interventions on professional practice and health outcomes. Methods: We searched MEDLINE, CINAHL, and the Cochrane EPOC Register from 2007 to 2010. Additional articles were identified through reference lists and discussion with experts. Randomised controlled trials (RCTs), controlled before and after (CBA), and interrupted time series (ITS) studies of IPE interventions reporting objectively measured or self-reported (validated instrument) patient and/or health-care process outcomes were included. Two reviewers independently assessed potential study eligibility, performed data abstraction, and quality assessments. Results: Three studies met inclusion criteria. The CBA study reported improvements in presurgical procedure briefings and teamwork behaviours in the operating room of a community hospital. One RCT showed mixed results with no change in adverse patient outcomes, but a reduction in process outcomes (time from decision to perform a caesarean section to incision) in a labour and delivery team. Another RCT did not demonstrate an impact on primary care management of asthma. Discussion & Conclusion: Although studies suggest some positive impact, the difficulty of drawing conclusions about the effectiveness of IPE remains. Due to the heterogeneous and small number of studies with methodological limitations, further rigorous study designs are warranted., Background/Purpose: Cognitive impairment can affect driving performance among older drivers. The objective of this study was to examine the association between selected cognitive measures and self-reported driving comfort, abilities, and behaviours. Methods: We conducted a cross-sectional analysis of data from the first year of the Candrive II prospective cohort study, a 5-year longitudinal study of healthy drivers aged 70+ from seven Canadian cities. Cognitive assessment tools included: the Montreal Cognitive Assessment (MoCA) and Trail Making Tests, parts A and B. Driver perceptions were assessed using the Day and Night Driving Comfort scales and the Perceived Driving Abilities scale, while driving practices were captured by the Situational Driving Frequency and Avoidance scales and the Driving Habits and Intentions Questionnaire. Results: A total of 928 drivers, 62.2% male, with a mean age of 76.2 ± 4.8, were recruited. Univariate regression analyses revealed that the times to complete Trails A and B were modestly associated with self-reported driving avoidance, day and night driving comfort, and perceived driving abilities (p < .05). The association persisted after adjusting for age and sex, as well as variables pertaining to health, vision, mood, and physical functioning. Neither MoCA total score nor errors on Trails A and B were associated with any of the self-reported driving variables (p >.05). Discussion & Conclusion: Time to complete Trails A and B was statistically significant, but only modest predictors of self-reported driving comfort, abilities, and behaviours in this cross-sectional analysis. Results from the prospective follow-up of this cohort of older drivers will help clarify the relationship between cognitive performance and self-reported driver perceptions and driving restrictions., Background/Purpose: Hospital malnutrition is prevalent in elderly and contributes to loss of functional status, increases morbidity, mortality, length of stay and cost of care. Nutritional interventions improves outcomes in hospitalized elderly. Systematic service of diet based solely on age is not customary in adult acute care settings. Methods: As part of the OPTIMAH approach of care, we analyzed the protein and caloric content of every available diet at the Montreal University Hospital and compared it to metabolic requirements of hospitalized elders (75 yrs). Results: Most diets did not meet increased metabolic needs of the hospitalized elder population. Thus, we elaborated a menu that fulfills nutritional requirements and preferences of elders. New enrichment processes were developed to minimize cost. We modified the distribution process to ensure automatic serving of the OPTIMAH diet to this population. Nutritionists, diet technicians, and nurses on ward received a short training to inform them of the new diet and process of distribution. Nurses and physicians were sensitized to avoid prescribing restricted diets unless part of immediate essential medical treatment. Six months after the availability of the OPTIMAH diet throughout the 3 sites of the Montreal University Hospital, 74% of elder hospitalized patients were receiving this adapted diet. Discussion & Conclusion: The new OPTIMAH diet more closely fulfills the metabolic needs of elders in acute care. It is the first step to prevent in-hospital malnutrition. Adult acute care services should, like pediatric health services, offer adapted diets according to age. Government norms and correspondent financing should be readjusted to meet elders’ metabolic requirements to prevent costly complications related to hospital-acquired malnutrition., Background/Purpose: Education is an important component of dementia treatment for patients and their support networks. To compliment recommending education available from the Alzheimer Society of Canada, practical booklets were developed to improve the written educational material available regarding dementia. Methods: Hobbs, Hurley and Rhynold wrote three booklets: An Introduction to Dementia, The Dementia Compass, and Later in the Dementia Journey. Dougan designed an eye-catching theme to appeal to a wide audience. These booklets have been piloted in the Horizon Health Network, New Brunswick. A satisfaction survey was given to 25 patients and/or caregivers attending the Geriatric Medicine Ambulatory clinics at St. Joseph’s Hospital in Saint John, NB at follow-up appointments. Email feedback was also solicited. Results: As of September 2012, six sites in New Brunswick have ordered a total of 4151 booklets. Survey results averaged > 9/10 on the visual analog scale with a score of 10 indicating “very helpful”. Email feedback was positive with some suggestions for improvements. By survey, clinic attendees often indicated they were not interested in reading the material online. Discussion & Conclusion: Future directions: The writing team has always made the free distribution of these booklets their priority. Now that these booklets are available, the focus has shifted to increase distribution through written and online versions., Background/Purpose: Osteoporosis Canada’s Clinical Practice Guidelines for the Diagnosis and Management of Osteoporosis (OCG) provide guidance for the management of individuals 50 years and older at risk for fractures. However, OCG cannot benefit long-term care (LTC) residents if physicians perceive barriers to their application. Our objectives are to explore current practices to fracture risk assessment by LTC physicians, and describe barriers to applying OCG for fracture assessment and prevention in LTC. Methods: A cross-sectional survey was conducted with the Ontario Long-Term Care Physicians Association using an online questionnaire. Closed-ended responses were analyzed using descriptive statistics and thematic framework analysis for open-ended responses. Results: We contacted 347 LTC physicians; 88 submitted completed surveys (81% men, mean age 60 years (SD 11), average 32 [SD 11] years in practice). 87% of LTC physicians considered the prevention of fragility fractures important, but a minority (34%) reported using validated fracture risk assessment tools, while 33% did not use any. Clinical risk factors recommended by OCG for assessing fracture risk considered applicable included: glucocorticoid use (99%), fall history (93%), age (92%), and fracture history (90%). Recommended clinical measurements considered applicable included: weight (84%), TSH (78%), creatinine (73%), height (61%), and Get-Up-and-Go (60%). Perceived barriers to assessing fracture risk included difficulty acquiring necessary information (35%) due to lack of access to tests (bone mineral density, X-rays) or obtaining medical history; resource constraints (30%); and a sentiment that assessing fracture risk is futile in this population because of short life expectancy and polypharmacy (28%). Discussion & Conclusion: These findings highlight the necessity to adapt the OC guidelines so they are evidence-based and applicable to LTC, and to disseminate them to LTC physicians., Background/Purpose: We conducted a systematic review examining the comparative safety and efficacy of cognitive enhancers for patients with Alzheimer’s disease (AD). Numerous outcomes to assess AD were identified but selecting optimal ones for inclusion in our systematic review remained unclear. We compiled the identified outcomes and surveyed decision-makers to identify relevant outcome measures for inclusion in our systematic review. Methods: A systematic review was conducted on cognitive enhancers for AD by searching MEDLINE, EMBASE, and the Cochrane Library. Subsequently, two reviewers independently abstracted outcome measures used to assess cognition, function, behaviour, and global status. The identified outcome measures were compiled and sent to 36 clinicians (geriatricians from the Divisions of Geriatric Medicine at the University of Toronto and McMaster University) and 17 health policy-makers (from Health Canada) using FluidSurvey. Participants voted on the utility of 72 cognition measures, 29 function measures, 13 behavioural measures, and 12 global status measures using a 7-point Likert scale ranging from not important to most important. The scores for each scale were averaged to obtain a rating per scale. Results: 60% of invitees completed the survey. The average ratings per scale ranged from 6.50 to 2.97. The top-rated scale for cognition was the Trail Making test (average score 5.80), for function was the Activities of Daily Living (6.50), for behaviour was the Brief Neuropsychiatric Inventory (5.53), and for global status was the Clinician Interview-based Impressions of Change plus Caregiver Input (6.10). These results were used to inform data abstraction for our systematic review. Discussion & Conclusion: Our results can inform clinicians and researchers about relevant outcomes to assess patients with AD., Background/Purpose: In Canada, cognitive enhancers such as donepezil, rivastigmine, galantamine, and memantine have been approved for use in AD. Our objective was to examine the comparative efficacy and safety of these agents through network meta-analysis (NMA). NMA is an extension of traditional meta-analysis, and covers both indirect treatment comparison and mixed treatment comparison. Methods: Experimental and observational studies were identified through searching electronic databases (e.g., MEDLINE, AgeLine) from inception to 2011. Studies reporting on adverse events, cognition (e.g., Alzheimer’s disease assessment scale – cognitive subscale [ADAS-cog]), function, behaviour or global status were included. Reviewers independently screened search results and abstracted data from relevant articles in duplicate. Methodological quality was appraised using the Cochrane Risk of Bias for experimental studies and the Newcastle Ottawa scale for observational studies. Random effects and network meta-analyses were conducted. Results: A total of 132 randomized controlled trials, 4 non-randomized clinical trials, 2 controlled before-after studies, and 44 cohort studies were included after screening 15,676 titles and abstracts and 964 full-text articles. Preliminary results from the NMA indicate the following drugs performed better than others on cognition as per the ADAS-cog scale (listed in descending order): donepezil 10 mg, donepezil 5 mg, galantamine 16–24 mg, and memantine 20 mg. For nausea, use of the following drugs resulted in lower proportions of patients experiencing nausea (listed in descending order): memantine 20 mg, rivastigmine patch 9.5 mg, placebo, and donepezil 5 mg. Discussion & Conclusion: Donepezil 5–10 mg was most effective at improving cognition for patients with AD. The cognitive enhancer with the lowest risk of nausea was memantine 20 mg. These results can be used by patients and clinicians to tailor their AD treatment by specific cognitive enhancers., Background/Purpose: Individuals with mild cognitive impairment (MCI) suffer from memory problems without significant limitations in activities of daily living (ADL). Cognitive enhancers are used to treat dementia, but their effectiveness for MCI is unclear. We conducted a systematic review to examine the comparative efficacy and safety of cognitive enhancers for patients with MCI. Methods: Experimental studies were identified through searching electronic databases (e.g., MEDLINE, EMBASE). Studies examining cognitive enhancers in MCI and reporting on adverse events, cognition (Mini-Mental State Exam [MMSE], Alzheimer’s disease assessment scale – cognitive subscale [ADAS-cog]) or function (Alzheimer’s disease cooperative study: ADL inventory [ADCS-ADL]) were included. Two reviewers independently screened search results, abstracted data, and appraised risk of bias using the Cochrane risk of bias tool. Random effects meta-analysis was conducted. Results: Nine randomized controlled trials were included after screening 15,676 titles and abstracts and 964 full-text articles. No significant findings were observed for impact on cognition (MMSE: 3 RCTs, mean difference [MD] 0.14, 95% confidence interval [CI] −0.22, 0.50, ADAS-cog 5 RCTs, MD −0.52, 95% CI −1.09, 0.06), although there was a trend towards favouring cognitive enhancers. Similarly, function was not significantly impacted (ADCS-ADL, 2 RCTs, MD 0.30, 95% CI −0.26, 0.86) and no trend was observed. Cognitive enhancers were associated with a higher risk of nausea (5 RCTs, relative risk [RR] 2.95, 95% CI 2.48, 3.52), diarrhea (5 RCTs, RR 2.71, 95% CI 1.90, 3.85), and vomiting (3 RCTs, RR 4.40, 95% CI 3.21, 6.03). Discussion & Conclusion: Cognitive enhancers did not improve cognition or function among patients with MCI and were associated with a greater risk of nausea, diarrhea, and vomiting., Background/Purpose: Venlafaxine is a commonly prescribed antidepressant, but it is unknown whether its noradrenergic effects impart an increased cardiovascular risk. Objective: To examine the cardiac safety of venlafaxine relative to sertraline in older patients. Methods: We conducted a retrospective cohort study using administrative health-care databases in Ontario, Canada. We included all patients aged 66 years or older who commenced treatment with either venlafaxine or sertraline between April 1, 2000 and March 31, 2009. We used inverse probability of treatment weighting (IPTW) with the propensity score to account for observed systematic differences between the two treatment groups. The primary outcome was a composite of death or hospitalization for acute myocardial infarction or congestive heart failure within the first year of therapy. In secondary analyses, each outcome was examined separately. Results: We studied 48,876 patients initiated on venlafaxine and 41,238 patients initiated on sertraline. Of these, 4259 (8.7%) and 3459 (8.4%) experienced the primary outcome, respectively. We found no significant difference in the risk of adverse cardiac events with venlafaxine relative to sertraline (hazard ratio 0.97; 95% confidence interval 0.94 to 1.02). Secondary analyses revealed no differences in the risk of death or acute myocardial infarction between the two drugs, but the risk of heart failure was unexpectedly lower among patients treated with venlafaxine (hazard ratio 0.87; 95% CI 0.80 to 0.95). We found consistent results after stratification according to pre-existing cardiovascular disease. Discussion & Conclusion: As compared with sertraline, venlafaxine is not associated with an increased risk of adverse cardiac events in older patients., Background/Purpose: Frequent users of emergency departments, clinics and hospitals utilize a disproportionately large amount of health-care resources, thereby reducing efficiency and decreasing overall quality of care. As such, efforts have been made to implement quality improvement (QI) strategies targeting this population. Our systematic review aims to identify effective care coordination QI strategies for frequent users. Methods: We searched multiple databases (e.g., Cochrane Library, EMBASE, MEDLINE) from earliest date to March 2012. Additional citations were identified by scanning the reference lists of included studies. Citations and full-text articles were screened by two independent reviewers and relevant studies were abstracted and appraised for quality in duplicate using the Cochrane Effective Practice and Organization of Care tool. Random effects meta-analyses were conducted using data from randomized clinical trials (RCTs). Results: We screened 9564 citations and 132 full-text articles resulting in the inclusion of 44 relevant studies, including 36 RCTs. The three most commonly examined QI strategies were case management, self-management, and team changes. Nineteen studies included only patients with mental illness, while 25 included patients with other chronic illnesses. Our overall meta-analyses identified that QI strategies were effective in reducing the mean length of stay in all patients. In studies including patients with chronic illness, QI strategies effectively reduced the number of patients with emergency visits and the number hospitalized. QI strategies did not significantly reduce clinic visits or the number of patients hospitalized in studies including patients with mental illness. Discussion & Conclusion: QI strategies can reduce utilization in patients with chronic conditions. However, patients with mental illness may be more difficult to target with these QI strategies., Background/Purpose: Acute and chronic wounds result in substantial costs to our health-care system and significantly impact quality of life. Although a number of interventions are available to treat wounds, optimal strategies for wound care remain unclear. Our objective was to identify effective wound care interventions from high-quality systematic reviews in the literature. Methods: A search was conducted using MEDLINE, EMBASE and the Cochrane Library. Citations and full-text articles were screened in duplicate to include systematic reviews of adult patients receiving wound care. Two reviewers independently abstracted study characteristic and outcome data from the included reviews and appraised review quality using the AMSTAR tool. Results: From the 6199 titles and abstracts and 421 full-texts screened for inclusion, 110 systematic reviews were included. Fifty-seven reviews included meta-analyses and approximately 40% were rated as high-quality. From the highest quality meta-analyses, we identified a number of effective interventions across 5 wound types: 2-layer stockings, high-compression stockings, 4-layer bandages, elastic bandages, multi-layer high-compression, elastic high-compression, Pentoxifylline with or without compression, Cadexomer iodine, and engineered skin in patients with leg ulcers; air-fluidized beds, foam mattresses, hydrocolloid dressing, nutritional support and electrotherapy for pressure ulcers; granulocyte-colony stimulating factor, hydrogel dressing, hyaluronic acid, low-frequency/high-frequency ultrasound, and skin grafts for patients with diabetic ulcers; skin grafts and silver dressing for mixed chronic wounds; and honey for patients with burns. Discussion & Conclusion: Our results can be used by clinicians and patients to tailor treatment by wound type. Further analysis of this data through network; meta-analysis will be of utility to decision makers, as it will allow ranking of the effectiveness of all wound care interventions in the literature., Background/Purpose: Osteoporosis affects over 200 million people worldwide at a high cost to health care. Guidelines are available, but many patients are not receiving appropriate care. We developed an osteoporosis knowledge translation (Op-KT) tool to support clinical decision making: a tablet-initiated risk assessment questionnaire (RAQ), which generates best practice recommendations for physicians; and a customized education sheet for patients. We evaluated its impact on the initiation of appropriate osteoporosis disease management in primary care. Methods: Following an implementation plan in 3 family practices in Hamilton, Ontario that included workflow analysis, the Op-KT tool was evaluated using an interrupted time series design. This involved multiple assessments 12 months before (baseline) and 12 months after introducing the tool. Analysis included segmented linear regression models and analysis of variance. Results: Five family physicians from 3 practices participated; 2840 patients (mean age 67 years; 79% women) were eligible (31% of the practice population). Time series regression models showed an increase from baseline in the initiation of bone mineral density testing (3.2%; p = .02), any osteoporosis medication (0.5%; p = .0064), and calcium or vitamin D (1%, p = .0013). The RAQ was completed without prompting by 351 patients (mean age 64 years; 77% women; mean time to completion 3.43 minutes). Of these, 276 patients (79%) were at risk for osteoporosis (1 major or 2 minor risk factors). Discussion & Conclusion: Our multi-component Op-KT tool significantly increased osteoporosis investigations in 3 family practices. The study highlights the potential of using decision support tools at the point of care in busy, short-visit practices to facilitate patient self-management., Background/Purpose: Almost 30,000 patients annually experience a hip fracture in Canada. They tend to be older, frail with multiple chronic illnesses, including a high incidence of dementia and delirium. For many, the hip fracture results in poor outcomes including loss of function and use of ALC (alternate level of care) beds. In 2011 Bone and Joint Canada (BJC) worked with health-care professionals from across the country to develop a National Hip Fracture Toolkit, which was based on available evidence and a consensus building approach, to provide clinical and system best practices to better manage these patients and return them home. Methods: A knowledge translation approach was used to assist provinces to review their performance and to facilitate uptake of best practices. Identified barriers to care included the management of frail patients and their co-morbidities, access to rehabilitation, weight bearing, and patient education. Results: All provinces participated in the KT strategy at a national level, as well as hosting provincial and local events to measure their performance against the Toolkits recommendations. Care maps were implemented at a provincial level, and local improvement initiatives were undertaken in all provinces in 2012/2013. Surgeon practices to promote weight bearing were investigated and patient education materials were developed. In Ontario, recommendations on best practice were made for future funding of hip fracture patients. Discussion & Conclusion: The National Toolkit provides a system and clinical practice information on pre-operative, surgical, and post-operative care. It uses a multidisciplinary and multi-faceted approach to the clinical and operational management of older hip fracture patients and has improved care across the country., Background/Purpose: The UK Commissioning for Quality and Innovation Dementia (CQUIN) framework (2012) aims to facilitate early identification of patients with dementia during their inpatient stay and ensure they are referred to appropriate services. Step 1 is to find all patients over age 75 years meeting the inclusion criteria. Step 2 is assessment using a screening questionnaire, AMTS, collateral history, examination, and investigations, in order to stratify all patients as suspected dementia, known dementia or no cognitive impairment. Step 3 is referral to memory services or GP for further follow-up. We aimed for rapid assessment of all patients over 75 years of age admitted acutely to achieve 90% compliance in Steps 1–3. Methods: All patients over 75 were identified on a daily basis. A pro forma was developed and available in all wards. Junior physicians in elderly care wards assessed patients during daily rounds. The roles of the memory nurses were changed to supervise data collection and review patients in other wards. Results: The total number of patients assessed in September was 341/377 (90.5%) and October 2012 465/494 (97%). Of these patients with a diagnosis of delirium or who scored positively on the screening question, 113/113 (100%) and 192/198 (97%), respectively, had a dementia diagnostic assessment. In September 54/55 (98.2%) and October 133/133 (100%) of patients with suspected dementia were referred for further follow-up who might have been missed with standard care. Discussion & Conclusion: Implementation of the UK Dementia (CQUIN) framework is achievable through staff education, change in working practice, and clear implementation of protocols, with little extra resources. Early recognition of suspected dementia increases early access to appropriate support for patients and their careers., Background/Purpose: Our objective was to examine the impact of specialized palliative care (PC) (defined as a physician consultation focusing on PC needs, lasting at least 40 minutes) for adults 70 and older on: (a) use of chemotherapy within 14 days of death, (b) more than one emergency department (ED) visit, (c) more than one hospitalization, and (d) at least one intensive care unit (ICU) admission, all within 30 days of death. Methods: A retrospective population-based cohort study using linked administrative databases in Ontario was conducted with patients diagnosed with advanced pancreatic cancer from 1 Jan 2005 to 31 Dec 2010. Multivariable logistic regression analyses were performed with the above quality indicators as the outcomes of interest and PC as the exposure, adjusting