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Oremus M, Tyas SL, Zeng L, Newall N, Maxwell CJ. The association between memory, COVID-19 testing, and COVID-19 incidence in middle-aged and older adults: a prospective analysis of the CLSA. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn 2024:1-18. [PMID: 38623833 DOI: 10.1080/13825585.2024.2342500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 04/04/2024] [Indexed: 04/17/2024]
Abstract
We investigated the association between pre-COVID-19 memory function and (a) receipt of a COVID-19 test and (b) incidence of COVID-19 using the COVID-19 Questionnaire Study (CQS) of the Canadian Longitudinal Study on Aging (CLSA). The CQS included 28,565 middle-aged and older adults. We regressed receipt of a COVID-19 test on participants' immediate and delayed recall memory scores and re-ran the regression models with COVID-19 incidence as the outcome. All regression models were adjusted for sociodemographic, lifestyle, and health covariates. In the analytical sample (n = 21,930), higher delayed recall memory (better memory) was significantly associated with lower COVID-19 incidence. However, this association was not significant for immediate recall memory. Immediate and delayed recall memory were not associated with receipt of a COVID-19 test. Health policymakers and practitioners may viewmemory status as a potential risk for COVID-19. Memory status may not be a barrier to COVID-19 testing.
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Affiliation(s)
- Mark Oremus
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Suzanne L Tyas
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Leilei Zeng
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON, Canada
| | - Nancy Newall
- Department of Psychology, Brandon University, Brandon, MB, Canada
| | - Colleen J Maxwell
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
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Marrie RA, Maxwell CJ, Rotstein DL, Tsai CC, Tremlett H. Prodromes in demyelinating disorders, amyotrophic lateral sclerosis, Parkinson disease, and Alzheimer's dementia. Rev Neurol (Paris) 2024; 180:125-140. [PMID: 37567819 DOI: 10.1016/j.neurol.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/24/2023] [Accepted: 07/03/2023] [Indexed: 08/13/2023]
Abstract
A prodrome is an early set of symptoms, which indicates the onset of a disease; these symptoms are often non-specific. Prodromal phases are now recognized in multiple central nervous system diseases. The depth of understanding of the prodromal phase varies across diseases, being more nascent for multiple sclerosis for example, than for Parkinson disease or Alzheimer's disease. Key challenges when identifying the prodromal phase of a disease include the lack of specificity of prodromal symptoms, and consequent need for accessible and informative biomarkers. Further, heterogeneity of the prodromal phase may be influenced by age, sex, genetics and other poorly understood factors. Nonetheless, recognition that an individual is in the prodromal phase of disease offers the opportunity for earlier diagnosis and with it the opportunity for earlier intervention.
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Affiliation(s)
- R A Marrie
- Departments of Internal Medicine and Community Health Sciences, Rady Faculty of Health Sciences, Max-Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - C J Maxwell
- Schools of Pharmacy and Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada; ICES, Toronto, Ontario, Canada
| | - D L Rotstein
- Department of Medicine, University of Toronto, 6, Queen's Park Crescent West, 3rd floor, M5S 3H2 Toronto, Ontario, Canada; Saint-Michael's Hospital, 30, Bond Street, M5B 1W8 Toronto, Ontario, Canada
| | - C-C Tsai
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - H Tremlett
- Faculty of Medicine (Neurology), University of British Columbia, Vancouver, BC, Canada
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Alkabbani W, Maxwell CJ, Marrie RA, Tyas SL, Lega IC, Gamble JM. Insulin, hypoglycaemia and dementia: A causal mediation analysis showcasing challenges and potential opportunities. Diabetes Obes Metab 2024; 26:1120-1124. [PMID: 38012861 DOI: 10.1111/dom.15385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/10/2023] [Accepted: 11/12/2023] [Indexed: 11/29/2023]
Affiliation(s)
- Wajd Alkabbani
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - Colleen J Maxwell
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Science, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Suzanne L Tyas
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Iliana C Lega
- Women's College Research Institute (WCRI), Women's College Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Maxwell CJ, Dampf H, Alkabbani W, Cotton CA, Gamble JM, Hogan DB, Gruneir A, McArthur E, Youngson E, Hsu Z, Hoben M. Psychotropic, Anticonvulsant, and Opioid Use in Assisted Living Residents Before and During the COVID-19 Pandemic. J Am Med Dir Assoc 2024; 25:121-129. [PMID: 37863111 DOI: 10.1016/j.jamda.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/04/2023] [Accepted: 09/12/2023] [Indexed: 10/22/2023]
Abstract
OBJECTIVES To examine the associations between COVID-19 pandemic waves (1-4) and prevalent antipsychotic, antidepressant, benzodiazepine, anticonvulsant, and opioid use among assisted living (AL) residents, by setting (dementia care vs other). DESIGN Population-based, repeated cross-sectional study. SETTING AND PARTICIPANTS Linked clinical and health administrative databases for residents of all publicly subsidized AL homes (N = 256) in Alberta, Canada, examined from January 2018 to December 2021. Setting-specific quarterly cohorts of residents were derived for pandemic (starting March 1, 2020) and comparable historical (2018/2019 combined) periods. METHODS The quarterly proportion of residents dispensed an antipsychotic, antidepressant, benzodiazepine, anticonvulsant, or opioid was examined for each setting and period. Log-binomial generalized estimating equations models estimated prevalence ratios (PR) for period (pandemic vs historical quarterly periods), setting (dementia care vs other AL), and period-setting interactions. RESULTS On March 1, 2020, there were 2874 dementia care and 6611 other AL residents (mean age 82.4 vs 79.9 years, 68.2% vs 66.1% female, 93.5% vs 42.6% with dementia, respectively). Antipsychotic use increased during waves 2 to 4 for residents of both settings, but this increase was significantly greater for dementia care than other AL residents during waves 3 and 4 (eg, wave 3, PR 1.21, 95% CI 1.14-1.27 vs PR 1.12, 95% CI 1.07-1.17, interaction term P = .029). In both settings, there was a significant but modest increase in antidepressant use and a significant decrease in benzodiazepine use during several pandemic waves. For other AL residents only, there was a small statistically significant increase in anticonvulsant use during waves 2 to 4. No significant pandemic effect was observed for prevalent opioid use in either setting. CONCLUSIONS AND IMPLICATIONS The persistence of the pandemic-associated increase in antipsychotic, antidepressant, and anticonvulsant use in AL residents, and greater increase in antipsychotic use for dementia care settings, raises concerns about the attendant risks for residents, especially those with dementia.
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Affiliation(s)
- Colleen J Maxwell
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada; ICES, Toronto, Ontario, Canada.
| | - Hana Dampf
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Wajd Alkabbani
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - Cecilia A Cotton
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada
| | | | - David B Hogan
- Division of Geriatric Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrea Gruneir
- ICES, Toronto, Ontario, Canada; Department of Family Medicine, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Eric McArthur
- London Health Sciences Centre, London, Ontario, Canada
| | - Erik Youngson
- Provincial Research Data Services, Alberta Health Services, Alberta, Edmonton, Canada; Data and Research Services, Alberta SPOR SUPPORT Unit, Alberta, Edmonton, Canada
| | - Zoe Hsu
- Provincial Research Data Services, Alberta Health Services, Alberta, Edmonton, Canada; Data and Research Services, Alberta SPOR SUPPORT Unit, Alberta, Edmonton, Canada
| | - Matthias Hoben
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada; School of Health Policy and Management, Faculty of Health, York University, Toronto, Ontario, Canada
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Yoo SS, Tyas SL, Maxwell CJ, Oremus M. The association between functional social support and memory in middle-aged and older adults: A Prospective Analysis of the Canadian Longitudinal Study on Aging's Comprehensive Cohort. Arch Gerontol Geriatr 2023; 114:105076. [PMID: 37245489 DOI: 10.1016/j.archger.2023.105076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/19/2023] [Accepted: 05/21/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Functional social support (FSS) impacts memory function through biological and psychological pathways. In a national sample of middle-aged and older adults in Canada, we explored the association between FSS and changes in memory over three years and investigated effect modification by age group and sex. METHODS We analyzed data from the Comprehensive Cohort of the Canadian Longitudinal Study on Aging (CLSA). FSS was measured with the Medical Outcomes Study - Social Support Survey; memory was measured with combined z-scores from immediate and delayed recall administrations of a modified version of the Rey Auditory Verbal Learning Test. We regressed memory change scores over three years on baseline overall FSS and four FSS subtypes in separate multiple linear regression models, controlling for sociodemographic, health, and lifestyle covariates. We also stratified our models by age group and sex. RESULT We found positive associations between higher FSS and improvement in memory score, although only the tangible FSS subtype (availability of practical assistance) was significantly associated with changes in memory (β^ = 0.07; 95% confidence interval = 0.01, 0.14). After stratification by age group and sex, this association remained significant for males, although we found no evidence of effect modification. CONCLUSION In a cognitively healthy sample of middle-aged and older adults, we found a statistically significant and positive association between tangible FSS and memory change over three years of follow-up. We did not find adults with low FSS to be at increased risk of memory decline compared to adults with higher FSS.
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Affiliation(s)
- Samantha S Yoo
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, N2L 3G1 Waterloo, ON Canada
| | - Suzanne L Tyas
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, N2L 3G1 Waterloo, ON Canada
| | - Colleen J Maxwell
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, N2L 3G1 Waterloo, ON Canada; School of Pharmacy, University of Waterloo, 10A Victoria St. S., N2G 1C5 Kitchener, Ontario, Canada
| | - Mark Oremus
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, N2L 3G1 Waterloo, ON Canada.
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Hoben M, Hogan DB, Poss JW, Gruneir A, McGrail K, Griffith LE, Chamberlain SA, Estabrooks CA, Maxwell CJ. Comparing quality of care outcomes between assisted living and nursing homes before and during the COVID-19 pandemic. J Am Geriatr Soc 2023; 71:3467-3479. [PMID: 37428008 DOI: 10.1111/jgs.18499] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/22/2023] [Accepted: 06/25/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND While assisted living (AL) and nursing home (NHs) residents in share vulnerabilities, AL provides fewer staffing resources and services. Research has largely neglected AL, especially during the COVID-19 pandemic. Our study compared trends of practice-sensitive, risk-adjusted quality indicators between AL and NHs, and changes in these trends after the start of the pandemic. METHODS This repeated cross-sectional study used population-based resident data in Alberta, Canada. Using Resident Assessment Instrument data (01/2017-12/2021), we created quarterly cohorts, using each resident's latest assessment in each quarter. We applied validated inclusion/exclusion criteria and risk-adjustments to create nine quality indicators and their 95% confidence intervals (CIs): potentially inappropriate antipsychotic use, pain, depressive symptoms, total dependency in late-loss activities of daily living, physical restraint use, pressure ulcers, delirium, weight loss, urinary tract infections. Run charts compared quality indicators between AL and NHs over time and segmented regressions assessed whether these trends changed after the start of the pandemic. RESULTS Quarterly samples included 2015-2710 AL residents and 12,881-13,807 NH residents. Antipsychotic use (21%-26%), pain (20%-24%), and depressive symptoms (17%-25%) were most common in AL. In NHs, they were physical dependency (33%-36%), depressive symptoms (26%-32%), and antipsychotic use (17%-22%). Antipsychotic use and pain were consistently higher in AL. Depressive symptoms, physical dependency, physical restraint use, delirium, weight loss were consistently lower in AL. The most notable segmented regression findings were an increase in antipsychotic use during the pandemic in both settings (AL: change in slope = 0.6% [95% CI: 0.1%-1.0%], p = 0.0140; NHs: change in slope = 0.4% [95% CI: 0.3%-0.5%], p < 0.0001), and an increase in physical dependency in AL only (change in slope = 0.5% [95% CI: 0.1%-0.8%], p = 0.0222). CONCLUSIONS QIs differed significantly between AL and NHs before and during the pandemic. Any changes implemented to address deficiencies in either setting need to account for these differences and require monitoring to assess their impact.
