Suchergebnisse

Home care is an important service for persons with neurological conditions, but little is known about factors affecting health care costs in this setting. Using administrative data collected with the Resident Assessment Instrument for Home Care (RAI-HC), this study identified factors associated with home care costs for recipients of home care services with Alzheimer disease or related dementias, multiple sclerosis, and/or amyotrophic lateral sclerosis. As part of this study, the effectiveness of the Resource Utilization Groups for Home Care (RUG-III/HC), a case-mix classification system developed for the RAI-HC, in predicting care costs for this population, was also tested. Clinical characteristics indicative of greater disease severity had high levels of significance in predicting home care costs. In particular, the RUG-III/HC was highly predictive of home care costs for 3 neurological conditions, indicating the validity of this case-mix system for this population. With the increasing prevalence of neurological conditions and demand for home care services, future studies should continue to focus on identifying specific predictors care costs for those with neurological conditions in this care setting.

The COVID-19 pandemic had profound effects on the long-term care (LTC) setting worldwide, including changes in admission practices. We aimed to describe the characteristics and medical complexity of newly admitted LTC residents before (March 1, 2019 to February 29, 2020) and during (March 1, 2020 to March 31, 2021) the COVID-19 pandemic via a population-based serial cross-sectional study in Ontario, Alberta, and British Columbia, Canada. With data from the Minimum Data Set 2.0 we characterize the medical complexity of newly admitted LTC residents via the Geriatric 5Ms framework (mind, mobility, medication, multicomplexity, matters most) through descriptive statistics (counts, percentages), stratified by pandemic wave, month, and province. We included 45 756 residents admitted in the year prior to and 35 744 during the first year of the pandemic. We found an increased proportion of residents with depression, requiring extensive assistance with activities of daily living, hip fractures, antipsychotic use, expected to live <6 months, with pneumonia, low social engagement, and admitted from acute care. Our study confirms an increase in medical complexity of residents admitted to LTC during the pandemic and can be used to plan services and interventions and as a baseline for continued monitoring in changes in population characteristics over time.

Background The importance of engaging the community in healthcare research and planning has been widely recognized. Currently however, there is a limited focus on older adults, Canada's fastest growing segment of the population and biggest users of the healthcare system. Objective This project aimed to develop an understanding of engagement of older adults and their caregivers in healthcare research and planning. Method A realist synthesis was conducted of the available knowledge on engagement in healthcare research and planning. The search methodology was informed by a framework for realist syntheses following five phases, including consultations with older adults. The synthesis included theoretical frameworks, and both peer-reviewed and grey literature. Results The search generated 15,683 articles, with 562 focusing on healthcare research and planning. The review lead to the development of a framework to engage older adults and their caregivers in healthcare research and planning. The 5 stages environment, plan, establish, build, and transition are accompanied with example context, mechanism, and outcomes to guide the use of this framework. Conclusion We have identified a framework that promotes meaningful engagement of older adults and their caregivers. We are continuing to collaborate with our community partners to further develop and evaluate engagement strategies that align with the presented framework. ; This work was supported by a Knowledge Synthesis Grant from the Technology Evaluation for the Elderly Network (TVN), grant # KS2013-08, which is funded by the Government of Canada's Networks of Centres of Excellence (NCE) Program.

Objective: Long-term care (LTC) homes ("nursing homes") were challenged during the first year of the COVID-19 pandemic in Canada. The objective of this study was to measure the impact of the COVID-19 pandemic on resident admission and discharge rates, resident health attributes, treatments, and quality of care. Design: Synthesis analysis of "Quick Stats" standardized data table reports published yearly by the Canadian Institute for Health Information. These reports are a pan-Canadian scorecard of LTC services rendered, resident health characteristics, and quality indicator performance. Setting and participants: LTC home residents in Alberta, British Columbia, Manitoba, and Ontario, Canada that were assessed with the interRAI Minimum Data Set 2.0 comprehensive health assessment in fiscal years 2018/2019, 2019/2020 (pre-pandemic period), and 2020/2021 (pandemic period). Methods: Risk ratio statistics were calculated to compare admission and discharge rates, validated interRAI clinical summary scale scores, medication, therapy and treatment provision, and seventeen risk-adjusted quality indicator rates from the pandemic period relative to prior fiscal years. Results: Risk of dying in the LTC home was greater in all provinces (risk ratio [RR] range 1.10 to 1.29) during the pandemic. Quality of care worsened substantially on 6 of 17 quality indicators in British Columbia and Ontario, and 2 quality indicators in Manitoba and Alberta. The only quality indicator where performance worsened during the pandemic in all provinces was the percentage of residents that received antipsychotic medications without a diagnosis of psychosis (RR range 1.02 - 1.16). Conclusions and implications: The COVID-19 pandemic has unveiled numerous areas to strengthen LTC and ensure that resident's physical, social, and psychological needs are addressed during public health emergencies. Except an increase in potentially inappropriate antipsychotic use, this provincial-level analysis indicates that most aspects of resident care were maintained during the first year of the COVID-19 pandemic.