for other variables (age, sex, comorbidity, rurality, and health region). Results: Of 6,076 patients with advanced pancreatic cancer, 58% were age 70 or older, and 5,381 had died at last follow-up. 57% (1251/2187) of those younger than 70 and 49% (1565/3194) of those 70 and older received a PC consultation (p = .0001). PC was associated with a lower odds (OR) of aggressive care among all age groups: 0.34 (95% CI 0.25–0.46) for chemotherapy; 0.12 (95% CI 0.08–0.18) for ICU; 0.19 (95% CI 0.16–0.23) for multiple ED visits; and 0.24 (95% CI 0.19–0.31) for multiple hospitalizations near death. Older age was also associated with lower odds of aggressive care for all four outcomes. Discussion & Conclusion: In patients with advanced pancreatic cancer, PC is associated with less frequent aggressive care across all age groups, but PC consultation and aggressive care were both less likely in older patients (70+)., Background/Purpose: To meet the challenges of population aging and increasing multimorbidity, significant reform to health-care systems is underway. New models of care include the patient-centred medical home and interprofessional team-based approaches; however, there has been limited exploration of the effectiveness of such interventions for patients with multimorbidity. To evaluate both the clinical-effectiveness and cost-effectiveness of a team-based model of primary care specifically designed for older patients with multimorbidity. Methods: Multi-site randomized controlled trial of the IMPACT clinic (Interprofessional Model of Practice for Aging and Complex Treatments). Inclusion criteria: patients aged 65+, three or more chronic diseases requiring monitoring and treatment, five or more long-term medications, and minimum of one functional ADL limitation. Exclusion criteria: home-bound or institutionalized patients, or deemed unsuitable by the usual family physician. The IMPACT team comprises family physicians, specialist physicians, visiting nurse, pharmacist, community social worker, occupational therapist, physiotherapist, dietitian, and care navigator. IMPACT patients are scheduled for extended visits (1.5 to 2 hours) during which the full team works collaboratively with the patient and family caregiver(s) to address current medical, functional, and psycho-social issues. During the visit, a pro-active interprofessional care plan is developed, a comprehensive medication review is conducted, and a discussion of anticipatory care planning is initiated. Results: Primary outcomes include Emergency Department visits, hospitalizations, and physician visits. Secondary outcomes include patient satisfaction, family caregiver satisfaction, provider satisfaction, quality of life, caregiver strain, and interprofessional team function. Discussion & Conclusion: This RCT will contribute much-needed evidence on the effectiveness of a team-based primary care intervention for older patients with multimorbidity., Background/Purpose: Cancer is a disease that mostly affects older adults. A geriatric assessment (GA) has been recommended for older adults to assist with treatment decision-making. The aims of review: 1) to provide an overview of the use of GA in oncology; 2) to examine feasibility and psychometric properties; 3) to systematically evaluate the effectiveness of GA in predicting/modifying outcomes. Methods: A systematic review of literature published between November 2010 and July 2012. Articles published in 5 databases in English, Dutch, French, and German were included. Articles were selected and reviewed by 2 independent reviewers. Results: 34 manuscripts reporting on 33 studies were identified. The quality of most studies was moderate to good. Of all studies, 14 were prospective, 8 cross-sectional, 5 retrospective and 7 others (mostly phase II trials of a new treatment regimen). A GA was shown to be feasible, the time needed to complete ranged between 5 and 120 minutes, were mostly conducted in the outpatient oncology setting by nurses, and most often included the domains activities of daily living, co-morbities, cognitive function, depression, medications, and fall risk assessment. Four studies examined psychometric properties of the GA with satisfactory results, and 18 studies examined the predictive ability of the GA and showed that components of the GA predicted treatment toxicity and overall survival. Discussion & Conclusion: Although the studies showed that GA was feasible and had predictive validity, there has not been a randomized controlled trial showing the effectiveness of the GA in improving outcomes for older adults with cancer., Background/Purpose: The capacity for bone repair and regeneration diminishes with age. This prolongs fracture healing time and, in some instances, results in non-union, requiring extensive surgery. The mechanism behind this is not known; however, studies thus far have assumed the reason to be a decrease in the capacity of bone marrow mesenchymal stem cells (MSCs) to differentiate into bone-forming cells (osteoblasts). We found that old MSCs can be “rescued” to behave like young MSCs when cultured in media pre-treated by young cells. These findings implicate the presence of a “youth factor” that is secreted by young bone marrow cells and is able to rescue the aged phenotype of old cells. Thus, the purpose of this study is to determine the cell type responsible for rescue of osteoblast differentiation in old cells, and to determine its effects on fracture repair in old mice. Methods: Bone marrow cells were isolated from young and old mice. Osteoblast differentiation in culture was determined by quantifying colony forming unit-osteoblast. Fracture repair was assessed using a tibial fracture mouse model. Results: Co-culture of old cells with young hematopoietic stem cells (HSCs) promoted osteoblast differentiation of these old cells. Interestingly, an adherent F4/80+ cell population (a marker of monocyte–macrophage cell lineage) was identified in young, but not old, HSC cultures. In culture, exposing old MSCs to media pre-treated by young macrophages induced osteoblast differentiation of these cells. Furthermore, bone marrow transplantation of young F4/80+ cells into old mice resulted in improved fracture repair. Discussion & Conclusion: This study demonstrates that young macrophages secrete soluble factors that can rescue osteoblast differentiation and improve fracture repair in older animals., Background/Purpose: The Canadian Institute of Health Information (CIHI) designates patients who remain in hospital after their acute care phase is completed as Alternate Level of Care (ALC) patients. Understanding who the ALC population is in hospital is needed. Methods: All ALC patients Horizon Health Network (HHN) as of Feb 9, 2012 were identified. A data collection tool, designed for the study, was used to review charts. Results: There were 413 ALC patients identified, occupying 25.2% of all hospital beds within HHN. A stratified random sample from 7 hospitals comprised the sample of 223. Two were excluded due to long length of stays, giving a sample of 221.The mean age was 78.4 years. Prior to admission, 51 (23.1%) were living in a care institution in the community. Dementia was a diagnosis in 53.9%. The overall mean length of stay until data collection was 293.4 days. Six months later, 81 (36.7%) were still in hospital, 32 (14.5%) had died, and 65(29.4%) were discharged to nursing home. For those discharged to a nursing home, the mean length of stay was 262.8 days. For those still in hospital, the mean length of stay was 683.9 days. Discussion & Conclusion: The majority of ALC patients are elderly with dementia. Six months after data collection, the majority remain in hospital with a mean length of stay of almost 2 years. Even those who went to a nursing home, the length of stay was almost 9 months., Background/Purpose: Identifying measures to predict short-term toxicities in patients undergoing intensive chemotherapy (IC) for acute myeloid leukemia (AML) is needed. Emerging data suggest that quality of life (QOL) assessment and/or physical performance measures (PPMs) may predict outcomes in oncology, although there are no data in AML patients. Methods: We conducted a prospective, longitudinal study of adults (age 18–59) and older (age 60+) AML patients undergoing IC. Prior to starting IC, patients completed the EORTC QLQ-C30 and FACT-Fatigue, in addition to PPMs (grip strength, timed chair stands, and 2-minute walk test). Outcomes included 60-day mortality, intensive care unit (ICU) admission, and achievement of complete remission (CR). Logistic regression was used to evaluate each outcome. Results: Of the 243 patients (median age 57.5 yrs), 56.7% were male, and 96 (40%) were older. 60-day mortality, ICU admission, and CR occurred in 9 (3.4%), 15 (6.2%), and 171 (70.4%), respectively. In univariate regressions, neither QOL nor PPMs were predictive of 60-day mortality (all p > .05), whereas cytogenetic risk group (p = .04), ICU admission (p ≤ .001), and remission status at 30 days (p = .006) were. Fatigue was a significant predictor of ICU admission (p = .02), whereas QOL and baseline PPMs were not. In univariate analyses, higher Charlson score was a significant predictor of both ICU admission (p = .01) and remission status at 30 days (p = .002). Neither QOL nor PPMs were predictive of achieving CR (all p > .05). Findings were similar among the subset of older patients. Discussion & Conclusion: Baseline QOL and PPMs were not associated with short-term mortality, ICU admission, or achievement of CR after the 1st cycle of chemotherapy for AML., Background/Purpose: Self-rated health (SRH) has been shown to predict functional status in older adults, but this has less often been examined for older cancer patients. The aim of this study was to determine the association between SRH and functional status, comorbidity, toxicity of treatment, and mortality in older newly diagnosed cancer patients. Methods: Patients aged 65 and over, newly diagnosed with cancer, recruited at the Jewish General Hospital. SRH was evaluated prior to treatment, and at 3, 6, and 12 months. Functional status (Instrumental Activities of Daily Living (IADL), Basic Activities of Daily Living (ADL), ECOG Performance Status (ECOG PS), and frailty markers (low grip strength, mobility impairment, physical inactivity, cognitive impairment, mood impairment, and poor nutritional status) were measured at baseline, 3, and 6 months. Treatment toxicity and mortality were abstracted from the chart. Chi-square tests and t-tests were used to compare patients who rated their SHR as fair/poor/very poor to those very good/good with regard to functional status, frailty, and co-morbidity. Logistic and Cox regression were used to examine the association between baseline SRH and treatment toxicity/time to death. Results: There were 112 participants, median age 74.1. At baseline, 74 (66.1%) had a good SRH and 38 (33.9%) had poor SRH and those had more co-morbidities, more frailty markers present, lower ECOG PS and IADL impairments. We found no association between SRH and toxicity or mortality. Discussion & Conclusion: There was a moderate correlation between SRH and the number of frailty markers, IADL disability, and co-morbidities, but SRH did not predict toxicity or mortality., Background/Purpose: People over the age of 60 account for 60% of paramedic responses in Canada. Many of these calls are not life-threatening or time-sensitive. Paramedics have a unique opportunity to engage people in their homes and they often see people in vulnerable circumstances. The field of Community Paramedicine is growing in Ontario and across Canada due to its potential to provide alternative patient care pathways. In 2006, Toronto Emergency Medical Services (EMS) established its Community Referrals by EMS (CREMS) program to link patients with Community Care Access Centres (CCAC). With a simple phone, call paramedics identify and connect patients with community support services. Methods: To determine the effectiveness of the Community Paramedicine program, 904 patients referred to CCACs in 2011 were evaluated for improved outcomes and reduced reliance on EMS. The 6-month period prior to initiating the CCAC referral was compared to the 6 months post-CCAC referral. Results: The total calls to EMS were reduced from 2,715 to 1,340 for this patient group. Transports to emergency departments also decreased from 1654 to 582. Paramedics spent less time overall with these patients, reduced from 4597.28 hours to 1898.87 hours. Based on the decreased transports and time spent assessing and treating these patients, cost savings have been estimated to be as high as $321,600.00 for the 6-month post-referral period. Discussion & Conclusion: Community Paramedicine offers an innovative, cost effective opportunity to improve the health care of elders wishing to age and live at home independently. Future directions will include exploring an expanded scope of clinical, practice for paramedics, and a more systematic evaluation of the CREMS program with an eye toward broader implementation., Background/Purpose: Men with PCa on ADT are at risk of decreased bone mineral density (BMD) and osteoporosis. Guidelines recommend referral to specialized clinics, but the quality of care in osteoporosis clinics and benefits to patient have never been reported. Methods: Charts for 67 men (mean age 74.2 yrs) on ADT referred to an academic osteoporosis clinic between 2010 and 2011 were reviewed. The following quality of care issues were examined: (a) services provided to PCa patients receiving ADT (e.g., screening, preventing, and treating osteoporosis); (b) use of Canadian guidelines to target appropriate therapies. Results: 56 (83.6%) received continuous ADT for a mean of 27.4 ± 30.7 months at the baseline visit. 