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Affiliation(s)
- Matthias Hoben
- School of Health Policy and Management, Faculty of Health, York University, Toronto, Ontario, Canada
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - David B Hogan
- Division of Geriatric Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jeffrey W Poss
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Andrea Gruneir
- Department of Family Medicine, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
- ICES, Toronto, Ontario, Canada
| | - Kim McGrail
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lauren E Griffith
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Stephanie A Chamberlain
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Carole A Estabrooks
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Colleen J Maxwell
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
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Hoben M, Keefe J, McGrail K, Lacey A, Taylor D, Maxwell CJ. Letter to the Editor Re: Manis DR, Bronskill SE, Rochon PA, et al. Defining the Assisted Living Sector in Canada: An Environmental Scan. J Am Med Dir Assoc. 2022;23(11):1871-1877.e1. J Am Med Dir Assoc 2023; 24:1094-1096. [PMID: 37247821 DOI: 10.1016/j.jamda.2023.03.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 05/31/2023]
Affiliation(s)
- Matthias Hoben
- School of Health Policy and Management, Faculty of Health, York University, Toronto, ON, Canada; Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Janice Keefe
- Department of Family Studies and Gerontology, Faculty of Arts and Science, Mount Saint Vincent University, Halifax, NS, Canada
| | - Kim McGrail
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Allison Lacey
- Continuing Care Branch, Government of Alberta, Edmonton, AB, Canada
| | - Deanne Taylor
- Rural Coordination Centre of British Columbia, Canada; Interior Health Authority, Kelowna, BC, Canada; School of Nursing, Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Colleen J Maxwell
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada; School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada; ICES, Toronto, ON, Canada
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Iacono A, Oremus M, Maxwell CJ, Tyas SL. Functional social isolation mediates the association between depression and executive function in older women: findings from the Canadian Longitudinal Study on Aging Comprehensive cohort. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn 2023:1-21. [PMID: 37350151 DOI: 10.1080/13825585.2023.2226855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
Depression and social isolation increase risk for executive function declines and are among the top five modifiable risk factors for dementia. However, the interrelationships between depression, social isolation and executive function are not well established. Further evidence is needed to inform strategies to promote executive function and independence in older age. We examined whether social isolation mediated the association between depression and executive function in community-dwelling middle-aged and older adults and whether this association was modified by age and sex. Adults aged 45 to 85 years from the Canadian Longitudinal Study on Aging (CLSA) Comprehensive cohort were followed over three years (complete case analysis, n = 14,133). Baseline depressive symptoms, a history of clinical depression, and functional social isolation (perceived lack of social support) were self-reported. Executive function at follow-up was a composite measure of five cognitive tests. Conditional process analysis assessed the mediating effects of functional social isolation across age group and sex, adjusted for sociodemographic and health covariates. Functional social isolation significantly mediated the association of depressive symptoms (proportion mediated [PM] = 8.0%) or clinical depression (PM = 17.5%) with executive function only among women aged 75+ years. Functional social isolation explains a proportion of the total effect of depressive symptoms or clinical depression on executive function in women aged 75 and older. Although reverse causation cannot be ruled out, our findings suggest that interventions that reduce functional social isolation or depression in older women may promote executive function.
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Affiliation(s)
- Anita Iacono
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Mark Oremus
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Colleen J Maxwell
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - Suzanne L Tyas
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Alkabbani W, Maxwell CJ, Marrie RA, Tyas SL, Lega IC, Gamble JM. Insulin Use in Type 2 Diabetes and the Risk of Dementia: A Comparative Population-Based Cohort Study. Diabetes Care 2023:dc230222. [PMID: 37315211 DOI: 10.2337/dc23-0222] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/10/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Evidence of an increased dementia risk with insulin use in type 2 diabetes (T2DM) is weakened by confounding by indication and disease severity. Herein we reassess this association, while accounting for confounding through design and analysis. RESEARCH DESIGN AND METHODS Using administrative healthcare data from British Columbia, Canada, we identified patients diagnosed with T2DM in 1998-2016. To adjust for confounding by diabetes severity through design, we compared new users of insulin to new users of a noninsulin class, both from a restricted cohort of those who previously received two noninsulin antihyperglycemic classes. We further adjusted for confounding using 1) conventional multivariable adjustment and 2) inverse probability of treatment weighting (IPTW) based on the high-dimensional propensity score algorithm. The hazard ratio [HR] (95% CI) of dementia was estimated using cause-specific hazards models with death as a competing risk. RESULTS The analytical comparative cohort included 7,863 insulin versus 25,230 non-insulin users. At baseline, insulin users were more likely to have worse health indicators. A total of 78 dementia events occurred over a median (interquartile range) follow-up of 3.9 (5.9) years among insulin users, and 179 events occurred over 4.6 (4.4) years among noninsulin users. The HR (95% CI) of dementia for insulin use versus non-insulin use was 1.68 (1.29-2.20) before adjustment and 1.39 (1.05-1.86) after multivariable adjustment, which was further attenuated to 1.14 (0.81-1.60) after IPTW weighting. CONCLUSIONS Among persons with T2DM previously exposed to two noninsulin antihyperglycemic medications, no significant association was observed between insulin use and all-cause dementia.
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Affiliation(s)
- Wajd Alkabbani
- School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada
| | - Colleen J Maxwell
- School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Science, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Suzanne L Tyas
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Iliana C Lega
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Mogic L, Rutter EC, Tyas SL, Maxwell CJ, O'Connell ME, Oremus M. Functional social support and cognitive function in middle- and older-aged adults: a systematic review of cross-sectional and cohort studies. Syst Rev 2023; 12:86. [PMID: 37211612 DOI: 10.1186/s13643-023-02251-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/07/2023] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND Intact cognitive function is crucial for healthy aging. Functional social support is thought to protect against cognitive decline. We conducted a systematic review to investigate the association between functional social support and cognitive function in middle- and older-aged adults. METHODS Articles were obtained from PubMed, PsycINFO, Sociological Abstracts, CINAHL, and Scopus. Eligible articles considered any form of functional social support and cognitive outcome. We narratively synthesized extracted data by following the Synthesis Without Meta-Analysis (SWiM) guidelines and assessed risk of bias using the Newcastle-Ottawa Scale (NOS). RESULTS Eighty-five articles with mostly low risk-of-bias were included in the review. In general, functional social support-particularly overall and emotional support-was associated with higher cognitive function in middle- and older-aged adults. However, these associations were not all statistically significant. Substantial heterogeneity existed in the types of exposures and outcomes evaluated in the articles, as well as in the specific tools used to measure exposures and outcomes. CONCLUSIONS Our review highlights the role of functional social support in the preservation of healthy cognition in aging populations. This finding underscores the importance of maintaining substantive social connections in middle and later life. SYSTEMATIC REVIEW REGISTRATION Rutter EC, Tyas SL, Maxwell CJ, Law J, O'Connell ME, Konnert CA, Oremus M. Association between functional social support and cognitive function in middle-aged and older adults: a protocol for a systematic review. BMJ Open;10(4):e037301. https://doi.org/10.1136/bmjopen-2020-037301.
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Affiliation(s)
- Lana Mogic
- School of Public Health Sciences, Faculty of Health, University of Waterloo, 200 University Ave. W, Waterloo, ON, N2L 3G1, Canada
| | - Emily C Rutter
- School of Public Health Sciences, Faculty of Health, University of Waterloo, 200 University Ave. W, Waterloo, ON, N2L 3G1, Canada
| | - Suzanne L Tyas
- School of Public Health Sciences, Faculty of Health, University of Waterloo, 200 University Ave. W, Waterloo, ON, N2L 3G1, Canada
| | - Colleen J Maxwell
- School of Public Health Sciences, Faculty of Health, University of Waterloo, 200 University Ave. W, Waterloo, ON, N2L 3G1, Canada
| | - Megan E O'Connell
- Department of Psychology, University of Saskatchewan, 9 Campus Drive, 154 Arts, Saskatoon, SK, S7N 5A5, Canada
| | - Mark Oremus
- School of Public Health Sciences, Faculty of Health, University of Waterloo, 200 University Ave. W, Waterloo, ON, N2L 3G1, Canada.
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Urslak R, Evans C, Nakhla N, Marrie RA, McConnell BM, Maxwell CJ. Peripartum mental health and the role of the pharmacist: A scoping review. Res Social Adm Pharm 2023:S1551-7411(23)00255-3. [PMID: 37210239 PMCID: PMC10171896 DOI: 10.1016/j.sapharm.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 04/21/2023] [Accepted: 05/08/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND The global prevalence of peripartum mental illness is 20%, though estimates have increased since the start of the COVID-19 pandemic. Chronic illnesses affect one in five pregnancies and may be associated with higher rates of peripartum mental illness. Though pharmacists are well-positioned to facilitate appropriate and timely care of co-occurring mental and physical health conditions during this period, little is understood regarding their potential roles. OBJECTIVES To understand the current evidence examining the role of pharmacists to improve the outcomes of women with peripartum mental illness, with and without chronic illness. METHODS A scoping review was performed with assistance from an interdisciplinary team following the Joanna Briggs Institute framework. MEDLINE, Embase, PsychNet and International Pharmaceutical Abstracts databases were searched. English-language articles (published up to May 30, 2022) were screened and assessed for eligibility, and data were charted to collate results, by dual independent reviewers. RESULTS The search strategy produced 922 articles. After screening, 12 articles were included (5 narrative reviews, 7 primary research). There was limited discussion or empirical data regarding specific interventions (screening, counseling), opportunities (accessibility, managing stigma, forming trusting relationships and building rapport with patients) or barriers (lack of privacy, time constraints, adequate remuneration, training) associated with an expanded role of pharmacists in peripartum mental health care. The clinical complexity arising from co-occurring mental health and chronic illnesses was not explored, other than a small pilot study involving pharmacists screening for depression among pregnant women with diabetes. CONCLUSIONS This review highlights the limited evidence available on the explicit role of pharmacists in supporting women with peripartum mental illness, including those with comorbidity. More research, including pharmacists as study participants, is required to fully understand the potential roles, barriers, and facilitators of integrating pharmacists into peripartum mental healthcare to improve the outcomes of women in the peripartum period.
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Affiliation(s)
- Randilynne Urslak
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - Charity Evans
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Nardine Nakhla
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - Ruth Ann Marrie
- Departments of Internal Medicine & Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brie M McConnell
- Davis Centre Library, University of Waterloo, Waterloo, Ontario, Canada
| | - Colleen J Maxwell
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada; School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada.
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12
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Ohman A, Maxwell CJ, Tyas SL, Oremus M. Subtypes of social support availability are not differentially associated with memory: a cross-sectional analysis of the Comprehensive Cohort of the Canadian Longitudinal Study on Aging. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn 2023; 30:354-369. [PMID: 35086434 DOI: 10.1080/13825585.2022.2030294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
This study investigated the association between subtypes of social support availability (SSA) and memory in persons aged 45 to 85 years (n = 24,719). We examined two memory outcomes using a modified Rey Auditory Verbal Learning Test (RAVLT)-immediate recall (RAVLT I) and delayed recall (RAVLT II)-and five subtypes of SSA: affectionate, emotional/informational, positive interactions, tangible, overall. We found statistically significant and adjusted positive associations between all SSA subtypes and memory, except for positive interactions and delayed recall memory. For RAVLT I, the regression coefficients (βˆs) ranged from 0.03 to 0.07; the βˆs for RAVLT II ranged from 0.02 to 0.05. The differences in βˆs for each SSA subtype (βˆ RAVLT I - βˆ RAVLT II) ranged from 0.00 to 0.02 (mean difference = 0.01; 95% confidence interval = -0.01 to 0.03). All effect sizes, regardless of SSA subtype or memory outcome, were small and clinically unimportant.
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Affiliation(s)
- Avery Ohman
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Colleen J Maxwell
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
- School of Pharmacy, University of Waterloo, Waterloo, Canada
| | - Suzanne L Tyas
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Mark Oremus
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
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13
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Malik P, Nakhla N, Guo Y, Tadrous M, Duqoum A, Hogan DB, Maxwell CJ. Pharmacists' knowledge, perceptions and practices regarding frailty: A cross-sectional survey across practice settings in Canada. Can Pharm J (Ott) 2023; 156:159-171. [PMID: 37201168 PMCID: PMC10186872 DOI: 10.1177/17151635231164957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Background Data on Canadian pharmacists' knowledge and perceptions about frailty in older adults and its assessment in pharmacy practice are scarce. Methods A cross-sectional survey of 349 Canadian pharmacists was conducted to evaluate pharmacists' knowledge, perceptions and practices regarding frailty. Descriptive analyses summarized responses by practice setting, and a multivariable logistic regression model examined associations between respondent characteristics and the likelihood of assessing frailty. Results Most respondents were female (70%), aged ≤34 years (47%), Canadian graduates (83%), from Ontario/Quebec (51%) and from urban centres (58%). Although a significant proportion agreed it is important for pharmacists to know (80%) and assess (56%) patient frailty status, only 36% reported assessing frailty in practice. Respondents exclusively practising in a community pharmacy were significantly less likely to agree that it is important for a pharmacist to know or assess frailty status and to report assessing it. Factors associated with a greater likelihood of assessment included positive beliefs about the importance of knowing a patient's frailty status and having a greater proportion of older patients with cognitive or functional impairment in practice. Discussion Findings suggest that pharmacists generally agree with the importance of understanding frailty as it relates to the appropriate use of medications, but most do not assess it. Further research is needed to identify the barriers to assessing frailty, while guidance is needed on which of the available screening tools can best be integrated into a clinical pharmacy practice. Conclusion There is an opportunity to improve pharmaceutical care for older adults by providing pharmacists the means and resources to assess frailty in practice.