Introduction: While patient and citizen engagement has been recognised as a crucial element in healthcare reform, limited attention has been paid to how best to engage seniors-the fastest growing segment of the population and the largest users of the healthcare system. To improve the healthcare services for this population, seniors and their families need to be engaged as active partners in healthcare decision-making, research and planning. This synthesis aims to understand the underlying context and mechanisms needed to achieve meaningful engagement of older adults in healthcare decision-making, research and planning. Methods and analysis: The CHOICE Knowledge Synthesis Project: Choosing Healthcare Options by Involving Canada's Elderly aims to address this issue by synthesising current knowledge on patient, family, and caregiver engagement. A realist synthesis will support us to learn from other patient and citizen engagement initiatives, from previous research, and from seniors, families and caregivers themselves. The synthesis will guide development or adaptation of a framework, leading to the development of best practice guidelines and recommendations for engagement of older people and their families and caregivers in clinical decision-making, healthcare delivery, planning and research. Ethics and dissemination: The components of this protocol involving consultation with patients or caregivers have received ethics clearance from the University of Waterloo, Office of Research Ethics (ORE# 19094). After completion of the project, we will amalgamate the information collected into a knowledge synthesis report which will include best practice guidelines and recommendations for patient, family and caregiver engagement in clinical and health system planning and research contexts. Results: Will be further disseminated to citizens, clinicians, researchers and policymakers with the help of our partners. ; Technology Evaluation in the Elderly Network (TVN, grant # KS2013-08), which is funded by the Government of ...

Objective: Examination of the impact of the COVID-19 pandemic on rates of antipsychotic medication use, initiation and discontinuation, among newly admitted long-term care residents. Design: Repeated cross-sectional study. Settings and Participants: Long-term care home residents in Alberta, British Columbia and Ontario, Canada assessed with the Minimum Data Set (MDS) 2.0 assessment. The cohort was segmented according to admission during the pandemic (March 2020/2021) and 2 pre-pandemic (March 2018/2019 and March 2019/2020) periods. Methods: Multivariable logistic regression models were fit to characterize the association between long-term care admission during the COVID-19 pandemic and the use of antipsychotic medications. A second set of logistic regression models were fit among residents with follow-up assessments to characterize the association between long-term care admission and antipsychotic initiation/discontinuation at follow-up. All models were adjusted for resident characteristics including sex, age group, Aggressive Behaviour Scale score, Cognitive Performance Scale score, and diagnoses of Alzheimer's disease and related dementias, anxiety disorder, depression, and bipolar disorder. Results: 21 612 residents admitted during the pandemic and over 30 000 in each pre-pandemic period were included. Antipsychotic use increased during the pandemic period among newly admitted residents from both community (adjusted odds ratio [aOR] 1.20-1.29) and hospital settings (aOR 1.21-1.23). Residents admitted during the pandemic period were more likely to have antipsychotic medications initiated (aOR 1.25-1.26) and less likely to have had them discontinued (aOR 0.74-0.76) at the time of follow-up assessment. Conclusion and Implications: Multiple factors contributed to the observed increase in antipsychotic medication use among newly admitted long-term care home residents during the COVID-19 pandemic: increased medication use at the time of admission, increased medication initiation at follow-up, and decreased medication discontinuation at follow-up. A whole-systems approach that extends beyond long-term care into hospital and community settings is necessary to address this prevalent issue.