37 (55.2%) had osteopenia and 15 (22.4%) had osteoporosis. At initial consultation, 55.2% were taking 1000 mg calcium daily from all sources, while 26.9% were taking more than 1200 mg; 22.4% were taking Vitamin D 3 months. For lifestyle recommendations, 71.4% of sedentary patients were advised to increase exercise. Of the 39 (70%) and 24 (39.2%) patients who were not taking appropriate amounts of calcium and vitamin D, respectively, 100% were recommended to adjust their intake to guideline levels. Discussion & Conclusion: The osteoporosis clinic performed a comprehensive assessment and recommended guideline-based bone health care for the vast majority of men on ADT, suggesting a systematic approach to assessing bone health is associated with high rates of guideline-adherent care., Background/Purpose: Metastatic castration-resistant prostate cancer (mCRPC) is characterized as disease progression despite adequate androgen deprivation therapy (ADT). Although chemotherapy for mCRPC prolongs survival, whether its impact on elderly-relevant outcomes and toxicity differ by frailty status is not known. Methods: Men aged 65+ with mCRPC who were starting first-line chemotherapy were enrolled in this longitudinal prospective pilot study. Elderly-relevant information was collected at baseline and before the start of each chemotherapy cycle. Frailty was assessed by the Vulnerable Elders Survey (VES-13), functional status by OARS-IADL, social activities limitation and support by MOS measures, and FACT-G and FACT-P for general and prostate-specific quality of life (QOL), respectively. Physical function was assessed by timed up and go (TUG), timed chair stands, and grip strength. Changes in outcomes were analyzed between frail vs. non-frail patients using Student’s t-test and linear regression. Results: 21 patients (mean age 74), of whom 11 were frail (VES-13 3), were assessed. Generally, at baseline frail patients were slightly older and scored lower than non-frail patients in QOL, functional status, physical function, and social support and activities. However, frail patients improved more than non-frail patients in all domains, except TUG. 18% of frail patients died during the course of therapy compared to no deaths in non-frail patients. Discussion & Conclusion: Frail patients, as determined by VES-13 3, with mCRPC may represent a heterogeneous population; one group destined to die soon and the other who may do well with chemotherapy. Further research and patient recruitment is needed to determine whether a subset of frail older patients would benefit from first-line chemotherapy treatment., Background/Purpose: The Clock Drawing Test (CDT) is a screening tool used by physicians for detecting dementia in the clinical setting and is commonly used for identifying drivers with a dementia whose driving skills may have declined to an unsafe level. However, the accuracy of the CDT for detecting declines in driving due to a dementia is not well-established and is confounded by the presence of multiple scoring systems. The purpose of the study was to examine the intra-rater reliability of a novice scorer; the inter-rater reliability between a novice scorer and a trained clinician; and the relationship between different CDT scoring methods and on-road driving performance. Methods: 50 cognitively impaired and cognitively intact participants completed the CDT and an on-road assessment. A novice scorer and a trained clinical geriatric specialist scored the clocks using 4 CDT scoring systems (Rouleau, Shulman, Freund, and MoCA). Results: The intra-rater reliability of the novice scorer across the four scoring schemes was high (Pearson’s r of 0.85 to 0.90, all p = .01), as was the inter-rater reliability between the Novice Scorer and the Geriatric Specialist (Pearson’s r of 0.68 to 090, all p = .01). None of the CDT scores were significantly related to on-road outcomes. Discussion & Conclusion: Although there was good intraand inter-rater reliability for the scoring systems tested, none of the CDTs examined were significantly associated with on-road outcomes, indicating that use of CDT scores is most likely to result in erroneous driving decisions for cognitively impaired patients., Background/Purpose: In 2010, Baycrest implemented a Slow Stream Rehabilitation Program (SSR) to deliver a low-intensity long-duration rehab for frail seniors’ post-acute hospitalization. To examine the change in function, length of stay, and discharge destination of patients admitted to SSR. Methods: Psychosocial and functional measures were administered to patients on admission and discharge to the SSR Unit. Results: Over a period of 15 months, 105 patients (70% of all admissions) were recruited; mean age was 82, mean stay in acute care was 32 days, and the mean LOS in SSR was 88 days. On admission, 85% had mild/moderate to severe cognitive impairment (MoCA: 26) and 78.5% were dependent with transfers with or without devices. Mean admission FIM: 51 and discharge FIM: 74; admission Berg Balance Scale (BBS): 10 and discharge BBS: 19.7. On admission 51% could ambulate 10 steps with a device and 80.4% on discharge. Upon discharge, 68% were discharged home or to other community residences; 24% to Long-Term Care (LTC) and 9% went to acute care. Discussion & Conclusion: This study confirms that the SSR population is a frail elderly group admitted after a mean of 32 days in acute care. With low functional ability on admission, this group was able to achieve over 80% ambulation with or without a device and had a mean discharge FIM of 74. After 88 days of low-intensity rehab, 68% were able to return to community living. After a long acute hospital stay, frail older adults with cognitive impairment can benefit from slow stream rehabilitation to prepare them for living in the community rather than going to LTC., Background/Purpose: Residents who are international medical graduates (IMGs) are a heterogeneous group of learners with distinct backgrounds of ethnicity, religion, and culture. They came from various countries with differing medical education standards, societal values, and professional codes of conduct. When training and working in Canada, IMG residents may experience trans-cultural challenges. The purpose of this study is to identify cultural strengths and challenges that IMG family medicine residents encounter when working and training within the Canadian medical context, and to identify the values, behaviours, and codes of conduct expected of family physicians working in Canada. Methods: Focus group with seven academic/community preceptors who teach residents. Qualitative data were transcribed and analyzed for emerging themes. Results: Distinctive Canadian socio-medico-cultural values were identified in six theme areas – communication, gender, cultural awareness, ethics, medical knowledge, and social hierarchy. IMG residents were noted to possess strengths in: ability to speak multiple languages; establishing rapport with patients of a similar culture; understanding culturally-defined gender roles; knowledge of global diseases; skilled at procedures; proficient in making diagnoses based on clinical indicators; and possessing a sense of responsibility to the greater community. The challenges that IMG residents were noted to encounter include: difficulty with language nuances; culturally-defined gender interactions; challenges of dealing with patients from diverse cultural groups; limited understanding of ethics; disease-focused care; hierarchical/didactic approach to learning; and tendency not to ask questions during the learning process. Discussion & Conclusion: Cultural gaps appear to be present when IMG residents interface within the Canadian medical context. Identification of trans-cultural challenges will assist in the development of teaching resources for use in IMG resident training., Background/Purpose: The purpose of this study is to develop a novel interdisciplinary pain management (IPM) model to better treat and manage pain within the elderly population residing in long-term care institutions. Methods: This project is being carried out as a multiphase study: Medical record review of 180 patient charts characterizing the usual care model currently relied upon in representative facilities.One-on-one staff oriented interviews discussing staff perceived barriers, challenges and strengths concerning current pain management practices. Grounded theory will be utilized to analyze transcripts and develop theories.Focus group session aimed at further exploring themes developed during one-on-one interviews.Details of the interdisciplinary model will be delineated. This phase will encompass creation of all educational materials, tools, and standard operating procedures.Implementation of model will take place via comparison study. A cohort of residents will have pain scores measured before (usual care) and following implementation of interdisciplinary pain management model. Results: An interdisciplinary pain management model for patients in long-term care facilities is established. Implementation and trialing of the interdisciplinary model will prove to be more beneficial than the standard care model. Ultimately, this will be demonstrated by an overall improvement in resident pain scores. Discussion & Conclusion: The development and utilization of an interdisciplinary pain management model will provide a useful and efficacious method to treat pain in the aged living within long-term care facilities., Background/Purpose: The growing number of elderly patients with multiple chronic conditions presents a pressing challenge to the Canadian health-care system. Current practice models are not well suited to this challenge. Our primary objective was to design and evaluate a new interprofessional care model for community-dwelling seniors with complex health-care needs. A secondary objective was to explore the potential of the new model as an interprofessional training opportunity. Methods: The IMPACT clinic (Interprofessional Model of Practice for Aging and Complex Treatments) features an extended visit (90 minutes) with a comprehensive interprofessional team. The model is designed to be patient-centred and family-friendly and attempts to bridge primary care, specialty care, and community care. IMPACT was pilot-tested at one site and peer-modeled at three other sites. A multi-method evaluation included a chart audit, survey of team function, and qualitative interviews with patients/families. Results: Observed benefits of the IMPACT clinic include: significantly more time and “space” for the patient and family to discuss current concerns; reduction in repeat visits and multiple referrals; enhanced real-time information-sharing; improved professional understanding of other disciplines; greater satisfaction among health-care providers; and enhanced interprofessional learning among clinical trainees. Challenges included: extended length of visits proved exhausting for some frail patients; interprofessional team-based models perhaps not optimal for patients with sensory impairments or severe mental health concerns; and scheduling issues sometimes arose owing to the number of clinicians involved. Discussion & Conclusion: Evaluation of the IMPACT clinic is encouraging with positive feedback from patients/ families, team members, and clinical trainees. Interprofessional care models hold great promise for meeting the challenge of complex chronic disease in the elderly. Further evaluation is underway., Background/Purpose: Medical Directors in LTC homes in Ontario are increasingly being faced with adminstrative needs of a more complex patient population and in an environment of increased legislative and regulatory oversight. There are roles identified within the LTC Homes Act, as well as key roles outlined in Medical Director Contracts agreed to by MOHLTC and the OMA. The Ontario Long Term Care Physicians is a non-profit organization with close to 300 members who are physicians working in LTC homes in Ontario. The organization runs a clinically focused conference each fall and increasingly is aware of administrative skills and expertise for which many members may not have received formal training. In