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Affiliation(s)
- Paul Malik
- Independent researcher in North Chicago,
Illinois
| | - Nardine Nakhla
- School of Pharmacy, University of Waterloo,
Waterloo, Ontario
| | - Yanling Guo
- School of Public Health Sciences, University of
Waterloo, Waterloo, Ontario
| | - Mina Tadrous
- Women’s College Research Institute, Women’s
College Hospital, Toronto
- Leslie Dan Faculty of Pharmacy, University of
Toronto
- ICES, Toronto, Ontario
| | - Areen Duqoum
- School of Pharmacy, University of Waterloo,
Waterloo, Ontario
| | - David B. Hogan
- Departments of Medicine & Community Health
Sciences, Cumming School of Medicine, University of Calgary, Calgary,
Alberta
| | - Colleen J. Maxwell
- School of Pharmacy, University of Waterloo,
Waterloo, Ontario
- School of Public Health Sciences, University
of Waterloo, Waterloo, Ontario
- ICES, Toronto, Ontario
- Departments of Medicine & Community Health
Sciences, Cumming School of Medicine, University of Calgary, Calgary,
Alberta
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14
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Amuah JE, Molodianovitsh K, Carbone S, Diestelkamp N, Guo Y, Hogan DB, Li M, Maxwell CJ, Muscedere J, Rockwood K, Sinha S, Theou O, Karmakar-Hore S. Development and validation of a hospital frailty risk measure using Canadian clinical administrative data. CMAJ 2023; 195:E437-E448. [PMID: 36972914 PMCID: PMC10042454 DOI: 10.1503/cmaj.220926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2023] [Indexed: 03/29/2023] Open
Abstract
Background: Accessible measures specific to the Canadian context are needed to support health system planning for older adults living with frailty. We sought to develop and validate the Canadian Institute for Health Information (CIHI) Hospital Frailty Risk Measure (HFRM). Methods: Using CIHI administrative data, we conducted a retrospective cohort study involving patients aged 65 years and older who were discharged from Canadian hospitals from Apr. 1, 2018, to Mar. 31, 2019. We used a 2-phase approach to develop and validate the CIHI HFRM. The first phase, construction of the measure, was based on the deficit accumulation approach (identification of age-related conditions using a 2-year look-back). The second phase involved refinement into 3 formats (continuous risk score, 8 risk groups and binary risk measure), with assessment of their predictive validity for several frailty-related adverse outcomes using data to 2019/20. We assessed convergent validity with the United Kingdom Hospital Frailty Risk Score. Results: The cohort consisted of 788 701 patients. The CIHI HFRM included 36 deficit categories and 595 diagnosis codes that cover morbidity, function, sensory loss, cognition and mood. The median continuous risk score was 0.111 (interquartile range 0.056–0.194, equivalent to 2–7 deficits); 35.1% (n = 277 000) of the cohort were found at risk of frailty (≥ 6 deficits). The CIHI HFRM showed satisfactory predictive validity and reasonable goodness-of-fit. For the continuous risk score format (unit = 0.1), the hazard ratio (HR) for 1-year risk of death was 1.39 (95% confidence interval [CI] 1.38–1.41), with a C-statistic of 0.717 (95% CI 0.715–0.720); the odds ratio for high users of hospital beds was 1.85 (95% CI 1.82–1.88), with a C-statistic of 0.709 (95% CI 0.704–0.714), and the HR of 90-day admission to long-term care was 1.91 (95% CI 1.88–1.93), with a C-statistic of 0.810 (95% CI 0.808–0.813). Compared with the continuous risk score, using a format of 8 risk groups had similar discriminatory ability and the binary risk measure had slightly weaker performance. Interpretation: The CIHI HFRM is a valid tool showing good discriminatory power for several adverse outcomes. The tool can be used by decision-makers and researchers by providing information on hospital-level prevalence of frailty to support system-level capacity planning for Canada’s aging population.
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Affiliation(s)
- Joseph Emmanuel Amuah
- Canadian Institute for Health Information (Amuah, Molodianovitsh, Carbone, Diestelkamp, Guo, Li, Karmakar-Hore); School of Epidemiology and Public Health (Amuah), University of Ottawa, Ottawa, Ont.; Institute of Health Policy, Management and Evaluation (Carbone), University of Toronto, Toronto, Ont.; School of Public Health Sciences (Guo, Maxwell), University of Waterloo, Waterloo, Ont.; Division of Geriatric Medicine (Hogan), Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alta.; School of Pharmacy (Maxwell), University of Waterloo, Waterloo, Ont.; Department of Critical Care Medicine (Muscedere), Queen's University; Canadian Frailty Network (Muscedere), Kingston, Ont.; Division of Geriatric Medicine, Department of Medicine (Rockwood), Dalhousie University, Halifax, NS; Division of Geriatric Medicine (Sinha), Department of Medicine, University of Toronto; National Institute on Ageing (Sinha), Ryerson University, Toronto, Ont.; School of Physiotherapy and Division of Geriatric Medicine (Theou), Dalhousie University, Halifax, NS
| | - Katy Molodianovitsh
- Canadian Institute for Health Information (Amuah, Molodianovitsh, Carbone, Diestelkamp, Guo, Li, Karmakar-Hore); School of Epidemiology and Public Health (Amuah), University of Ottawa, Ottawa, Ont.; Institute of Health Policy, Management and Evaluation (Carbone), University of Toronto, Toronto, Ont.; School of Public Health Sciences (Guo, Maxwell), University of Waterloo, Waterloo, Ont.; Division of Geriatric Medicine (Hogan), Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alta.; School of Pharmacy (Maxwell), University of Waterloo, Waterloo, Ont.; Department of Critical Care Medicine (Muscedere), Queen's University; Canadian Frailty Network (Muscedere), Kingston, Ont.; Division of Geriatric Medicine, Department of Medicine (Rockwood), Dalhousie University, Halifax, NS; Division of Geriatric Medicine (Sinha), Department of Medicine, University of Toronto; National Institute on Ageing (Sinha), Ryerson University, Toronto, Ont.; School of Physiotherapy and Division of Geriatric Medicine (Theou), Dalhousie University, Halifax, NS
| | - Sarah Carbone
- Canadian Institute for Health Information (Amuah, Molodianovitsh, Carbone, Diestelkamp, Guo, Li, Karmakar-Hore); School of Epidemiology and Public Health (Amuah), University of Ottawa, Ottawa, Ont.; Institute of Health Policy, Management and Evaluation (Carbone), University of Toronto, Toronto, Ont.; School of Public Health Sciences (Guo, Maxwell), University of Waterloo, Waterloo, Ont.; Division of Geriatric Medicine (Hogan), Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alta.; School of Pharmacy (Maxwell), University of Waterloo, Waterloo, Ont.; Department of Critical Care Medicine (Muscedere), Queen's University; Canadian Frailty Network (Muscedere), Kingston, Ont.; Division of Geriatric Medicine, Department of Medicine (Rockwood), Dalhousie University, Halifax, NS; Division of Geriatric Medicine (Sinha), Department of Medicine, University of Toronto; National Institute on Ageing (Sinha), Ryerson University, Toronto, Ont.; School of Physiotherapy and Division of Geriatric Medicine (Theou), Dalhousie University, Halifax, NS
| | - Naomi Diestelkamp
- Canadian Institute for Health Information (Amuah, Molodianovitsh, Carbone, Diestelkamp, Guo, Li, Karmakar-Hore); School of Epidemiology and Public Health (Amuah), University of Ottawa, Ottawa, Ont.; Institute of Health Policy, Management and Evaluation (Carbone), University of Toronto, Toronto, Ont.; School of Public Health Sciences (Guo, Maxwell), University of Waterloo, Waterloo, Ont.; Division of Geriatric Medicine (Hogan), Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alta.; School of Pharmacy (Maxwell), University of Waterloo, Waterloo, Ont.; Department of Critical Care Medicine (Muscedere), Queen's University; Canadian Frailty Network (Muscedere), Kingston, Ont.; Division of Geriatric Medicine, Department of Medicine (Rockwood), Dalhousie University, Halifax, NS; Division of Geriatric Medicine (Sinha), Department of Medicine, University of Toronto; National Institute on Ageing (Sinha), Ryerson University, Toronto, Ont.; School of Physiotherapy and Division of Geriatric Medicine (Theou), Dalhousie University, Halifax, NS
| | - Yanling Guo
- Canadian Institute for Health Information (Amuah, Molodianovitsh, Carbone, Diestelkamp, Guo, Li, Karmakar-Hore); School of Epidemiology and Public Health (Amuah), University of Ottawa, Ottawa, Ont.; Institute of Health Policy, Management and Evaluation (Carbone), University of Toronto, Toronto, Ont.; School of Public Health Sciences (Guo, Maxwell), University of Waterloo, Waterloo, Ont.; Division of Geriatric Medicine (Hogan), Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alta.; School of Pharmacy (Maxwell), University of Waterloo, Waterloo, Ont.; Department of Critical Care Medicine (Muscedere), Queen's University; Canadian Frailty Network (Muscedere), Kingston, Ont.; Division of Geriatric Medicine, Department of Medicine (Rockwood), Dalhousie University, Halifax, NS; Division of Geriatric Medicine (Sinha), Department of Medicine, University of Toronto; National Institute on Ageing (Sinha), Ryerson University, Toronto, Ont.; School of Physiotherapy and Division of Geriatric Medicine (Theou), Dalhousie University, Halifax, NS
| | - David B Hogan
- Canadian Institute for Health Information (Amuah, Molodianovitsh, Carbone, Diestelkamp, Guo, Li, Karmakar-Hore); School of Epidemiology and Public Health (Amuah), University of Ottawa, Ottawa, Ont.; Institute of Health Policy, Management and Evaluation (Carbone), University of Toronto, Toronto, Ont.; School of Public Health Sciences (Guo, Maxwell), University of Waterloo, Waterloo, Ont.; Division of Geriatric Medicine (Hogan), Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alta.; School of Pharmacy (Maxwell), University of Waterloo, Waterloo, Ont.; Department of Critical Care Medicine (Muscedere), Queen's University; Canadian Frailty Network (Muscedere), Kingston, Ont.; Division of Geriatric Medicine, Department of Medicine (Rockwood), Dalhousie University, Halifax, NS; Division of Geriatric Medicine (Sinha), Department of Medicine, University of Toronto; National Institute on Ageing (Sinha), Ryerson University, Toronto, Ont.; School of Physiotherapy and Division of Geriatric Medicine (Theou), Dalhousie University, Halifax, NS
| | - Mingyang Li
- Canadian Institute for Health Information (Amuah, Molodianovitsh, Carbone, Diestelkamp, Guo, Li, Karmakar-Hore); School of Epidemiology and Public Health (Amuah), University of Ottawa, Ottawa, Ont.; Institute of Health Policy, Management and Evaluation (Carbone), University of Toronto, Toronto, Ont.; School of Public Health Sciences (Guo, Maxwell), University of Waterloo, Waterloo, Ont.; Division of Geriatric Medicine (Hogan), Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alta.; School of Pharmacy (Maxwell), University of Waterloo, Waterloo, Ont.; Department of Critical Care Medicine (Muscedere), Queen's University; Canadian Frailty Network (Muscedere), Kingston, Ont.; Division of Geriatric Medicine, Department of Medicine (Rockwood), Dalhousie University, Halifax, NS; Division of Geriatric Medicine (Sinha), Department of Medicine, University of Toronto; National Institute on Ageing (Sinha), Ryerson University, Toronto, Ont.; School of Physiotherapy and Division of Geriatric Medicine (Theou), Dalhousie University, Halifax, NS
| | - Colleen J Maxwell
- Canadian Institute for Health Information (Amuah, Molodianovitsh, Carbone, Diestelkamp, Guo, Li, Karmakar-Hore); School of Epidemiology and Public Health (Amuah), University of Ottawa, Ottawa, Ont.; Institute of Health Policy, Management and Evaluation (Carbone), University of Toronto, Toronto, Ont.; School of Public Health Sciences (Guo, Maxwell), University of Waterloo, Waterloo, Ont.; Division of Geriatric Medicine (Hogan), Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alta.; School of Pharmacy (Maxwell), University of Waterloo, Waterloo, Ont.; Department of Critical Care Medicine (Muscedere), Queen's University; Canadian Frailty Network (Muscedere), Kingston, Ont.; Division of Geriatric Medicine, Department of Medicine (Rockwood), Dalhousie University, Halifax, NS; Division of Geriatric Medicine (Sinha), Department of Medicine, University of Toronto; National Institute on Ageing (Sinha), Ryerson University, Toronto, Ont.; School of Physiotherapy and Division of Geriatric Medicine (Theou), Dalhousie University, Halifax, NS
| | - John Muscedere
- Canadian Institute for Health Information (Amuah, Molodianovitsh, Carbone, Diestelkamp, Guo, Li, Karmakar-Hore); School of Epidemiology and Public Health (Amuah), University of Ottawa, Ottawa, Ont.; Institute of Health Policy, Management and Evaluation (Carbone), University of Toronto, Toronto, Ont.; School of Public Health Sciences (Guo, Maxwell), University of Waterloo, Waterloo, Ont.; Division of Geriatric Medicine (Hogan), Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alta.; School of Pharmacy (Maxwell), University of Waterloo, Waterloo, Ont.; Department of Critical Care Medicine (Muscedere), Queen's University; Canadian Frailty Network (Muscedere), Kingston, Ont.; Division of Geriatric Medicine, Department of Medicine (Rockwood), Dalhousie University, Halifax, NS; Division of Geriatric Medicine (Sinha), Department of Medicine, University of Toronto; National Institute on Ageing (Sinha), Ryerson University, Toronto, Ont.; School of Physiotherapy and Division of Geriatric Medicine (Theou), Dalhousie University, Halifax, NS
| | - Kenneth Rockwood
- Canadian Institute for Health Information (Amuah, Molodianovitsh, Carbone, Diestelkamp, Guo, Li, Karmakar-Hore); School of Epidemiology and Public Health (Amuah), University of Ottawa, Ottawa, Ont.; Institute of Health Policy, Management and Evaluation (Carbone), University of Toronto, Toronto, Ont.; School of Public Health Sciences (Guo, Maxwell), University of Waterloo, Waterloo, Ont.; Division of Geriatric Medicine (Hogan), Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alta.; School of Pharmacy (Maxwell), University of Waterloo, Waterloo, Ont.; Department of Critical Care Medicine (Muscedere), Queen's University; Canadian Frailty Network (Muscedere), Kingston, Ont.; Division of Geriatric Medicine, Department of Medicine (Rockwood), Dalhousie University, Halifax, NS; Division of Geriatric Medicine (Sinha), Department of Medicine, University of Toronto; National Institute on Ageing (Sinha), Ryerson University, Toronto, Ont.; School of Physiotherapy and Division of Geriatric Medicine (Theou), Dalhousie University, Halifax, NS
| | - Samir Sinha
- Canadian Institute for Health Information (Amuah, Molodianovitsh, Carbone, Diestelkamp, Guo, Li, Karmakar-Hore); School of Epidemiology and Public Health (Amuah), University of Ottawa, Ottawa, Ont.; Institute of Health Policy, Management and Evaluation (Carbone), University of Toronto, Toronto, Ont.; School of Public Health Sciences (Guo, Maxwell), University of Waterloo, Waterloo, Ont.; Division of Geriatric Medicine (Hogan), Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alta.; School of Pharmacy (Maxwell), University of Waterloo, Waterloo, Ont.; Department of Critical Care Medicine (Muscedere), Queen's University; Canadian Frailty Network (Muscedere), Kingston, Ont.; Division of Geriatric Medicine, Department of Medicine (Rockwood), Dalhousie University, Halifax, NS; Division of Geriatric Medicine (Sinha), Department of Medicine, University of Toronto; National Institute on Ageing (Sinha), Ryerson University, Toronto, Ont.; School of Physiotherapy and Division of Geriatric Medicine (Theou), Dalhousie University, Halifax, NS
| | - Olga Theou
- Canadian Institute for Health Information (Amuah, Molodianovitsh, Carbone, Diestelkamp, Guo, Li, Karmakar-Hore); School of Epidemiology and Public Health (Amuah), University of Ottawa, Ottawa, Ont.; Institute of Health Policy, Management and Evaluation (Carbone), University of Toronto, Toronto, Ont.; School of Public Health Sciences (Guo, Maxwell), University of Waterloo, Waterloo, Ont.; Division of Geriatric Medicine (Hogan), Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alta.; School of Pharmacy (Maxwell), University of Waterloo, Waterloo, Ont.; Department of Critical Care Medicine (Muscedere), Queen's University; Canadian Frailty Network (Muscedere), Kingston, Ont.; Division of Geriatric Medicine, Department of Medicine (Rockwood), Dalhousie University, Halifax, NS; Division of Geriatric Medicine (Sinha), Department of Medicine, University of Toronto; National Institute on Ageing (Sinha), Ryerson University, Toronto, Ont.; School of Physiotherapy and Division of Geriatric Medicine (Theou), Dalhousie University, Halifax, NS
| | - Sunita Karmakar-Hore
- Canadian Institute for Health Information (Amuah, Molodianovitsh, Carbone, Diestelkamp, Guo, Li, Karmakar-Hore); School of Epidemiology and Public Health (Amuah), University of Ottawa, Ottawa, Ont.; Institute of Health Policy, Management and Evaluation (Carbone), University of Toronto, Toronto, Ont.; School of Public Health Sciences (Guo, Maxwell), University of Waterloo, Waterloo, Ont.; Division of Geriatric Medicine (Hogan), Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alta.; School of Pharmacy (Maxwell), University of Waterloo, Waterloo, Ont.; Department of Critical Care Medicine (Muscedere), Queen's University; Canadian Frailty Network (Muscedere), Kingston, Ont.; Division of Geriatric Medicine, Department of Medicine (Rockwood), Dalhousie University, Halifax, NS; Division of Geriatric Medicine (Sinha), Department of Medicine, University of Toronto; National Institute on Ageing (Sinha), Ryerson University, Toronto, Ont.; School of Physiotherapy and Division of Geriatric Medicine (Theou), Dalhousie University, Halifax, NS
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15
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Hogan DB, Campitelli MA, Bronskill SE, Iaboni A, Barry HE, Hughes CM, Gill SS, Maxwell CJ. Trends and correlates of concurrent opioid and benzodiazepine and/or gabapentinoid use among Ontario nursing home residents. J Am Geriatr Soc 2023. [PMID: 36942992 DOI: 10.1111/jgs.18320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/17/2023] [Accepted: 02/23/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND A concern with long-term opioid use is the increased risk arising when opioids are used concurrently with drugs that can potentiate their associated adverse effects. The drugs most often encountered are benzodiazepines (BZDs) and gabapentinoids. Our study objectives were to examine trends in the concurrent use of opioids and BZDs, or gabapentinoids, in a Canadian nursing home population over an 11-year period, and current resident-level correlates of this concurrent use. METHODS We conducted a population-based, repeated cross-sectional study among Ontario nursing home residents (>65 years) dispensed opioids between April 2009 and February 2020. For the last study year, we examined cross-sectional associations between resident characteristics and concurrent use of opioids with BZDs or gabapentinoids. Linked data on nursing home residents from clinical and health administrative databases was used. The yearly proportions of residents who were dispensed an opioid concurrently with a BZD or gabapentinoid were plotted with percent change derived from log-binomial regression models. Separate modified Poisson regression models estimated resident-level correlates of concurrent use of opioids with BZDs or gabapentinoids. RESULTS Over the study period, among residents dispensed an opioid there was a 53.2% relative decrease (30.7% to 14.4%) in concurrent BZD and a 505.4% relative increase (4.4% to 26.6%) in concurrent gabapentinoid use. In adjusted models, increasing age and worsening cognition were inversely associated with the concurrent use of both classes, but most other significantly related covariates were unique to each drug class (e.g., sex and anxiety disorders for BZD, pain severity and presence of pain-related conditions for gabapentinoids). CONCLUSIONS Co-administration of BZDs or gabapentinoids in Ontario nursing home residents dispensed opioids remains common, but the pattern of co-use has changed over time. Observed covariates of concurrent use in 2019/20 suggest distinct but overlapping resident populations requiring consideration of the relative risks versus benefits of this co-use and monitoring for potential harm.
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Affiliation(s)
- David B Hogan
- Department of Medicine, Division of Geriatric Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Susan E Bronskill
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Andrea Iaboni
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Heather E Barry
- School of Pharmacy, Primary Care Research Group, Queen's University Belfast, Belfast, UK
| | - Carmel M Hughes
- School of Pharmacy, Primary Care Research Group, Queen's University Belfast, Belfast, UK
| | - Sudeep S Gill
- ICES, Toronto, Ontario, Canada
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Colleen J Maxwell
- ICES, Toronto, Ontario, Canada
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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16
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Harris DA, Maclagan LC, Pequeno P, Iaboni A, Austin PC, Rosella LC, Guan J, Maxwell CJ, Bronskill SE. Variation and Correlation of Potential Unintended Consequences of Antipsychotic Reduction in Ontario Nursing Homes Over Time. Med Care 2023; 61:173-181. [PMID: 36728617 DOI: 10.1097/mlr.0000000000001814] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Potentially inappropriate antipsychotic use has declined in nursing homes over the past decade; however, increases in the documentation of relevant clinical indications (eg, delusions) and the use of other psychotropic medications have raised concerns about diagnosis upcoding and medication substitution. Few studies have examined how these trends over time vary across and within nursing homes, information that may help to support antipsychotic reduction efforts. OBJECTIVE To jointly model facility-level time trends in potentially inappropriate antipsychotic use, antidepressant use, and the indications used to define appropriate antipsychotic use. RESEARCH DESIGN We conducted a repeated cross-sectional study of all nursing homes in Ontario, Canada between April 1, 2010 and December 31, 2019 using linked health administrative data (N=649). Each nursing home's quarterly prevalence of potentially inappropriate antipsychotic use, antidepressant use, and relevant indications were measured as outcome variables. With time as the independent variable, multivariate random effects models jointly estimated time trends for each outcome across nursing homes and the correlations between time trends within nursing homes. RESULTS We observed notable variations in the time trends for each outcome across nursing homes, especially for the relevant indications. Within facilities, we found no correlation between time trends for potentially inappropriate antipsychotic and antidepressant use ( r =-0.0160), but a strong negative correlation between time trends for potentially inappropriate antipsychotic use and relevant indications ( r =-0.5036). CONCLUSIONS Nursing homes with greater reductions in potentially inappropriate antipsychotics tended to show greater increases in the indications used to define appropriate antipsychotic use-possibly leading to unmonitored use of antipsychotics.
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Affiliation(s)
- Daniel A Harris
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto
| | | | | | - Andrea Iaboni
- KITE Research Institute-Toronto Rehabilitation Institute, University Health Network.,Department of Psychiatry, University of Toronto
| | - Peter C Austin
- ICES.,Sunnybrook Research Institute.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto
| | - Laura C Rosella
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto.,ICES.,Institute for Better Health, Trillium Health Partners, Mississauga.,Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto.,Vector Institute, Toronto
| | | | - Colleen J Maxwell
- ICES.,Schools of Pharmacy and Public Health Sciences, University of Waterloo, Waterloo
| | - Susan E Bronskill
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto.,ICES.,Sunnybrook Research Institute.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
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17
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Maxwell CJ, Alkabbani W, Yasar S. Pioglitazone and Lower Risk of Dementia: Will This Change Practice? Neurology 2023; 100:803-804. [PMID: 36792376 DOI: 10.1212/wnl.0000000000207182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 01/26/2023] [Indexed: 02/17/2023] Open
Affiliation(s)
- Colleen J Maxwell
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - Wajd Alkabbani
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - Sevil Yasar
- School of Medicine, Johns Hopkins University, Baltimore, MD, United States
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18
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Harris DA, Maclagan LC, Pequeno P, Iaboni A, Austin PC, Rosella LC, Guan J, Maxwell CJ, Bronskill SE. Changes in the Initiation of Antipsychotics and Trazodone Over Time: A Cohort Study of New Admissions to Nursing Homes in Ontario, Canada. Am J Geriatr Psychiatry 2023; 31:449-455. [PMID: 36842890 DOI: 10.1016/j.jagp.2023.01.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/27/2023] [Accepted: 01/27/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To investigate whether trazodone is being initiated in lieu of antipsychotics following antipsychotic reduction efforts, this study described changes in medication initiation over time. METHODS We conducted a retrospective cohort study of new admissions to nursing homes in Ontario, Canada between April 2010 and December 2019 using health administrative data (N = 61,068). The initiation of antipsychotic and trazodone use was compared by year of admission using discrete time survival analysis and stratified by history of dementia. RESULTS Relative to residents admitted in 2014, antipsychotic initiation significantly decreased in later years (e.g., 2017 admission year hazard odds ratio [HOR2017]=0.72 [95% confidence interval (95%CI)=0.62-0.82]) while trazodone initiation modestly increased (e.g., HOR2017=1.09 [95%CI=0.98-1.21]). The relative increase in trazodone initiation was larger among residents with dementia (e.g., HOR2017Dem =1.22 [95%CI=1.07-1.39]). CONCLUSIONS Differences in which medications were started following nursing home admission were observed and suggest trazodone may be initiated in lieu of antipsychotics.
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Affiliation(s)
- Daniel A Harris
- Division of Epidemiology, Dalla Lana School of Public Health (DAH, LCR, SEB), University of Toronto, Toronto, ON, Canada.
| | | | | | - Andrea Iaboni
- KITE Research Institute-Toronto Rehabilitation Institute (AI), University Health Network, Toronto, ON, Canada; Department of Psychiatry (AI), University of Toronto, Toronto, ON, Canada
| | - Peter C Austin
- ICES (LCM, PP, PCA, LCR, JG, CJM, SEB), Toronto, ON, Canada; Sunnybrook Research Institute (PCA, SEB), Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health (PCA, SEB), University of Toronto, Toronto, ON, Canada
| | - Laura C Rosella
- Division of Epidemiology, Dalla Lana School of Public Health (DAH, LCR, SEB), University of Toronto, Toronto, ON, Canada; ICES (LCM, PP, PCA, LCR, JG, CJM, SEB), Toronto, ON, Canada; Institute for Better Health, Trillium Health Partners (LCR) , Mississauga, ON, Canada; Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine (LCR), University of Toronto, Toronto, ON, Canada; Vector Institute (LCR), Toronto, ON, Canada
| | - Jun Guan
- ICES (LCM, PP, PCA, LCR, JG, CJM, SEB), Toronto, ON, Canada
| | - Colleen J Maxwell
- ICES (LCM, PP, PCA, LCR, JG, CJM, SEB), Toronto, ON, Canada; Schools of Pharmacy and Public Health Sciences, University of Waterloo (CJM), Waterloo, ON, Canada
| | - Susan E Bronskill
- Division of Epidemiology, Dalla Lana School of Public Health (DAH, LCR, SEB), University of Toronto, Toronto, ON, Canada; ICES (LCM, PP, PCA, LCR, JG, CJM, SEB), Toronto, ON, Canada; Sunnybrook Research Institute (PCA, SEB), Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health (PCA, SEB), University of Toronto, Toronto, ON, Canada; Women's College Research Institute (SEB), Women's College Hospital, Toronto, ON, Canada
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19
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Alkabbani W, Maxwell CJ, Marrie RA, Tyas SL, Lega IC, Gamble JM. Associations of Mid- and Late-Life Severe Hypoglycemic Episodes With Incident Dementia Among Patients With Type 2 Diabetes: A Population-Based Cohort Study. Diabetes Care 2023; 46:331-340. [PMID: 36516080 DOI: 10.2337/dc22-1496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 11/12/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Severe hypoglycemia is associated with an increased risk of dementia. We examined if the association is consistently present in mid- and late-life hypoglycemia. RESEARCH DESIGN AND METHODS Using health care data from Population Data BC, we created a base cohort of patients age ≥40 years with incident type 2 diabetes. Exposure was the first occurrence of severe hypoglycemia (hospitalization or physician visit). We assessed exposure versus no exposure in mid- (age 45-64 years) and late-life (age 65-84 years) cohorts. Index date was the later of the 45th birthday (midlife cohort), 65th birthday (late-life cohort), or diabetes diagnosis. Those with hypoglycemia or dementia before the index date were excluded. Patients were followed from index date until dementia diagnosis, death, emigration, or 31 December 2018. Exposure was modeled as time dependent. We adjusted for confounding using propensity score weighting. Dementia risk was estimated using cause-specific hazards models with death as a competing risk. RESULTS Of 221,683 patients in the midlife cohort, 1,793 experienced their first severe hypoglycemic event. Over a median of 9.14 years, 3,117 dementia outcomes occurred (32 among exposed). Of 223,940 patients in the late-life cohort, 2,466 experienced their first severe hypoglycemic event. Over a median of 6.7 years, 15,997 dementia outcomes occurred (158 among exposed). The rate of dementia was higher for those with (vs. without) hypoglycemia in both the mid- (hazard ratio 2.85; 95% CI 1.72-4.72) and late-life (2.38; 1.83-3.11) cohorts. CONCLUSIONS Both mid- and late-life hypoglycemia were associated with approximately double the risk of dementia, indicating the need for prevention throughout the life course of those with diabetes.