addition, we hear from members challenges they face with being informed of important system changes and new programs being implemented. The purpose of the survey was to identify perceived and unperceived learning needs of physicians working in Long Term Care to explore future educational initiatives. Methods: Unrestricted grant received from Pfizer to develop a LTC physician survey and begin developing educational initiatives based on outcomes of the survey. Survey questionnaire developed with input from OLTCP board member working group. Survey was circulated via OLTCP database. Survey results then analysed and presented to OLTCP board and membership. Results: Survey identified perceived and unperceived learning needs in areas of legislative requirements, quality improvement, program management, high-risk clinical areas, and working with teams. Barriers to involvement in areas of administration included time and knowledge, not lack of interest. The details of these results will be shared in the poster format. Discussion & Conclusion: Survey identified key learning needs that are facing medical directors in LTC homes that are integral to the role of Medical Director. The OLTCP has explored training programs and conferences in North America and has determined that the content areas of the Core Curriculum on Medical Direction in LTC run by the American Medical Directors Association in the United States best matches the learning needs we have identified. We have now developed goals and objectives for an equivalency curriculum, and are in the process of developing the curriculum to address medical direction and leadership skills required to be an effective medical director in LTC., Background/Purpose: As the life expectancy and chronicity of health conditions affecting Canadians continues to rise, the assessment of autonomous decision-making capacity becomes an issue of increasing importance. Adults with diseases and disabilities are at particular risk in this regard. Comprehensive assessments and realistic interventions that employ the least intrusive and least restrictive measures possible have been determined to be the most ethical and desirable. Methods: The inter-disciplinary DMC Model was developed based on a literature search, environmental scan, needs assessment, surveys, and discussions with inter-disciplinary groups at various health-care sites within Covenant Health in 2006. An iterative process was used to formulate a model, which was then implemented in the Covenant Health and AHS sites, Edmonton zone, from 2007–2012. Results: This model was “provincialized” through the AHS Seniors Health Cognitive Strategic Planning Committee and has been made available for use provincially. It includes a care map, worksheets, and staff training workshops and in-services, and an inventory of educational materials. Staff trained in the assessment of decision-making capacity and use of the model (e.g., physicians, psychologist, nurses, nurse practitioners, social workers, occupational therapists, care co-ordinators) effectively implemented the DMC Model in Edmonton and Calgary zones, and to varying degrees in the other zones from 2010–2012. Discussion & Conclusion: The DMC Model offers a holistic inter-disciplinary approach to capacity assessment that maximizes client autonomy, offers the least restrictive and intrusive solutions, and facilitates inter-disciplinary and inter-organization collaboration., Background/Purpose: In a re-analysis of data from the Canadian Study of Health and Aging, non-traditional risk factors, which were not typically associated with dementia, were found to impact an individual’s level of frailty and subsequently their risk of Alzheimer’s disease (AD). We examined whether an index consisting of such factors could predict future reports of incident AD and dementia, as well as mortality, in a similar manner to traditional risk factors, in a larger, multinational cohort. Methods: Secondary analyses were conducted on data from the Survey of Health, Ageing, and Retirement in Europe and consisted of cognitively healthy individuals 50 years or over, from 12 European countries (N = 11,817). Three AD risk factor indices (RFIs) were constructed to predict a ∼ 4-year risk for a self or informant report of AD, dementia, and survival; a 31-item non-traditional RFI, a 6-item traditional RFI, and a 37-item combined RFI. Results: After adjusting our risk model for age, sex, education, and traditional risk factors for AD, the non-traditional RFI significantly predicted the risk of dementia (OR = 1.49, 95% CI 1.34–1.67), and mortality (OR = 1.53, 95% CI 1.19–1.96) after an average of 4.3 years. The combined RFI exhibited the strongest prediction of dementia (OR = 1.79, 95% CI 1.38–2.32) and mortality (OR = 1.68, 95% CI = 1.50–1.89). Discussion & Conclusion: The typically small impact of health deficits that are not traditionally associated with AD can significantly increase one’s risk of both dementia and mortality when combined. Health professionals should place greater importance on the examination of overall health decline, rather than solely assessing traditional risk factors for illness., Background/Purpose: Based on clinical trials, treatment of metastatic castration-resistant prostate cancer (mCRPC) with chemotherapy is seen to improve disease control and survival in older men (age 65+). Its effects, though, on the daily functioning, physical performance, and quality of life (QOL) in elderly men outside the clinical trial setting are not well understood. Methods: Men aged 65+ with mCRPC starting first-line chemotherapy at a tertiary cancer centre were enrolled in this prospective observational pilot study. Physical function was assessed with the timed up and go (TUG) test, Timed Chair Stands, and grip strength. Functional status was measured using the OARS-IADL questionnaire, in addition to social activities limitations and social support (MOS measures). Patients completed the FACT-P and FACT-G to measure prostate-specific QOL and general QOL, respectively. Assessments were completed before each cycle of chemotherapy. Pre–post within-group comparisons were done using Student’s t-tests and linear regression. Results: 25 patients (mean age 75) receiving Docetaxel + Prednisone were enrolled, 3 of whom died and 2 dropped out. Both general and prostate-specific QOL improved over a median of 6 cycles. Patients’ instrumental activities of daily living (IADL) scores remained stable over time. On average, grip strength was stable, and lower extremity function improved on both the TUG and Timed Chair Stands. Discussion & Conclusion: Contrary to our hypotheses, QOL improved in this frail elderly cohort, and IADL function remained stable. Although physical function remained stable or improved during first-line chemotherapy, there was significant variability among individual patients. Older men with mCRPC appear to tolerate first-line chemotherapy fairly well in terms of QOL and geriatric domains., Background/Purpose: Despite treatment of the associated condition delirious persons do not always recover, for unknown reasons. We sought to derive and validate a prognostic model to predict poor recovery after an episode of delirium based on early admission characteristics. Methods: This prospective cohort study consecutively enrolled older medical in-patients (admitted to London Health Sciences Centre) from the community. Participants were screened for delirium. Delirious (by the Confusion Assessment Method) patients were followed in hospital and after discharge.The primary outcome was poor recovery, in delirious patients, defined by death, institutionalization or functional decline (decreased activities of daily living), at discharge or 3 months after discharge, elicited from the medical chart or post-discharge caregiver telephone interviews. Results: 1235 medical in-patients (mean age 82.6 years, 42% male) were screened. Delirium occurred in 355 (or 29%) and recovery status was known in 342 (96%). Fifty-four patients (15%) died in hospital and 24% (n = 86) were discharged to a permanent residential institution. At a median of 103 days after discharge, another 97 (or 48%) delirious individuals who were discharged from hospital, had poor recovery (one deceased, 50 institutionalized, and 46 with decreased activities of daily living ability), resulting in an overall rate of poor recovery of 69% (237). Poor recovery was associated with advanced age, lower baseline function, not being on a benzodiazepine prior to admission, hypoxia, having higher delirium severity scores, and acute renal failure. This model was predictive of poor recovery in the validation sample (ROC area of 0.68, 95% CI: 0.57–0.80). Discussion & Conclusion: Results suggest that poor recovery after delirium is common, and is associated with certain characteristics available on admission., Background/Purpose: The Regroupement des Unités de courte durée gériatriques et des services hospitaliers de gériatrie du Québec (RUSHGQ) is a community of practice, established in 2010, bringing together health professionals and managers working in GAU. It was previously observed that the quality of care processes varies between GAU. The mobility committee of the RUSHGQ recommends that all GAU units use similar gait and balance scales to standardize patient evaluation, management and follow-up in Quebec. The objectives of the study are: 1) to characterize scales used by physiotherapists; and 2) to inquire about scales that must be used to assess patients with moderate-to-severe gait and balance disorder. Methods: Two surveys were held among physiotherapists and physical rehabilitation therapists working at a GAU unit (n = 48) associated with the RUSHGQ. Results: Overall, professionals from 36 GAU responded to one or both surveys. The most frequent scales used by the participants are Berg Balance Scale (BBS)–97%; Timed Up and Go Test (TUG)–80%; and walking speed test–57%. Those tests (BBS, TUG, and walking speed test) were also the most frequently recommended by the participants for assessing a patient with moderate-to-severe gait and balance disorder. Discussion & Conclusion: The mobility committee of the RUSHGQ recommends that the assessment of gait and balance disorders should include at least the Berg Balance Scale, the Timed Up and Go Test, and a walking speed test., Background/Purpose: Traditionally physicians have viewed Subjective Cognitive Impairment (SCI) in older people to be benign and related to age-associated memory loss. However, research in this field suggests that people who self-report memory problems, but score normal on cognitive testing, have a higher rate of progressing to mild cognitive impairment (MCI). Methods: Over the last 4 years a total of 165 people over 55 responded to newspaper advertisements with self-reported memory loss. Participants received cognitive screening tests using the standardized MMSE, the MoCA, the 15-point GDS, the AD8, the Cornell Scale for Depression in Dementia, and the Lawton Brody Activities of Daily Living Scale. The test results were case conferenced with a geriatrician, and a clinical suspicion of normal, SCI, MCI, depressive symptoms/mixed picture, possible dementia or other was given. 