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Affiliation(s)
- Wajd Alkabbani
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - Colleen J Maxwell
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Science, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Suzanne L Tyas
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Iliana C Lega
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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20
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Hoben M, Baumbusch J, B. Hogan D, Gruneir A, A. Chamberlain S, Corbett K, E. Griffith L, McGrail KM, E. Amuah J, E. Lane N, J. Maxwell C. Caregivers' Concerns About Assisted Living Residents' Mental Health During the COVID-19 Pandemic: A Cross-Sectional Survey Study. J Fam Nurs 2023; 29:28-42. [PMID: 36124925 PMCID: PMC9490393 DOI: 10.1177/10748407221124159] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Family or friend caregivers' concerns about assisted living (AL) residents' mental health are reflective of poor resident and caregiver mental health. COVID-19-related visiting restrictions increased caregiver concerns, but research on these issues in AL is limited. Using web-based surveys with 673 caregivers of AL residents in Western Canada, we assessed the prevalence and correlates of moderate to severe caregiver concerns about residents' depressed mood, loneliness, and anxiety in the 3 months before and after the start of the COVID-19 pandemic. Caregiver concerns doubled after the start of the pandemic (resident depressed mood: 23%-50%, loneliness: 29%-62%, anxiety: 24%-47%). Generalized linear mixed models identified various modifiable risk factors for caregiver concerns (e.g., caregivers' perception that residents lacked access to counseling services or not feeling well informed about and involved in resident care). These modifiable factors can be targeted in efforts to prevent or mitigate caregiver concerns and resident mental health issues.
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Affiliation(s)
- Matthias Hoben
- York University, Toronto, Ontario, Canada
- University of Alberta, Edmonton, Canada
| | | | | | - Andrea Gruneir
- University of Alberta, Edmonton, Canada
- ICES, Toronto, Ontario, Canada
| | | | | | | | | | | | - Natasha E. Lane
- The University of British Columbia, Vancouver, Canada
- ICES, Toronto, Ontario, Canada
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21
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Maxwell CJ, Dayes L, Amuah JE, Hogan DB, Lane NE, McGrail KM, Gruneir A, Griffith LE, Chamberlain SA, Rutter EC, Corbett K, Hoben M. Coping Behaviors and Health Status during the COVID-19 Pandemic among Caregivers of Assisted Living Residents in Western Canada. J Am Med Dir Assoc 2022; 24:410-418.e9. [PMID: 36669529 PMCID: PMC9771753 DOI: 10.1016/j.jamda.2022.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 12/09/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To examine the prevalence of coping behaviors during the first 2 waves of the COVID-19 pandemic among caregivers of assisted living residents and variation in these behaviors by caregiver gender and mental health. DESIGN Cross-sectional and longitudinal survey. SETTING AND PARTICIPANTS Family/friend caregivers of assisted living residents in Alberta and British Columbia. METHODS A web-based survey, conducted twice (October 28, 2020 to March 31, 2021 and July 12, 2021 to September 7, 2021) on the same cohort obtained data on caregiver sociodemographic characteristics, anxiety and depressive symptoms, and coping behaviors [seeking counselling, starting a psychotropic drug (sedative, anxiolytic, antidepressant), starting or increasing alcohol, tobacco and/or cannabis consumption] during pandemic waves 1 and 2. Descriptive analyses and multivariable (modified) Poisson regression models identified caregiver correlates of each coping behavior. RESULTS Among the 673 caregivers surveyed at baseline, most were women (77%), White (90%) and age ≥55 years (81%). Alcohol (16.5%) and psychotropic drug (13.3%) use were the most prevalent coping behaviors reported during the initial wave, followed by smoking and/or cannabis use (8.0%), and counseling (7.4%). Among the longitudinal sample (n = 386), only alcohol use showed a significantly lower prevalence during the second wave (11.7% vs 15.1%, P = .02). During both waves, coping behaviors did not vary significantly by gender, however, psychotropic drug and substance use were significantly more prevalent among caregivers with baseline anxiety and depressive symptoms, including in models adjusted for confounders [eg, anxiety: adjusted risk ratio = 3.87 (95% CI 2.50-6.00] for psychotropic use, 1.87 (1.28-2.73) for alcohol use, 2.21 (1.26-3.88) for smoking/cannabis use). CONCLUSIONS AND IMPLICATIONS Assisted living caregivers experiencing anxiety or depressive symptoms during the pandemic were more likely to engage in drug and substance use, potentially maladaptive responses. Public health and assisted living home initiatives that identify caregiver mental health needs and provide targeted support during crises are required to mitigate declines in their health.
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Affiliation(s)
- Colleen J. Maxwell
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada,School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada,ICES, Toronto, Ontario, Canada,Address correspondence to Colleen J. Maxwell PhD, School of Pharmacy, University of Waterloo, 200 University Ave West, Waterloo, Ontario, Canada, N2L 3G1
| | - Lauren Dayes
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - Joseph E. Amuah
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - David B. Hogan
- Division of Geriatric Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Natasha E. Lane
- ICES, Toronto, Ontario, Canada,Department of Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kimberlyn M. McGrail
- Center for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrea Gruneir
- ICES, Toronto, Ontario, Canada,Department of Family Medicine, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Lauren E. Griffith
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Stephanie A. Chamberlain
- Department of Family Medicine, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Emily C. Rutter
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Kyle Corbett
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Matthias Hoben
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada,School of Health Policy and Management, Faculty of Health, York University, Toronto, Ontario, Canada
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22
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Osman A, Duncan A, Giurca P, Maxwell CJ, Kamkar N, Hogan DB, Montero-Odasso M. Listening to Trainee Concerns and Suggestions During COVID-19: a Report from the Canadian Consortium on Neurodegeneration in Aging (CCNA). Can Geriatr J 2022; 25:262-268. [PMID: 36117738 PMCID: PMC9427181 DOI: 10.5770/cgj.25.564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
The COVID-19 pandemic has caused significant disruption to research activities across Canada. The Training and Capacity Building (T&CB) Program of the Canadian Consortium on Neurodegeneration in Aging (CCNA) conducted a survey be-tween May 11th, 2020 and May 19th, 2020 to identify the chal-lenges faced by CCNA trainees because of the pandemic and how to best support trainees in response to those challenges.
Methods
Graduate students and postdoctoral researchers working under the supervision of CCNA investigators (n=113) were invited to complete a web-based survey of 13 questions. Trainees were asked questions about the impact of COVID-19 on their research activities, degree progression, funding status, and suggestions for support from the T&CB Program during the COVID-19 pandemic.
Results
A total of 41 trainees responded to the survey (response rate: 36.3%); 83% of respondents reported that they experienced changes to their research activities as a result of COVID-19, and 50% anticipated that their degree completion would be delayed. Respondents requested information from the T&CB Program on funding for non-COVID-19 projects, alternative datasets, and short educational workshops.
Conclusion
The majority of CCNA trainees surveyed experienced sig-nificant changes to their research activities as a result of the COVID-19 pandemic. The T&CB Program responded by switching to online programming and facilitating remote research. Further engagement with trainees is needed to ensure continued progress of research in age-related neurodegenera-tive disease in Canada post-pandemic.
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23
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Alkabbani W, Maxwell CJ, Marrie RA, Tyas SL, Lega IC, Gamble JM. Hypoglycaemia and the risk of dementia: a population-based cohort study using exposure density sampling. Int J Epidemiol 2022:6680498. [PMID: 36048015 DOI: 10.1093/ije/dyac168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/04/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Previous studies have shown hypoglycaemia to be associated with an increased risk of dementia; however, there are several design challenges to consider. The objective of this study is to assess the association between hypoglycaemia and dementia while addressing these challenges using a lag period, exposure density sampling (EDS) and inverse probability of treatment weighting (IPTW). METHODS This was a population-based cohort using data (1996-2018) from British Columbia, Canada. From a cohort of incident type 2 diabetes patients aged 40-70 years, we created a dynamic sub-cohort of hypoglycaemia-exposed (≥1 episode requiring hospitalization or a physician visit) and unexposed individuals using EDS, in which four unexposed individuals per one exposed were randomly selected into risk sets based on diabetes duration and age. Follow-up was until dementia diagnosis, death, emigration or 31 December 2018. Those diagnosed with dementia within 2 years of follow-up were censored. We adjusted for confounding using IPTW and estimated the hazard ratio (HR, 95% CI) of dementia using weighted conditional cause-specific hazards risk models with death as a competing risk. RESULTS Among 13 970 patients with incident type 2 diabetes, 2794 experienced hypoglycaemia. There were 329 dementia events over a median (interquartile range: IQR) follow-up of 5.03 (5.7) years. IPTW resulted in well-balanced groups with weighted incidence rates (95% CI) of 4.59 (3.52, 5.98)/1000 person-years among exposed and 3.33 (2.58, 3.88)/1000 person-years among unexposed participants. The risk of dementia was higher among those with hypoglycaemia (HR, 1.83; 95% CI 1.31, 2.57). CONCLUSIONS After addressing several methodological challenges, we showed that hypoglycaemia contributes to an increased risk of all-cause dementia among patients with type 2 diabetes.
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Affiliation(s)
- Wajd Alkabbani
- School of Pharmacy, University of Waterloo, Kitchener, ON, Canada
| | - Colleen J Maxwell
- School of Pharmacy, University of Waterloo, Kitchener, ON, Canada.,School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Science, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Suzanne L Tyas
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Iliana C Lega
- Women's College Research Institute (WCRI), Women's College Hospital, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
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24
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Iacono A, Campitelli MA, Bronskill SE, Hogan DB, Iaboni A, Maclagan LC, Gomes T, Tadrous M, Evans C, Gruneir A, Guan Q, Hadjistavropoulos T, Cotton C, Gill SS, Seitz DP, Ho J, Maxwell CJ. Correlates of Opioid Use Among Ontario Long-Term Care Residents and Variation by Pain Frequency and Intensity: A Cross-sectional Analysis. Drugs Aging 2022; 39:811-827. [PMID: 35976489 PMCID: PMC9381389 DOI: 10.1007/s40266-022-00972-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 11/25/2022]
Abstract
Background Chronic non-cancer pain is common among older residents of long-term care (LTC) homes and often poorly recognized and treated. With heightened concerns regarding opioid prescribing in recent years, it is important to examine the current prevalence of opioid use and its association with resident characteristics to help identify those potentially at risk of medication harms as well as suboptimal pain management. Objectives The aims were to estimate the prevalence and correlates of opioid use among non-palliative LTC residents and explore variation in opioid prevalence and correlates across strata defined by pain frequency and intensity. Methods We conducted a population-based cross-sectional study of all older (aged > 65 years) LTC residents (excluding those with cancer or receiving palliative care) in Ontario, Canada during 2018–2019. Health administrative databases were linked with standardized clinical assessment data to ascertain residents’ health and pain characteristics and their opioid and other medication use. Modified Poisson regression models estimated unadjusted and adjusted associations between residents’ characteristics and opioid use, overall and across strata capturing pain frequency and intensity. Results Among 75,020 eligible residents (mean age 85.1 years; 70% female), the prevalence of opioid use was 18.5% and pain was 29.4%. Opioid use ranged from 12.2% for residents with no current pain to 55.7% for those with severe pain. In adjusted models, residents newly admitted to LTC (adjusted risk ratio [aRR] = 0.60, 95% confidence interval [CI] 0.57–0.62) and with moderate to severe cognitive impairment (aRR = 0.69, 95% CI 0.66–0.72) or dementia (aRR = 0.76, 95% CI 0.74–0.79) were significantly less likely to receive an opioid, whereas residents with select conditions (e.g., arthritis, aRR = 1.37, 95% CI 1.32–1.41) and concurrently using gabapentinoids (aRR = 1.80, 95% CI 1.74–1.86), benzodiazepines (aRR = 1.33, 95% CI 1.28–1.38), or antidepressants (aRR = 1.31, 95% CI 1.27–1.35) were significantly more likely to receive an opioid. The associations observed for residents newly admitted, with dementia, and concurrently using gabapentinoids, benzodiazepines, or antidepressants were largely consistent across all pain strata. Conclusions Our findings describe resident sub-groups at potentially higher risk of adverse health outcomes in relation to both opioid use and non-use. LTC clinical and policy changes informed by research are required to ensure the appropriate recognition and management of non-cancer pain in this setting. Supplementary Information The online version contains supplementary material available at 10.1007/s40266-022-00972-9.
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Affiliation(s)
- Anita Iacono
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | | | - Susan E Bronskill
- ICES, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - David B Hogan
- Division of Geriatric Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Andrea Iaboni
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Tara Gomes
- ICES, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Unity Health, Toronto, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Mina Tadrous
- ICES, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Charity Evans
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | - Andrea Gruneir
- ICES, Toronto, ON, Canada.,Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
| | - Qi Guan
- ICES, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Thomas Hadjistavropoulos
- Department of Psychology and Centre on Aging and Health, University of Regina, Regina, SK, Canada
| | - Cecilia Cotton
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON, Canada
| | - Sudeep S Gill
- ICES, Toronto, ON, Canada.,Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Dallas P Seitz
- ICES, Toronto, ON, Canada.,Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Joanne Ho
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Schlegel Research Institute for Aging, Waterloo, ON, Canada
| | - Colleen J Maxwell
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada. .,ICES, Toronto, ON, Canada. .,School of Pharmacy, University of Waterloo, Waterloo, ON, Canada.
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25
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Lane NE, Hoben M, Amuah JE, Hogan DB, Baumbusch J, Gruneir A, Chamberlain SA, Griffith LE, McGrail KM, Corbett K, Maxwell CJ. Prevalence and correlates of anxiety and depression in caregivers to assisted living residents during COVID-19: a cross-sectional study. BMC Geriatr 2022; 22:662. [PMID: 35962356 PMCID: PMC9372518 DOI: 10.1186/s12877-022-03294-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/12/2022] [Indexed: 12/30/2022] Open
Abstract
Background Family and friend caregivers play significant roles in advocating for and ensuring quality health and social care of residents in Assisted Living (AL) homes. However, little is known about how the COVID-19 pandemic and related visitor restrictions affected their health and mental well-being. We examined the prevalence and correlates of anxiety and depressive symptoms among caregivers of AL residents during the initial wave of COVID-19 in two Canadian provinces. Methods A cross-sectional web-based survey was conducted among family/friend caregivers of AL residents in Alberta and British Columbia (Oct 28, 2020—Mar 31, 2021) to collect data on their sociodemographic, health and caregiving characteristics, as well as concerns about residents’ health and social care before and during the first wave of the pandemic. A clinically significant anxiety disorder and depressive symptoms were assessed with the GAD-7 and CES-D10 instruments, respectively. Separate multivariable (modified) Poisson regression models identified caregiver correlates of each mental health condition. Results Among the 673 caregivers completing the survey (81% for Alberta residents), most were women (77%), white (90%) and aged ≥ 55 years (81%). Clinically significant anxiety and depression were present in 28.6% and 38.8% of caregivers respectively. Both personal stressors (comorbidity level, income reduction, low social support) and caregiving stressors exacerbated by the pandemic were independently associated with caregiver anxiety and depression. The latter included increased concern about the care recipients’ depression (adjusted risk ratio [adjRR] = 1.84, 95% confidence interval [CI] 1.19–2.85 for caregiver anxiety and adjRR = 1.75, 95% CI 1.26–2.44 for caregiver depressive symptoms) and reported intention to withdraw the resident from AL because of COVID-19 (adjRR = 1.24, 95%CI 0.95–1.63 for caregiver anxiety and adjRR = 1.37, 95%CI 1.13–1.67 for caregiver depressive symptoms). Conclusions Caregivers of residents in AL homes reported significant personal and caregiving-related stressors during the initial wave of COVID-19 that were independently associated with an increased likelihood of experiencing clinically significant anxiety and depressive symptoms. Healthcare providers and AL staff should be aware of the prevalence and varied correlates of caregivers’ mental health during public health crises so that appropriate screening and support may identified and implemented. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03294-y.
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Affiliation(s)
- Natasha E Lane
- ICES, Toronto, ON, Canada.,Department of Internal Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Matthias Hoben
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Joseph E Amuah
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - David B Hogan
- Division of Geriatric Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jennifer Baumbusch
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Andrea Gruneir
- ICES, Toronto, ON, Canada.,Department of Family Medicine, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Stephanie A Chamberlain
- Department of Family Medicine, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Lauren E Griffith
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Kimberlyn M McGrail
- School of Population and Public Health, Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada
| | - Kyle Corbett
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Colleen J Maxwell
- ICES, Toronto, ON, Canada. .,School of Pharmacy, University of Waterloo, ON, N2L 3G1, Waterloo, Canada. .,School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada.
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26
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Harris DA, Guo Y, Nakhla N, Tadrous M, Hogan DB, Hennessy D, Langlois K, Garner R, Leslie S, Bronskill SE, Heckman G, Maxwell CJ. Prevalence of prescription and non-prescription polypharmacy by frailty and sex among middle-aged and older Canadians. Health Rep 2022; 33:3-16. [PMID: 35876612 DOI: 10.25318/82-003-x202200600001-eng] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Estimates of polypharmacy have primarily been derived from prescription claims, and less is known about the use of non-prescription medications (alone or in combination with prescription medications) across the frailty spectrum or by sex. Our objectives were to estimate the prevalence of polypharmacy (total, prescription, non-prescription, and concurrent prescription and non-prescription) overall, and by frailty, sex and broad age group. DATA Canadian Health Measures Survey, Cycle 5, 2016 to 2017. METHODS Among Canadians aged 40 to 79 years, all prescription and non-prescription medications used in the month prior to the survey were documented. Polypharmacy was defined as using five or more medications total (prescription and non-prescription), prescription only and non-prescription only. Concurrent prescription and non-prescription use was defined as two or more and three or more of each. Frailty was defined using a 31-item frailty index (FI) and categorized as non-frail (FI ≤ 0.1) and pre-frail or frail (FI > 0.1). Survey-weighted descriptive statistics were calculated overall and age standardized. RESULTS We analyzed 2,039 respondents, representing 16,638,026 Canadians (mean age of 56.9 years; 51% women). Overall, 52.4% (95% confidence interval [CI] = 47.3 to 57.4) were defined as pre-frail or frail. Age-standardized estimates of total polypharmacy, prescription polypharmacy and concurrent prescription and non-prescription medication use were significantly higher among pre-frail or frail versus non-frail adults (e.g., total polypharmacy: 64.1% versus 31.8%, respectively). Polypharmacy with non-prescription medications was common overall (20.5% [95% CI = 16.1 to 25.8]) and greater among women, but did not differ significantly by frailty. INTERPRETATION Polypharmacy and concurrent prescription and non-prescription medication use were common among Canadian adults, especially those who were pre-frail or frail. Our findings highlight the importance of considering non-prescribed medications when measuring the exposure to medications and the potential risk for adverse outcomes.
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Affiliation(s)
- Daniel A Harris
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
- ICES, Toronto, Ontario
| | - Yanling Guo
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario
| | - Nardine Nakhla
- School of Pharmacy, University of Waterloo, Waterloo, Ontario
| | - Mina Tadrous
- ICES, Toronto, Ontario
- WCH Institute for Health System Solutions & Virtual Care, Women's College Hospital, Toronto, Ontario
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | - David B Hogan
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Deirdre Hennessy
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta
- Health Analysis Division, Analytical Studies and Modelling Branch, Statistics Canada, Ottawa, Ontario
| | - Kellie Langlois
- Health Analysis Division, Analytical Studies and Modelling Branch, Statistics Canada, Ottawa, Ontario
| | - Rochelle Garner
- Health Analysis Division, Analytical Studies and Modelling Branch, Statistics Canada, Ottawa, Ontario
| | - Sarah Leslie
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario
| | - Susan E Bronskill
- ICES, Toronto, Ontario
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
| | - George Heckman
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario
- Research Institute for Aging, Waterloo, Ontario
| | - Colleen J Maxwell
- ICES, Toronto, Ontario
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario
- School of Pharmacy, University of Waterloo, Waterloo, Ontario
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta
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Kirkham J, Shorey CL, Iaboni A, Quirt H, Grigorovich A, Astell A, Lin E, Maxwell CJ. Staff perceptions of the consequences of COVID-19 on quality of dementia care for residents in Ontario long-term care homes. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5725. [PMID: 35510483 PMCID: PMC9087411 DOI: 10.1002/gps.5725] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 04/20/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVES The first wave of the COVID-19 pandemic necessitated extensive infection control measures in long-term care (LTC) and had a significant impact on staffing and services. Anecdotal reports indicate that this negatively affected LTC residents' quality of care and wellbeing, but there is scarce evidence on the effects of COVID-19 on quality of dementia care in LTC. METHODS From December 2020 to March 2021, we conducted a cross-sectional online survey among staff who worked in LTC homes in Ontario, Canada. Survey questions examined staffs' perceptions of the impact of COVID-19 on dementia quality of care during the initial wave of the COVID-19 pandemic (beginning 1 March 2020). RESULTS There were a total of 227 survey respondents; more than half reported both worsened overall quality of care (51.3%) and worsening of a majority of specific quality of care measures (55.5%). Measures of cognitive functioning, mobility and behavioural symptoms were most frequently described as worsened. Medical and allied/support staff had the highest odds of reporting overall worsened quality of care, while specialized behavioural care staff and those with more experience in LTC were less likely to. LTC home factors including rural location and smaller size, staffing challenges, higher number of outbreaks and less COVID-19 preparedness were associated with increased odds of perceived worsening of quality of dementia care outcomes. CONCLUSIONS These findings suggest that COVID-19 pandemic restrictions and related effects such as inadequate staffing may have contributed to poor quality of care and outcomes for those with dementia in LTC.
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Affiliation(s)
- Julia Kirkham
- Department of PsychiatryCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Carrie L. Shorey
- School of Public Health SciencesUniversity of WaterlooWaterlooOntarioCanada
| | - Andrea Iaboni
- KITE‐Toronto Rehabilitation InstituteUniversity Health NetworkTorontoOntarioCanada,Department of PsychiatryTemerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Hannah Quirt
- KITE‐Toronto Rehabilitation InstituteUniversity Health NetworkTorontoOntarioCanada
| | - Alisa Grigorovich
- Recreation and Leisure StudiesBrock UniversitySt CatharinesOntarioCanada
| | - Arlene Astell
- KITE‐Toronto Rehabilitation InstituteUniversity Health NetworkTorontoOntarioCanada,Department of PsychiatryTemerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Esther Lin
- Department of PsychiatryCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Colleen J. Maxwell
- School of Public Health SciencesUniversity of WaterlooWaterlooOntarioCanada,School of PharmacyUniversity of WaterlooWaterlooOntarioCanada
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Groome PA, Webber C, Maxwell CJ, McClintock C, Seitz D, Mahar A, Marrie RA. Multiple Sclerosis and the Cancer Diagnosis: Diagnostic Route, Cancer Stage, and the Diagnostic Interval in Breast and Colorectal Cancer. Neurology 2022; 98:e1798-e1809. [PMID: 35501160 DOI: 10.1212/wnl.0000000000200163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 01/21/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The multiple sclerosis (MS) population's survival from breast cancer and colorectal cancer is compromised. Cancer screening and timely diagnoses affect cancer survival and have not been studied in the MS cancer population. We investigated whether the diagnostic route, cancer stage, or diagnostic interval differed in patients with cancer with and without MS. METHODS We conducted a matched population-based cross-sectional study of breast cancers (2007-2015) and colorectal cancers (2009-2012) in patients with MS from Ontario, Canada, using administrative data. Exclusion criteria included second or concurrent primary cancers, no health care coverage, and, for the patients without MS, those with any demyelinating disease. We based 1:4 matching of MS to non-MS on birth year, sex (colorectal only), postal code, and cancer diagnosis year (breast only). Cancer outcomes were diagnostic route (screen-detected vs symptomatic), stage (stage I vs all others), and diagnostic interval (time from first presentation to diagnosis). Multivariable regression analyses controlled for age, sex (colorectal only), diagnosis year, income quintile, urban/rural residence, and comorbidity. RESULTS We included 351 patients with MS and breast cancer, 1,404 matched patients with breast cancer without MS, 54 patients with MS and colorectal cancer, and 216 matched patients with colorectal cancer without MS. MS was associated with fewer screen-detected cancers in breast (odds ratio [OR] 0.68 [95% CI 0.52, 0.88]) and possibly colorectal (0.52 [0.21, 1.28]) cancer. MS was not associated with differences in breast cancer stage at diagnosis (stage I cancer, OR 0.81 [0.64, 1.04]). MS was associated with greater odds of stage I colorectal cancer (OR 2.11 [1.03, 4.30]). The median length of the diagnostic interval did not vary between people with and without MS in either the breast or colorectal cancer cohorts. Controlling for disability status attenuated some findings. DISCUSSION Breast cancers were less likely to be detected through screening and colorectal cancer more likely to be detected at early stage in people with MS than without MS. MS-related disability may prevent people from getting mammograms and colonoscopies. Understanding the pathways to earlier detection in both cancers is critical to developing and planning interventions to ameliorate outcomes for people with MS and cancer.