46 individuals have repeat measures on these tests from 2009 to 2012. Results: In 2012, of those 46 follow-up participants, 54% had no change on their cognitive tests. However 33% had declined over the 4 years and 9% had improved. Of those who were given the clinical impression of SCI in 2009 or 2010, 39% had declined to amnestic MCI or multiple-domain MCI. Those individuals who reported depressive symptoms in 2009 (32%) tended to have lower scores on the GDS and Cornell on follow-up visits. Discussion & Conclusion: In studies published on SCI, those who self-report memory problems compared to normal health controls are at greater risk of declining to MCI. Our study captured this trend as 39% of those with SCI had declined to MCI within 4 years. Those with depressive symptoms may have improved with non-drug/drug approaches., Background/Purpose: Many older adults are prescribed benzodiazepines despite their association with cognitive decline, postural instability, falls, hip fractures, and a five-fold risk of hospitalization after a motor vehicle collision. Yet, 16% to 33% of elderly, community-dwellers use benzodiazepines, and 54% use them daily. In this review, we address the approach to discontinuation and effective alternative options. Methods: MEDLINE (1946–2012), EMBASE (1980–2012), and the Cochrane Database of Systematic Reviews (2005– 2012) were searched. The following key search terms were used: MeSH & EMBASE terms for benzodiazepines, sleep initiation and maintenance disorders, drug withdrawal and abuse terms, and keywords for sleep, addiction, dependence, and insomnia, as well as specific drug names and terms for taper, withdrawal, and alternative therapies. Results: Chronic benzodiazepine use is associated with many adverse outcomes. Hospitalization may play a pivotal role in both the initiation and discontinuation of sedative hypnotics. There is a paucity of long-term data for the use of non-benzodiazepine sedative hypnotics. Cognitive behavioural therapy, brief behavioural interventions, and benzodiazepine tapering protocols have shown proven benefit in benzodiazepine discontinuation. Discussion & Conclusion: There may be evidence for non-benzodiazepine sedative hypnotics; however, there is a paucity of long-term, placebo-controlled studies to support their safety, and some evidence to suggest harm in the frail older adult. Cognitive behavioural therapy and/or the use of a taper protocol may increase the success of withdrawal and improve sleep parameters. Exercise, sleep education, massage, and brief behavioural intervention are excellent non-pharmacological options for managing insomnia and for aiding discontinuation. Lastly, it is important to be cognizant of the impact that prescribing sedative hypnotics in hospital can have on long-term use., Background/Purpose: Clinical practice guidelines are intended to improve patient care. Clinicians may not be able to implement guideline recommendations because of time pressures, which are particularly challenging in primary care. We aimed to quantify the time required to implement guideline recommendations regarding the most common chronic diseases in older adults, including hypertension, diabetes, dyslipidemia, asthma, chronic obstructive pulmonary disease, and chronic kidney disease. Methods: We determined the time required to apply national guidelines to a cohort of primary care patients. Eight Canadian clinical practice guidelines addressing management of chronic diseases in adults were reviewed. Their recommended interventions, along with the indications for each intervention, were identified. Three primary care physicians reviewed each recommendation and identified the time required to perform it on an average patient. A cohort of 160 randomly selected patients aged 55 years from a university-affiliated primary care clinic was analyzed to determine how often each intervention should be applied to these patients. These data were used to estimate how much time it would take a clinician to apply guideline recommendations to his or her practice. Results: 103 different interventions from 8 clinical practice guidelines were identified. The total time required to apply these interventions to the selected cohort of patients was 340 hours (SD ± 189). Extrapolating this value to a clinical roster of 1000 patients, 266 working days would be required each year to implement the recommended interventions. Discussion & Conclusion: The implementation of chronic disease guideline recommendations in primary care requires a prohibitive amount of time. Guideline developers should consider the time required to implement their recommendations when drafting clinical practice guidelines., Background/Purpose: Quebec will face accelerated aging of its population in the years to come. Its health-care system will have to adapt to this situation in order to assure efficiency and relevance of interventions to meet the growing needs. The model of care of the Geriatric Evaluation and Management Unit (GEMU) is a well-known hospital-based mode of organization of geriatric services, and its efficiency has been proven. However, the implementation of this model of care within various Quebec hospitals has brought a noticeable heterogeneity in the care practices among GEMUs. We then want to provide hospital managers with a tool which would define the processes and framework needed to efficiently run GEMUs. This tool would direct the evaluation and development of these services with a strong scientific basis. Methods: We first did a worldwide literature review and identified two recent meta-analyses on the efficiency of GEMUs. The studies included in the two meta-analyses were rigorously selected and both were analyzed. We also included in our review a Quebec Delphi study on selection criteria applicable to the GEMUs in Quebec. Results: We extracted and categorized all the process of care items from the studies including: patient selection, type of ward, type of health centre, composition of the geriatric team, and evaluation and treatment processes. Discussion & Conclusion: This tool will allow the decision makers and hospital managers to conduct evaluation and development of GEMUs in Quebec and elsewhere., Background/Purpose: Studies have shown increased adverse outcomes are related to hospital admissions from Long-Term Care (LTC) homes, often for etiologies that could be safely treated in the facility. We examined the reasons for transfer and outcomes of LTC residents admitted to Hamilton Health Sciences (HHS) hospitals. Methods: Patient matched hospital and LTC home charts were retrospectively reviewed for all HHS hospital admissions transferred from LTC homes during 4 non-consecutive months in 2011. We considered patient demographics, events leading to transfer, diagnosis, and course during admission to hospital. Data presented within are limited to the analysis of hospital medical charts. Results: A total of 201 charts were reviewed. Altered level of consciousness (21%), dyspnea (18%), and fever (9%) were the most frequent events leading to transfers from LTC homes. Most patients (33%) transferred for altered LOC were diagnosed with either a urinary tract infection (UTI) or pneumonia. A total of 47 patients experienced an adverse event(s) while hospitalized. Fifteen patients were transferred despite a “do not hospitalize” order. Advanced directives were not documented in 34 patients on arrival to the hospital. Discussion & Conclusion: The rate of adverse events in patients transferred from LTC homes to hospitals is high. An intervention aimed at identifying early signs of altered level of consciousness, as well as treating frequent causes, such as UTI’s and pneumonia in the LTC homes, may prevent avoidable transfers to hospitals. There is a need to improve discussions and documentation of advanced directives, as well as a system to ensure these are followed., Background/Purpose: Hyponatremia has been associated with increased mortality and length of stay (LOS) in hospitalized patients. However, other adverse associations such as falls or syncope, fractures, unplanned readmission, need for inpatient rehabilitation, and change in discharge destination to a more dependent category have not been widely studied. Our aim was to investigate these associations. Methods: This is a retrospective case control study of patients admitted with hyponatremia (serum Na ≤ 134 mEq/l) under the General Internal Medicine Unit during a 6-month period. The relevant data were collected by explicit medical record review and analyzed in univariate and multivariate models. Data from 3 months in patients aged 65 years are presented. Results: The prevalence of hyponatremia was 21%. Hyponatremia had a significant univariate association with LOS (OR 1.03 p = .016), unplanned readmission within 30 days (OR 2.43, p = .017), falls or syncope at presentation (OR 4.0, p < .001), and admission diagnosis of metabolic disorders (OR 17.27, p < .001). However, after adjustments hyponatremia was independently associated with only unplanned readmission within 30 days (OR3.0, CI: 1.4, 6.6; p = .005), falls or syncope (OR 4.4, CI: 2.2, 9.0; p ≤ .001), and admission diagnosis of metabolic disorders (OR13.7, CI: 3.1, 60.0; p = .001). Although other predefined adverse associations more frequently occurred in hyponatremic patients, they were not significant. Discussion & Conclusion: The study confirms the association between hyponatremia and falls or syncope. Among the adverse outcomes of hospitalization, hyponatremia was independently associated with only unplanned readmission within 30 days. Falls or syncope at presentation and admission diagnosis of metabolic disorders appear to have a greater association with LOS than hyponatremia. The study was probably underpowered to assess other outcomes., Background/Purpose: In 2011, the Memorial University Family Medicine (FM) Residency Program introduced a Care of the Elderly (COE) rotation to enhance residents’ skills in managing the complex health issues of the elderly population. The purpose of this project was to understand FM residents’ perceived needs in COE training and to evaluate the COE rotation with respect to these needs. Methods: Survey methodology was used with the pre-rotation survey designed to evaluate perceived needs in COE training and the post-rotation survey designed to assess whether learning needs where addressed. Results: The pre-rotation survey was sent to 57 FM residents with a response rate of 40%. The majority of students indicated a need for further training in COE topics. Students identified that in certain areas further training was necessary or essential. These included managing polypharmacy (65.2% identified this as essential), managing the behavioural and psychological symptoms of dementia (52.2% as very necessary and 39.1% as essential), and managing chronic wounds (65.2% as very necessary). The post-rotation survey was sent to 11 FM residents with a response rate of 82%. Most students felt learning needs were fully satisfied in the following areas: performing a dementia assessment (55.6%); distinguishing between dementia, delirium and depression (55.6%); and managing the behavioural and psychological symptoms of dementia (66.7%). Discussion & Conclusion: Memorial University FM residents recognize the need for COE training. With the growth of the elderly population, newly trained family physicians must be prepared to provide these patients with appropriate care. This COE rotation addresses most learning needs. However, results from our survey indicate that there is room for improvement., Background/Purpose: The most common cognitive screening tool used by family physicians is the Folstein Mini-Mental State Examination (MMSE). In 2009, Brown et al. created a new cognitive screening test called the Test Your Memory (TYM), which is unique in the fact that it is a patient self-administered exam. In a system where family physicians and other specialists are pressed for time, the TYM offers a potential to save 10 minutes of screening time. This study aimed to determine the validity of the TYM tool in comparison to the traditional MMSE in a Canadian primary care sitting. Methods: Patients aged 65 and older attending a regularly scheduled appointment in two family physician offices in New Brunswick were invited to participate in the study. Participants had to complete the self-administered Test Your Memory tool and complete a MMSE. Results: A total of 52 participants completed the study. The mean TYM score was 44.7/50 (SD 2.4) and the mean MMSE score was 27.8 (SD 5.6). The Pearson correlation coefficient between the TYM and MMSE is R2 = .58. This is a significant correlation with a p-value of .01. A score of ≤ 42/50 on the TYM had a 100% specificity for picking up patients who will score < 24 on the MMSE. The sensitivity of the TYM was 100% and the specificity was 81.6%. Discussion & Conclusion: This study validates the TYM test as a screening tool in a Canadian primary care population. However, the strength of the TYM test is in its negative predictive value in participants who score above 42., Background/Purpose: Sedentary behaviour has been proposed as an independent cardiometabolic risk factor, even in adults who are otherwise physically active through leisure-time recreational activities. Because little is known about the metabolic effects of sedentary behaviour in seniors, we examined the relationship between sedentary behaviour and cardiometabolic risk in physically active older adults. Methods: 54 community-dwelling men and women 65 years of age (mean 71.5 years) were enrolled in this cross-sectional observational study. Subjects were in good health and free of known diabetes. Activity levels (sedentary, light activity, moderate activity, and vigorous activity time per day) were recorded with accelerometers worn continuously for 7 days. Cardiometabolic risk factors measured consisted of the American Heart Association diagnostic criteria for metabolic syndrome (waist circumference, triglycerides, high-density lipoprotein (HDL), systolic blood pressure, fasting glucose), as well as low-density lipoprotein (LDL). The relationships between activity measures and cardiometabolic risk factors were examined. Significant variables were entered into a multivariate regression model. Results: All but 1 subject met Canada Health guidelines for an active “fit” adult. Despite this, the average proportion of time spent at a sedentary activity level each day was 72.7%. From the regression analysis, the only significant association found was between LDL and sedentary time, with LDL detrimentally associated with average sedentary time per day (Standardized Beta Correlation Coefficient 0.302, p < .05). Discussion & Conclusion: Sedentary behaviour is associated with an adverse metabolic effect on LDL in older adults, even those who meet Canada Health guidelines for an active “fit” adult. Emphasizing activities that reduce sitting (e.g., standing desks, less television) may be a practical recommendation to reduce sedentary behaviour in older adults., Background/Purpose: Post-operative delirium in older adults is a common complication of surgery with significant consequences. Delirium often portends poorer clinical outcomes including increased mortality, length of stay, and increased likelihood of discharge to a facility. The role of antipsychotics to prevent post-operative delirium has not been well-established. We therefore wished to determine the effectiveness of antipsychotics in preventing postoperative delirium. Methods: We searched online literature databases and registers for randomized controlled trials (RCTs) of adults undergoing surgery who were given antipsychotics to prevent post-operative delirium, using a placebo as the comparator. Two researchers independently reviewed citations and abstracts, selecting those meeting inclusion criteria. Quality was assessed via the Cochrane risk of bias tool. Random effects meta-analysis and meta-regression were conducted. Q-statistics and I2 were used for assessment of heterogeneity. Results: We evaluated 4340 citations from our initial search and from this reviewed 32 full-text articles. Five randomized controlled trials met criteria for inclusion. Antipsychotics were found to reduce post-operative delirium [OR: 0.41; 95% CI: 0.235 to 0.744]. The effect-size estimate was heterogeneous [Q-value: 15; p = .003; I2 = 75] and overall significant [p = .003]. Further examination of the heterogeneity showed that several factors could help reach statistical homogeneity: acuity of surgery (elective vs. mixed acute/elective), anti-psychotic type (generation), and method of administration. Meta-regression showed that as one gets older and as the dosage in chlorpromazine equivalents increases, the Log Odds Ratio increases. Discussion & Conclusion: Within the limits of few RCT’s available, antipsychotics appeared to reduce the incidence of post-operative delirium in a variety of surgical settings. Larger, well-designed RCTs are needed to help confirm our findings., Background/Purpose: Patients with mild cognitive impairment (MCI) and significant amyloid burden on PiB PET imaging manifest impaired performance on episodic memory tasks when compared to MCI patients with lower amyloid burden. This association has yet to be defined with regards to non-episodic memory tasks. Therefore, we sought to further characterize the cognitive profile of subjects with MCI who underwent PiB PET imaging. Methods: Forty-six subjects aged 60–90 with a clinical diagnosis of MCI underwent neurospychological evaluation. PiB PET images were obtained within 8 months of a subject’s cognitive assessment. Subjects were matched for age and education and classified as PiB− (SUV < 1.5; n = 22) or PiB+ (SUV > 1.5; n = 24). The results from the neuropsychological evaluation were compared between groups and correlated with amyloid burden. A regression analysis was conducted to determine whether amyloid burden was a predictor of cognitive performance. Results: There were no significant group differences on global cognitive measures. There was considerable overlap between PiB+ and PiB− subjects on all cognitive domains, but the PiB+ subjects performed significantly worse than PiB− subjects on tasks of episodic memory and executive functioning. Regression analysis showed that amyloid beta deposition was a significant predictor of performance on episodic memory and inhibition. Discussion & Conclusion: These preliminary results suggest that MCI patients who are considered to be prodromal Alzheimer’s disease may be distinguishable by the presence of impairment in both episodic memory and inhibition. Future studies may be useful for addressing whether a specific neuro-psychological battery can aid in early diagnosis of dementia., Background/Purpose: Frail elderly adults are particularly vulnerable to medication errors when transitioning from hospital to home. The objective of this study is to describe the prevalence and causes of medication discrepancies (MDs) in geriatric community-dwelling adults during this transition period. Methods: A descriptive study was carried out from a community hospital setting in British Columbia, Canada. The study population consists of patients 70 years and older who met selection criteria for home visits within 24–72 hours after hospital discharge by a Geriatric Transition Nurse (GTN) between November 2011 to May 2012. Using the Medication Discrepancy Tool, the GTN performed medication reconciliation between discharge medications and medications individuals were taking at home. Patient-level and system-level factors contributing to the MDs were identified. Results: Out of the 100 patients seen by the GTN, 65% were female and 85% were on five or more medications at the time of discharge. 72% of patients had five or more co-morbid chronic conditions. Medication reconciliation identified 46% of patients with at least one medication discrepancy. More than half of MDs were caused by patient-level factors and the remainder were caused by system-level factors. The most common reported patient-level factors were: non-intentional non-adherence and intentional non-adherence. The most frequently seen system-level factors were: incomplete/inaccurate/illegible discharge instructions and not recognizing patient’s lack of support. In some instances both types of factors contributed to the occurrence of a medication discrepancy. Discussion & Conclusion: Medication discrepancies in the frail elderly are common when transitioning from hospital to home. Identifying common patient-level and system-level factors may serve as starting points when designing quality improvement efforts with the aim to decrease medication discrepancies., Background/Purpose: In 2010, Osteoporosis Canada developed guidelines for the diagnosis and management of osteoporosis for people > 50 at high risk of fragility fractures. These guidelines did not address frail elderly where access to diagnostic technology, such as bone mineral density, and research is limited. Methods: We used the GRADE process to develop guidelines applicable to frail elderly with over 50 stakeholders, including resident/family representatives of long-term care, interdisciplinary health professionals, and program managers. We surveyed the panel to determine questions and outcomes most relevant for this population. We searched the literature for baseline risks of fractures and intervention effects. When making recommendations, we discussed benefits/harms, strength of evidence, values/preferences, and resources. Results: In addition to outcomes from the 2010 guidelines, this panel identified mobility, pain, and quality of life as important in this population. However, few studies reported these outcomes. To make recommendations, the panel considered absolute risk differences in outcomes with or without treatment, which are calculated from baseline risks. It was critical that the panel agreed on baseline risks which can vary between low- and high-risk groups. Agreement was challenging, but the process was enlightening to recognize gaps/uncertainties in existing research. When evidence in frail elderly was lacking, the panel assessed the applicability of effects found in other populations to make recommendations. The GRADE process incorporated values/preferences, particularly of families and residents, which was uniquely challenging in view of life expectancy, multiple co-morbidities, and serious consequences of fractures. Discussion & Conclusion: The GRADE process helped identify gaps in the literature for important outcomes, the impact of baseline risks, and the importance of balancing benefits and harms, and their value and consequences in this population., Background/Purpose: Since 2006, the Ontario Osteoporosis Strategy for Long-Term Care has engaged in outreach activities to increase uptake of evidence-based osteoporosis/fracture prevention strategies (www.osteoporosislongtermcare.ca). A baseline environmental scan revealed a wide spectrum of prescribing practices between LTC homes reflecting the lack of standardized guidelines and academic detailing. The objective of the present study was to describe current osteoporosis prescribing practices across Ontario LTC homes. Methods: In August 2012, de-identified medication/demographic data were downloaded from Medical Pharmacies, a pharmacy provider for approximately one-third of Ontario LTC homes. After excluding 40 LTC homes participating in a targeted intervention (ViDOS), we analyzed data for 166 LTC homes. The percentage of residents receiving 1) Vitamin D (800 IU/day), 2) calcium ( 500 mg/day), and 3) osteoporosis medication was calculated for each LTC home. Mean (95% CI) LTC home prescribing rates and ranges are reported. Results: The analysis cohort was 21,699 residents, mean age 83.5 (SD: 10.7) years, 70% women. 57% of LTC homes were for-profit, 45% affiliated with a corporate chain, 61% had age-100 residents. Mean LTC home prescribing rates were 59.9% (95% CI: 57.2, 62.6) for vitamin D, 32.2% (95% CI: 30.2, 34.2) for calcium, and 18.5% (95% CI: 17.4, 19.7) for osteoporosis medications. Prescribing rates were normally distributed and ranged from 22.3%–94.9% (vitamin D), 1.6%–78.4% (calcium), and 0%–55.9% (osteoporosis medications). Discussion & Conclusion: Although there was a range in prescribing between LTC homes, our results indicate that wide-scale implementation of outreach activities resulted in uptake by many LTC homes, particularly for Vitamin D, with half the homes prescribing at approximately 60% or better. Currently, osteoporosis consensus guidelines for LTC are being developed., Background/Purpose: Currently far too many seniors (∼ 20%) consume inappropriate benzodiazepines, which increase the risk of adverse drug reactions and unnecessary hospitalizations among community-dwelling elders. As of 2012, the new Beers criteria lists all benzodiazepines as drugs to avoid in the elderly no matter the half-life. Methods: A written educational tool was mailed to 144 benzodiazepine consumers aged 65 years recruited from community pharmacies. Knowledge and beliefs about inappropriate prescriptions were queried prior to and 1-week after the intervention. Primary outcome was a change in risk perception. Explanatory variables were a change in knowledge and beliefs about medications, as well as cognitive dissonance occurrence. Self-efficacy for tapering and intent to discuss discontinuation were also measured. Results: Post-intervention, 65 (45.1%) of chronic benzodiazepine consumers (mean duration use 10.5 years, SD 8.2 years) perceived increased risk. Increased risk perceptions were explained by better knowledge acquisition (mean change score 0.9, 95% CI (0.5, 1.3)), and a change in beliefs (BMQ differential mean change score −5.03, 95% CI (−6.4, −3.6), suggesting elicitation of cognitive dissonance. Experience of cognitive dissonance was associated with a 6-fold higher likelihood of patients reporting increased risk perception (OR = 6.61 95% CI (3.2, 13.8)). Intent to discuss discontinuation of benzodiazepines with a doctor (83.1% vs. 44.3%, p < .001) was higher among participants who perceived increased risk. Discussion & Conclusion: Risk perception on benzodiazepines can be altered through direct delivery of an educational tool to aging consumers. Results suggest patients could potentially be targeted directly with information to catalyze discontinuation of inappropriate prescriptions., Background/Purpose: Gait and cognition are interrelated. Executive dysfunction is associated with slower gait. It is unknown if memory dysfunction, a cardinal sign in MCI, is associated with the gait disturbances seen in MCI. The objective was to determine if gait in older adults with MCI varies by subtype: amnestic (a-MCI) or non-amnestic (na-MCI) type. Methods: Older adults with MCI from the “Gait and Brain Study” were included. Cognition was evaluated using MMSE, MoCA, Trails Making Test A and B, Rey Auditory Verbal Learning Test, Digit Span Test, and Letter Number Sequence Test. Gait performance (velocity and gait variability) was evaluated with the GaitRITE® mat under usual walking and three dual-task conditions (walking while: naming animals out loud, serial subtractions by 1s and serial subtractions by 7). Participants were divided into a-MCI and na-MCI by episodic memory test. The relationship between cognitive subtype and gait was evaluated with multivariable linear regression. Results: Fifty-six participants (mean age 76.3 ± 7.2 years, 50.9% female) were included. Thirty-eight were a-MCI and 18 were na-MCI. Groups were similar in age, co-morbidities, and history of previous falls. The a-MCI participants walked slower than na-MCI (98.5 vs. 112.2 cm/sec, p < .03) in all test conditions. Regression (adjusted for age, sex, physical activity, number of co-morbidities, and executive function) showed a-MCI was associated with slower gait under usual and dual-task conditions and higher gait variability (p < .001) under dual-task tests. Discussion & Conclusion: Episodic memory impairment was associated with poor gait performance, in particular under dual-task conditions. This suggests slow gait and higher variability under dual-task testing is a motor feature in a-MCI independent of executive dysfunction., Background/Purpose: Assessing frailty should be an essential part of the care of older adults. Several scales have been proposed to quantify frailty and the operational criteria of each scale vary. The purpose of this study was to compare the prevalence of frailty in community-dwelling, middle-aged and older Europeans as estimated by eight scales and to examine the agreement among scales in classifying participants as frail. Methods: 27,527 participants aged 50+ years (mean age 65.3 ± 10.5, 54.8% women) from the 11 countries (Austria, Belgium, Denmark, France, Germany, Greece, Italy, Netherlands, Spain, Sweden, Switzerland) which participated in the first wave of the Survey of Health, Ageing and Retirement in Europe comprised the study sample. Frailty was operationalized, based on eight scales: frailty phenotype, a 70-item Frailty Index, a 44-item Frailty Index based on a Comprehensive Geriatric Assessment, Clinical Frailty Scale, Edmonton Frail Scale, Groningen Frailty Indicator, Tilburg Frailty Indicator, and “FRAIL” scale. A score threshold was assigned for each scale to represent the frailty state, based on the relevant literature. Results: The prevalence of frailty ranged from 44% (Groningen scale) to 6% (FRAIL scale). About half of participants were categorized differently between scales. 