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Affiliation(s)
- Patti A Groome
- From ICES Queen's (P.A.G., C.M., D.S., A.M.) and Division of Cancer Care and Epidemiology, Cancer Research Institute (P.A.G.), Queen's University, Kingston; Ottawa Hospital Research Institute (C.W.); Bruyère Research Institute (C.W.), Ottawa; ICES (C.J.M.), Toronto; Schools of Pharmacy and Public Health & Health Systems (C.J.M.), University of Waterloo; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Department of Community Health Sciences (A.M., R.A.M.), Manitoba Centre for Health Policy (A.M.), and Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Colleen Webber
- From ICES Queen's (P.A.G., C.M., D.S., A.M.) and Division of Cancer Care and Epidemiology, Cancer Research Institute (P.A.G.), Queen's University, Kingston; Ottawa Hospital Research Institute (C.W.); Bruyère Research Institute (C.W.), Ottawa; ICES (C.J.M.), Toronto; Schools of Pharmacy and Public Health & Health Systems (C.J.M.), University of Waterloo; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Department of Community Health Sciences (A.M., R.A.M.), Manitoba Centre for Health Policy (A.M.), and Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Colleen J Maxwell
- From ICES Queen's (P.A.G., C.M., D.S., A.M.) and Division of Cancer Care and Epidemiology, Cancer Research Institute (P.A.G.), Queen's University, Kingston; Ottawa Hospital Research Institute (C.W.); Bruyère Research Institute (C.W.), Ottawa; ICES (C.J.M.), Toronto; Schools of Pharmacy and Public Health & Health Systems (C.J.M.), University of Waterloo; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Department of Community Health Sciences (A.M., R.A.M.), Manitoba Centre for Health Policy (A.M.), and Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Chad McClintock
- From ICES Queen's (P.A.G., C.M., D.S., A.M.) and Division of Cancer Care and Epidemiology, Cancer Research Institute (P.A.G.), Queen's University, Kingston; Ottawa Hospital Research Institute (C.W.); Bruyère Research Institute (C.W.), Ottawa; ICES (C.J.M.), Toronto; Schools of Pharmacy and Public Health & Health Systems (C.J.M.), University of Waterloo; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Department of Community Health Sciences (A.M., R.A.M.), Manitoba Centre for Health Policy (A.M.), and Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Dallas Seitz
- From ICES Queen's (P.A.G., C.M., D.S., A.M.) and Division of Cancer Care and Epidemiology, Cancer Research Institute (P.A.G.), Queen's University, Kingston; Ottawa Hospital Research Institute (C.W.); Bruyère Research Institute (C.W.), Ottawa; ICES (C.J.M.), Toronto; Schools of Pharmacy and Public Health & Health Systems (C.J.M.), University of Waterloo; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Department of Community Health Sciences (A.M., R.A.M.), Manitoba Centre for Health Policy (A.M.), and Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Alyson Mahar
- From ICES Queen's (P.A.G., C.M., D.S., A.M.) and Division of Cancer Care and Epidemiology, Cancer Research Institute (P.A.G.), Queen's University, Kingston; Ottawa Hospital Research Institute (C.W.); Bruyère Research Institute (C.W.), Ottawa; ICES (C.J.M.), Toronto; Schools of Pharmacy and Public Health & Health Systems (C.J.M.), University of Waterloo; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Department of Community Health Sciences (A.M., R.A.M.), Manitoba Centre for Health Policy (A.M.), and Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Ruth Ann Marrie
- From ICES Queen's (P.A.G., C.M., D.S., A.M.) and Division of Cancer Care and Epidemiology, Cancer Research Institute (P.A.G.), Queen's University, Kingston; Ottawa Hospital Research Institute (C.W.); Bruyère Research Institute (C.W.), Ottawa; ICES (C.J.M.), Toronto; Schools of Pharmacy and Public Health & Health Systems (C.J.M.), University of Waterloo; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Department of Community Health Sciences (A.M., R.A.M.), Manitoba Centre for Health Policy (A.M.), and Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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Iraniparast M, Shi Y, Wu Y, Zeng L, Maxwell CJ, Kryscio RJ, John PDS, SantaCruz KS, Tyas SL. Cognitive Reserve and Mild Cognitive Impairment: Predictors and Rates of Reversion to Intact Cognition vs Progression to Dementia. Neurology 2022; 98:e1114-e1123. [PMID: 35121669 PMCID: PMC8935444 DOI: 10.1212/wnl.0000000000200051] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 01/03/2022] [Indexed: 11/18/2022] Open
Abstract
Background and Objectives Little is known about the effect of education or other indicators of cognitive reserve on the rate of reversion from mild cognitive impairment (MCI) to normal cognition (NC) or the relative rate (RR) of reversion from MCI to NC vs progression from MCI to dementia. Our objectives were to (1) estimate transition rates from MCI to NC and dementia and (2) determine the effect of age, APOE, and indicators of cognitive reserve on the RR of reversion vs progression using multistate Markov modeling. Methods We estimated instantaneous transition rates between NC, MCI, and dementia after accounting for transition to death across up to 12 assessments in the Nun Study, a cohort study of religious sisters aged 75+ years. We estimated RRs of reversion vs progression for age, APOE, and potential cognitive reserve indicators: education, academic performance (high school grades), and written language skills (idea density, grammatical complexity). Results Of the 619 participants, 472 were assessed with MCI during the study period. Of these 472, 143 (30.3%) experienced at least one reverse transition to NC, and 120 of the 143 (83.9%) never developed dementia (mean follow-up = 8.6 years). In models adjusted for age group and APOE, higher levels of education more than doubled the RR ratio of reversion vs progression. Novel cognitive reserve indicators were significantly associated with a higher adjusted RR of reversion vs progression (higher vs lower levels for English grades: RR ratio = 1.83; idea density: RR ratio = 3.93; and grammatical complexity: RR ratio = 5.78). Discussion Knowledge of frequent reversion from MCI to NC may alleviate concerns of inevitable cognitive decline in those with MCI. Identification of characteristics predicting the rate of reversion from MCI to NC vs progression from MCI to dementia may guide population-level interventions targeting these characteristics to prevent or postpone MCI and dementia. Research on cognitive trajectories would benefit from incorporating predictors of reverse transitions and competing events, such as death, into statistical modeling. These results may inform the design and interpretation of MCI clinical trials, given that a substantial proportion of participants may experience improvement without intervention.
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Affiliation(s)
- Maryam Iraniparast
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Yidan Shi
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON, Canada
| | - Ying Wu
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON, Canada.,School of Statistics and Data Science, Nankai University, Tianjin, China
| | - Leilei Zeng
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON, Canada
| | - Colleen J Maxwell
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada.,School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Richard J Kryscio
- Department of Statistics, University of Kentucky, Lexington, KY, USA.,Department of Biostatistics, University of Kentucky, Lexington, KY, USA.,Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
| | - Philip D St John
- Department of Medicine, Section of Geriatric Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Centre on Aging, University of Manitoba, Winnipeg, MB, Canada
| | - Karen S SantaCruz
- Department of Laboratory Medicine and Pathology, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Suzanne L Tyas
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
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Maxwell CJ, Maclagan LC, Harris DA, Wang X, Guan J, Marrie RA, Hogan DB, Austin PC, Vigod SN, Swartz RH, Bronskill SE. Incidence of neurological and psychiatric comorbidity over time: a population-based cohort study in Ontario, Canada. Age Ageing 2022; 51:6520504. [PMID: 35134841 DOI: 10.1093/ageing/afab277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/14/2021] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Comprehensive, population-based investigations of the extent and temporality of associations between common neurological and psychiatric disorders are scarce. METHODS This retrospective cohort study used linked health administrative data for Ontarians aged 40-85 years on 1 April 2002, to estimate the adjusted rate of incident dementia, Parkinson's disease (PD), stroke or mood/anxiety disorder (over 14 years) according to the presence and time since diagnosis of a prior disorder. Sex differences in the cumulative incidence of a later disorder were also examined. RESULTS The cohort included 5,283,546 Ontarians (mean age 56.2 ± 12.1 years, 52% female). The rate of dementia was significantly higher for those with prior PD (adjusted hazard ratio [adjHR] 4.05, 95% confidence interval [CI] 3.99-4.11); stroke (adjHR 2.49, CI 2.47-2.52) and psychiatric disorder (adjHR 1.79, CI 1.78-1.80). The rate of PD was significantly higher for those with prior dementia (adjHR 2.23, CI 2.17-2.30) and psychiatric disorder (adjHR 1.77, CI 1.74-1.81). The rate of stroke was significantly higher among those with prior dementia (adjHR 1.56, CI 1.53-1.58). Prior dementia (adjHR 2.36, CI 2.33-2.39), PD (adjHR 1.80, CI 1.75-1.85) and stroke (adjHR 1.47, CI 1.45-1.49) were associated with a higher rate of an incident psychiatric disorder. Generally, associations were strongest in the 6 months following a prior diagnosis and demonstrated a J-shape relationship over time. Significant sex differences were evident in the absolute risks for several disorders. CONCLUSIONS The observed nature of bidirectional associations between these neurological and psychiatric disorders indicates opportunities for earlier diagnosis and interventions to improve patient care.
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Affiliation(s)
- Colleen J Maxwell
- Schools of Pharmacy and Public Health, Sciences University of Waterloo, Waterloo, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | | | - Daniel A Harris
- ICES, Toronto, Ontario, Canada
- Public Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - David B Hogan
- Division of Geriatric Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Peter C Austin
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Simone N Vigod
- ICES, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Richard H Swartz
- ICES, Toronto, Ontario, Canada
- Department of Medicine (Neurology), Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Susan E Bronskill
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
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Maxwell CJ, Campitelli MA, Cotton CA, Hogan DB, Iaboni A, Gruneir A, Evans C, Bronskill SE. Greater opioid use among nursing home residents in Ontario, Canada during the first two waves of the COVID-19 pandemic. J Am Med Dir Assoc 2022; 23:936-941. [PMID: 35337790 PMCID: PMC8882429 DOI: 10.1016/j.jamda.2022.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/31/2022] [Accepted: 02/19/2022] [Indexed: 11/17/2022]
Abstract
Objectives To examine the association between the COVID-19 pandemic and opioid use among nursing home residents followed up to March 2021, and possible variation by dementia and frailty status. Design Population-based cohort study with an interrupted time series analysis. Setting and Participants Linked health administrative databases for residents of all nursing homes (n = 630) in Ontario, Canada were examined. Residents were divided into consecutive weekly cohorts (first observation week was March 5 to 11, 2017 and last was March 21 to March 27, 2021). Methods The weekly proportion of residents dispensed an opioid was examined overall and by strata defined by the presence of dementia and frailty. Autoregressive Integrated Moving Average models with step and ramp intervention functions tested for immediate level and slope changes in weekly opioid use after the onset of the pandemic (March 1, 2020) and were fit on prepandemic data for projected trends. Results The average weekly cohort ranged from 76,834 residents (prepandemic) to 69,359 (pandemic period), with a consistent distribution by sex (69% female) and age (54% age 85 + years). There was a statistically significant increased slope change in the weekly proportion of residents dispensed opioids (parameter estimate (β) = 0.035; standard error (SE) = 0.005, P < .001). Although significant for all 4 strata, the increased slope change was more pronounced among nonfrail residents (β = 0.038; SE = 0.008, P < .001) and those without dementia (β = 0.044; SE = 0.008, P < .001). The absolute difference in observed vs predicted opioid use in the last week of the pandemic period ranged from 1.25% (frail residents) to 2.28% (residents without dementia). Conclusions and Implications Among Ontario nursing home residents, there was a statistically significant increase in opioid dispensations following the onset of the pandemic that persisted up to 1 year later. Investigations of the reasons for increased use, potential for long-term use and associated health consequences for residents are warranted.
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Affiliation(s)
- Colleen J Maxwell
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada; ICES, Toronto, Ontario, Canada.
| | | | - Cecilia A Cotton
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada
| | - David B Hogan
- Division of Geriatric Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrea Iaboni
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Andrea Gruneir
- ICES, Toronto, Ontario, Canada; Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Charity Evans
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Susan E Bronskill
- ICES, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Bronskill SE, Maclagan LC, Maxwell CJ, Iaboni A, Jaakkimainen RL, Marras C, Wang X, Guan J, Harris DA, Emdin A, Jones A, Sourial N, Godard-Sebillotte C, Vedel I, Austin PC, Swartz RH. Trends in Health Service Use for Canadian Adults With Dementia and Parkinson Disease During the First Wave of the COVID-19 Pandemic. JAMA Health Forum 2022; 3:e214599. [PMID: 35977228 PMCID: PMC8903126 DOI: 10.1001/jamahealthforum.2021.4599] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 11/07/2021] [Indexed: 12/15/2022] Open
Abstract
Question Was the COVID-19 pandemic associated with changes in health service use and mortality among community-dwelling persons with dementia and Parkinson disease compared with older adults? Findings In this population-based repeated cross-sectional analysis, large declines in hospital use and nursing home admission were experienced across all cohorts. After the first wave, most services returned to historical levels, with physician visits elevated and mostly virtual, nursing home admissions reduced, and excess all-cause mortality. Meaning The pandemic was associated with meaningful health service disruptions for persons with dementia and Parkinson disease, highlighting that continued support for virtual care is needed to ensure optimal health outcomes. Importance Persons with dementia and Parkinson disease (PD) are vulnerable to disruptions in health care and services. Objective To examine changes in health service use among community-dwelling persons with dementia, persons with PD, and older adults without neurodegenerative disease during the first wave of the COVID-19 pandemic. Design, Setting, and Participants Repeated cross-sectional analysis using population-based administrative data among community-dwelling persons with dementia, persons with PD, and adults 65 years and older at the start of each week from March 1 through the week of September 20, 2020 (pandemic period), and March 3 through the week of September 22, 2019 (historical period), in Ontario, Canada. Exposures COVID-19 pandemic as of March 1, 2020. Main Outcomes and Measures Main outcomes were weekly rates of emergency department visits, hospitalizations, nursing home admissions, home care, virtual and in-person physician visits, and all-cause mortality. Poisson regression models were used to calculate weekly rate ratios (RRs) with 95% CIs comparing pandemic weeks with historical levels. Results Among those living in the community as of March 1, 2020, persons with dementia (n = 131 466; mean [SD] age, 80.1 [10.1] years) were older than persons with PD (n = 30 606; 73.7 [10.2] years) and older adults (n = 2 363 742; 74.0 [7.1] years). While all services experienced declines, the largest drops occurred in nursing home admissions (RR for dementia: 0.10; 95% CI, 0.07-0.15; RR for PD: 0.03; 95% CI, 0.00-0.21; RR for older adults: 0.11; 95% CI, 0.06-0.18) and emergency department visits (RR for dementia: 0.45; 95% CI, 0.41-0.48; RR for PD: 0.40; 95% CI, 0.34-0.48; RR for older adults: 0.45; 95% CI, 0.44-0.47). After the first wave, most services returned to historical levels except physician visits, which remained elevated (RR for dementia: 1.07; 95% CI, 1.05-1.09; RR for PD: 1.10, 95% CI, 1.06-1.13) and shifted toward virtual visits. Older adults continued to experience lower hospitalizations. All-cause mortality was elevated across cohorts. Conclusions and Relevance In this population-based repeated cross-sectional study in Ontario, Canada, those with dementia, those with PD, and older adults sought hospital care far less than usual, were not admitted to nursing homes, and experienced excess mortality during the first wave of the pandemic. Most services returned to historical levels, but virtual physician visits remained a feature of care. While issues of equity and quality of care are still emerging among persons with neurodegenerative diseases, policies to support virtual care are necessary.