49.3% of participants were categorized as non-frail by all scales, and 2.5% were categorized identically as frail by all scales. Discussion & Conclusion: Frailty scales capture related but distinct groups of individuals, and each scale provides different estimates of frailty prevalence. Future studies should compare various scales using data from clinical settings., Background/Purpose: Hip fracture patients are at high risk for recurrence. Appropriate pharmacotherapy reduces this risk and is associated with reduced mortality after hip fracture, but a care gap exists for fracture prevention in these patients. This evaluation determined rates of osteoporosis treatment and bone mineral density (BMD) testing in hip fracture patients following discharge from a rehabilitation unit. Methods: A prospective cohort study of hip fracture patients aged 50 on an inpatient rehabilitation unit in 2008 and 2011. Patients were seen by a nurse specialist, and encouraged to see their family physician for further assessment and treatment. Physicians were sent a letter indicating the need to follow up with their patient. Patients were contacted following discharge from hospital to determine treatment rates. Results: Of 310 eligible hip fracture patients admitted to the rehabilitation unit in the years studied, 207 patients were reached post-discharge and provided data. Of patients who were not previously taking osteoporosis medication, 50% of patients had osteoporosis treatment initiated by 6 months following discharge. By 2 months following discharge, 46% of patients in the 2008 cohort had a new BMD performed or scheduled, while this was true for 14% of patients from the 2011 cohort. 35% of patients in 2011 had not seen their family physician by 2 months following discharge. Discussion & Conclusion: Rates for osteoporosis treatment and BMD were higher than those reported in the literature for patients not enrolled in case manager programs. BMD testing declined from 2008 to 2011. Lower treatment rates may be due to concerns regarding bisphophonates. There remains room for improvement for follow-up with family physicians., Background/Purpose: Assessing fitness to drive in patients with dementia is challenging. The SIMARD was developed as a tool to assist with assessing fitness to drive. This study compares the clinical decision made by a geriatrician regarding driving with the score on the SIMARD. Methods: Patients seen by geriatricians with a diagnosis of dementia or mild cognitive impairment, who had had a SIMARD test completed after the clinical decision regarding driving was made, were included in the sample. Charts were reviewed to gather diagnosis, driving status and history, cognitive and functional information. Results: Sixty-three patients were identified and 57 met the inclusion criteria. The mean age was 77.07 years. Alzheimer’s dementia in 22 (38.6%) patients was the most common diagnosis. The mean MMSE was 24.85 (SD 3.34) and the MoCA was 19.85 (SD3.58). The mean SIMARD score was 37.16 (SD 19.54). Twenty-four patients had a SIMARD score below 31, 28 scored between 31–70, and 5 scored greater than 70. Of those scoring less than 31, 8 patients continued to drive, 3 of whom had passed a driving test performed by the Department of Public Safety of New Brunswick. In the 5 patients who scored greater than 70, 2 had their licenses revoked by the geriatrician. Discussion & Conclusion: There did not appear to be a clear association between the SIMARD score and the clinical decision made by the geriatrician., Background/Purpose: Cancer survivorship programs often focus on modifiable behaviours such as smoking and alcohol use and physical activity. Whether these behaviours differ among elderly survivors and whether special considerations should be given to these elderly cancer survivors (age 65+) is unclear. Methods: 616 adult cancer survivors (23% elderly) across multiple solid and haematologic malignancies and treatment trajectories were surveyed about smoking, alcohol, physical activity, and attitudes and knowledge about effects of these habits on cancer outcomes. Multivariate logistic regression models evaluated the effect of age on these factors. Results: 9.0% of elderly survivors were current smokers; 35.7% had been binge drinkers recently or in the past (5 or more standard drinks per day for male; 4 or more for female); 24.0% were not meeting exercise guidelines (150 minutes of moderate-to-vigorous intensity activity per week). Compared to younger survivors, elderly were one-third as likely to be current smokers (p < .0001), but twice as likely to be ex-smokers than never smokers (p < .0001). They were half as likely to know how smoking affected cancer treatment (p = .007) or prognosis (p = .008). Elderly were one-third as likely to binge drink (p < .001), twice as likely to perceive alcohol as improving survival (p = .018), and half as likely to receive information about alcohol use (p = .042). Meeting exercise guidelines at diagnosis (p = .015) and improving/maintaining them after treatment (p = .016) were lower in elderly survivors, but perceived benefits/harms of exercise did not differ with age. Discussion & Conclusion: Elderly cancer survivors have different smoking, alcohol, and exercise characteristics from younger survivors. Survivorship programs may need to tailor counseling by age group., Background/Purpose: Indwelling urinary catheterization is a ubiquitous procedure in the inpatient setting: between 16% and 25% of hospitalized patients will receive an in-dwelling catheter at some point during their stay. While sometimes medically indicated, previous studies have shown that between 21% and 52% of catheters are used unnecessarily, exposing patients to significant morbidity and mortality, including increased risk of urinary tract infection and bacteremia. Here we present the results of a multi-modal educational intervention directed at reducing the overuse of catheters in a large teaching hospital. Methods: The multi-modal intervention targeted nurses and used a variety of approaches to improve catheter use, including small group meetings, educational posters, and modifications to the patient chart. The study patient population included all admitted patients to internal medicine, surgery, and orthopedic surgery, as well as the GIM/ACE Unit from 1 September 2009 to 1 October 2011. Data were structured and analyzed as an interrupted time series using a segmented regression approach. Results: A total of 14,531 patients, 1,878 of whom were catheterized, were included in this study. A decrease in mean catheter days per patient of between 5.8 and 9.7 days (p < .01) across the wards under study was observed after the intervention. The proportion of patients catheterized decreased by between 0.35%/month and 0.93%/month (p < .01); ultimately % patients catheterized halved from 15% pre-intervention to 7% post-intervention. A trend of greater discharges directly home was observed in older (65+) patients. Discussion & Conclusion: A multi-modal educational intervention using nurse education and process changes resulted in a significant reduction in catheter days per patient and the proportion of patients catheterized., Background/Purpose: Life course influences on health may be most evident at older ages. In a large sample of middle-aged and older Europeans, we compared grip strength, cognitive performance, and walking speed between native-born participants, immigrants who were born in low- and middle-income countries (LMICs), and immigrants who were born in high-income countries (HICs). Methods: This is a retrospective cohort study of the Survey of Health, Ageing, and Retirement in Europe, including 33,745 participants age 50+ in 14 countries (mean age = 64.9 ± 10.2 years; 54% women). Four performance-based measures were assessed: grip strength, delayed recall, and verbal fluency were measured in all participants, while walking speed was measured only in individuals age 75+. Analyses were divided by participants’ current residence in either relatively wealthier Northern/Western or relatively poorer Southern/Eastern Europe, and adjusted for age, gender, and education. Results: About 7% of participants (n = 2,369) were immigrants. In Northern/Western Europe, compared to native-born participants, LMIC-born immigrants demonstrated weaker grip strength (mean 32.8 kg vs. 35.7 kg, p < .001), and lower delayed recall (3.0 vs. 3.6, p < .001) and verbal fluency scores (16.1 vs. 20.4, p < .001), but similar walking speed (0.66 m/sec vs. 0.72 m/sec, p = .1). HIC-born immigrants demonstrated grip strength (34.7 kg), delayed recall (3.4), and verbal fluency performance (18.5) lower than native-born participants, but higher than LMIC-born immigrants (p < .001). In Southern/Eastern Europe, scores did not differ between groups on any measure. Discussion & Conclusion: Middle-aged and older immigrants demonstrated worse physical function and cognitive performance than native-born Europeans in Northern/ Western Europe, but not in Southern/Eastern Europe. Country of birth and current country of residence were each associated with these performance-based measures of age-related health., Background/Purpose: The importance of traditional risk factors on prediction of adverse events has been established for many chronic diseases. A recent study demonstrated that even non-traditional risk factors, when considered in consort, predicted dementia similarly to any traditional risk factors. The objective of this study was to investigate contributions of non-traditional risk factors to coronary heart disease (CHD) events. Methods: This analysis included community-dwelling adults with no history of CHD (n= 2669, mean age 46.4 ± 19.1 years, 48.6% men) who participated in the 1995 Nova Scotia Health Survey. We constructed 3 risk factor indices (RFIs): 1) a 17-item non-traditional RFI (e.g., sinusitis, arthritis); 2) a 9-item traditional RFI (e.g., hypertension, diabetes); and 3) a combined RFI (all 26 items). Ten-year risks of CHD-related hospitalization and mortality were evaluated. Results: The non-traditional RFI score was significantly predictive of CHD-related hospitalizations and deaths, even after controlling for the traditional RFI (age and sex adjusted hazard ratio [adj. HR] 1.26; 95% CI 1.09–1.44). However, including all possible variables in the combined RFI predicted the highest rate of CHD events (adj. HR 1.55; 1.36–1.76). Considered separately, the traditional and non-traditional RFIs similarly discriminated participants who had CHD events from those who did not (area under receiver operating characteristic curve [AUC] 0.70, CI 0.67–0.74; vs. 0.69, 0.65–0.73). When all variables were combined in an index, the AUC was significantly higher (combined RFI = 0.76; 0.720.79). Discussion & Conclusion: The accumulation of non-traditional risk factors adds a unique contribution to the prediction of CHD hospitalizations and mortality. This supports the idea that maintenance of general health lowers risk for late-life disease.

Congress of the European-Society-of-Cardiology (ESC) -- AUG 25-29, 2012 -- Munchen, GERMANY WOS: 000308012404636 … European Soc Cardiol (ESC)