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Affiliation(s)
- Susan E. Bronskill
- ICES, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - Colleen J. Maxwell
- ICES, Toronto, Ontario, Canada
- Schools of Pharmacy and Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Andrea Iaboni
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - R. Liisa Jaakkimainen
- ICES, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Connie Marras
- ICES, Toronto, Ontario, Canada
- Edmond J. Safra Program in Parkinson Disease, Toronto Western Hospital, Toronto, Ontario, Canada
| | | | | | - Daniel A. Harris
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Abby Emdin
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Aaron Jones
- ICES, Toronto, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Nadia Sourial
- Department of Health Management, Evaluation and Policy, School of Public Health, University of Montreal, Montreal, Quebec, Canada
| | | | - Isabelle Vedel
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | - Peter C. Austin
- ICES, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Richard H. Swartz
- ICES, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine (Neurology), University of Toronto, Toronto, Ontario, Canada
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Iaboni A, Grigorovich A, Barned C, Rodrigues K, Pia K, Chu CH, Astell AJ, Flint A, Bingham K, Maxwell CJ, Kirkham J, McMurray J, Quirt H, Tsokas M. Development and dissemination of an ethical guidance and person-centred isolation care planning tool to support the care of people with dementia during the COVID-19 pandemic. Alzheimers Dement 2022; 17 Suppl 8:e054003. [PMID: 34971276 PMCID: PMC9011551 DOI: 10.1002/alz.054003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background
Long‐term care (LTC) residents have been disproportionately impacted by the COVID‐19 pandemic, both from the virus itself and the restrictions in effect for infection prevention and control. Many barriers exist in LTC to prevent the effective isolation of suspect or confirmed COVID‐19 cases. Furthermore, these measures have a severe impact on the well‐being of LTC residents. Our aim was to develop a guide for long‐term care to address the ethical challenges associated with isolating dementia patients during the pandemic. The Dementia Isolation Toolkit (DIT) was developed by members of the research team in partnership with LTC stakeholders to address: 1) the practical challenges of isolating or quarantining people with dementia in a compassionate, safe, and effective manner; and 2) the need for ethical guidance to support decision‐making regarding isolation and infection control in LTC, to prevent indecision and moral distress. To develop the DIT the team reviewed and synthesized the literature on pandemic ethics in a plain‐language document, which was then reviewed by our partners and stakeholders. The final ethical guidance tool includes a discussion of the ethics around infection control measures in a pandemic, an ethical decision‐making tool, and a person‐centred isolation care planning tool. The ethical guidance tool has been downloaded more than 6500 times since it was published (bit.ly/dementiatoolkit), and has been disseminated internationally. The worksheets are being used during outbreaks to support care and decision‐making, as well as proactively, to prepare for outbreaks by developing isolation care plans. There is a need for support for ethical decision‐making in the context of a pandemic, particularly in settings such as LTC. Future studies will evaluate the implementation of the tool and its impact in addressing moral distress in health care providers in long‐term care.
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Affiliation(s)
- Andrea Iaboni
- Toronto Rehab, University Health Network, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | - Alisa Grigorovich
- Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
| | | | | | - Kontos Pia
- University of Toronto, Toronto, ON, Canada.,Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
| | | | | | - Alastair Flint
- University of Toronto, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada.,Centre for Mental Health, University Health Network, Toronto, ON, Canada
| | - Kathleen Bingham
- University of Toronto, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada
| | - Colleen J Maxwell
- ICES, Toronto, ON, Canada.,University of Waterloo, Waterloo, ON, Canada
| | | | | | - Hannah Quirt
- Toronto Rehabilitation Institute, Toronto, ON, Canada
| | - Mario Tsokas
- Regional Geriatric Program, Toronto Rehabilitation Institute, Toronto, ON, Canada
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Maclagan LC, Maxwell CJ, Harris DA, Wang X, Guan J, Marrie RA, Hogan DB, Austin PC, Vigod SN, Swartz RH, Bronskill SE. How common is concurrent neurological and mood/anxiety disorder comorbidity over time? A population‐based cohort study in Ontario, Canada. Alzheimers Dement 2021. [DOI: 10.1002/alz.053889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | | | | | | | - David B Hogan
- University of Calgary / Faculty of Medicine Calgary AB Canada
| | - Peter C Austin
- ICES Toronto ON Canada
- University of Toronto Toronto ON Canada
| | - Simone N Vigod
- ICES Toronto ON Canada
- University of Toronto Toronto ON Canada
- Women's College Research Institute Toronto ON Canada
| | - Richard H. Swartz
- ICES Toronto ON Canada
- University of Toronto Toronto ON Canada
- Sunnybrook Health Sciences Centre Toronto ON Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute Toronto ON Canada
| | - Susan E Bronskill
- ICES Toronto ON Canada
- University of Toronto Toronto ON Canada
- Women's College Hospital Toronto ON Canada
- Sunnybrook Research Institute Toronto ON Canada
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Bronskill SE, Maclagan LC, Wang X, Guan J, Harris DA, Austin PC, Maxwell CJ, Jaakkimainen L, Iaboni A, Marras C, Vedel I, Sourial N, Godard‐Sebillotte C, Swartz RH. The impact of the first wave of the COVID‐19 pandemic on health service use by persons with dementia in Ontario, Canada: A population‐based time series analysis. Alzheimers Dement 2021. [PMCID: PMC9011592 DOI: 10.1002/alz.055623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Background Little has been quantified, at a population‐level, about the magnitude of heath service disruption to persons living with dementia in community settings during the COVID‐19 pandemic. Sustained access to health care services is particularly important for persons with dementia and other neurodegenerative diseases as they are vulnerable to decline. Method Health administrative data from Ontario, Canada were used to examine patterns of health service use among all persons with Alzheimer disease and related dementias (dementia) who were alive and living in the community. This cohort was compared to persons with Parkinson’s disease (PD) as well as all older adults (age 65+ years) without neurodegenerative diseases. Rates of all‐cause hospital admissions, emergency department visits, primary care and specialist physician visits and home care visits were analyzed for all individuals alive and eligible for provincial health insurance at the start of each weekly period from March 1, 2020 to September 20, 2020 (pandemic period) and from March 3, 2019 to September 22, 2019 (pre‐pandemic period). Rates of health service use during specific weeks in the pandemic period (i.e., lowest week, last available week) were compared to corresponding weeks in the pre‐pandemic period within each cohort using percent changes. Results On March 1, 2020, 128,696 persons with dementia, 30,099 with PD and 2,460,358 older adults were eligible for provincial health services. Across cohorts and services, dramatic declines in use of health services were observed at the lowest week: hospitalization (‐38.7% dementia, ‐72.3% PD, ‐44.2% older adults); emergency department (‐54.9% dementia, ‐57.7% PD, ‐53.6% older adults); home care (‐14.8% dementia, ‐19.4% PD, ‐7.4% older adults). Health services varied in how quickly they rebounded to pre‐pandemic levels within cohorts; notably, by the end of the study period, emergency department visits had increased to a level higher than corresponding 2019 weekly rates (24.2% dementia, 15.2% PD, 7.4% older adults). Conclusions The first wave of the COVID‐19 pandemic meaningfully and immediately disrupted use of health care services for persons living with dementia and PD and may have resulted in long‐term consequences that should be monitored.
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Affiliation(s)
- Susan E Bronskill
- ICES Toronto ON Canada
- Women's College Hospital Toronto ON Canada
- Sunnybrook Research Institute Toronto ON Canada
- University of Toronto Toronto ON Canada
| | | | | | | | | | - Peter C Austin
- ICES Toronto ON Canada
- University of Toronto Toronto ON Canada
| | | | - Liisa Jaakkimainen
- ICES Toronto ON Canada
- University of Toronto Toronto ON Canada
- Sunnybrook Health Sciences Centre Toronto ON Canada
| | - Andrea Iaboni
- University of Toronto Toronto ON Canada
- Toronto Rehab, University Health Network Toronto ON Canada
| | | | | | | | | | - Richard H Swartz
- ICES Toronto ON Canada
- University of Toronto Toronto ON Canada
- Sunnybrook Health Sciences Centre Toronto ON Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute Toronto ON Canada
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36
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Kitano T, Brown KA, Daneman N, MacFadden DR, Langford BJ, Leung V, So M, Leung E, Burrows L, Manuel D, Bowdish DME, Maxwell CJ, Bronskill SE, Brooks JI, Schwartz KL. The Impact of COVID-19 on Outpatient Antibiotic Prescriptions in Ontario, Canada; An Interrupted Time Series Analysis. Open Forum Infect Dis 2021; 8:ofab533. [PMID: 34805442 PMCID: PMC8601042 DOI: 10.1093/ofid/ofab533] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/27/2021] [Indexed: 01/21/2023] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has potentially impacted outpatient antibiotic prescribing. Investigating this impact may identify stewardship opportunities in the ongoing COVID-19 period and beyond. Methods We conducted an interrupted time series analysis on outpatient antibiotic prescriptions and antibiotic prescriptions/patient visits in Ontario, Canada, between January 2017 and December 2020 to evaluate the impact of the COVID-19 pandemic on population-level antibiotic prescribing by prescriber specialty, patient demographics, and conditions. Results In the evaluated COVID-19 period (March–December 2020), there was a 31.2% (95% CI, 27.0% to 35.1%) relative reduction in total antibiotic prescriptions. Total outpatient antibiotic prescriptions decreased during the COVID-19 period by 37.1% (95% CI, 32.5% to 41.3%) among family physicians, 30.7% (95% CI, 25.8% to 35.2%) among subspecialist physicians, 12.1% (95% CI, 4.4% to 19.2%) among dentists, and 25.7% (95% CI, 21.4% to 29.8%) among other prescribers. Antibiotics indicated for respiratory infections decreased by 43.7% (95% CI, 38.4% to 48.6%). Total patient visits and visits for respiratory infections decreased by 10.7% (95% CI, 5.4% to 15.6%) and 49.9% (95% CI, 43.1% to 55.9%). Total antibiotic prescriptions/1000 visits decreased by 27.5% (95% CI, 21.5% to 33.0%), while antibiotics indicated for respiratory infections/1000 visits with respiratory infections only decreased by 6.8% (95% CI, 2.7% to 10.8%). Conclusions The reduction in outpatient antibiotic prescribing during the COVID-19 pandemic was driven by less antibiotic prescribing for respiratory indications and largely explained by decreased visits for respiratory infections.
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Affiliation(s)
- Taito Kitano
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada
| | - Kevin A Brown
- Public Health Ontario, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Nick Daneman
- Public Health Ontario, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Derek R MacFadden
- ICES, Toronto, Ontario, Canada.,Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Valerie Leung
- Public Health Ontario, Toronto, Ontario, Canada.,Toronto East Health Network, Michael Garron Hospital, Toronto, Ontario, Canada
| | - Miranda So
- Sinai Health System-University Health Network Antimicrobial Stewardship Program, Toronto, Ontario, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Leung
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.,Unity Health Toronto, St. Michael's Hospital, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Lori Burrows
- Department of Biochemistry and Biomedical Sciences and the Michael G. DeGroote Institute for Infectious Disease Research, McMaster University, Hamilton, Ontario, Canada
| | - Douglas Manuel
- ICES, Toronto, Ontario, Canada.,Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Dawn M E Bowdish
- Michael DeGroote Institute for Infectious Disease Research, McMaster Immunology Research Centre, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Colleen J Maxwell
- ICES, Toronto, Ontario, Canada.,Schools of Pharmacy and Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Susan E Bronskill
- ICES, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Women's College Hospital, Toronto, Ontario, Canada
| | - James I Brooks
- Public Health Agency of Canada, Ottawa, Ontario, Canada.,Division of Infectious Diseases, University of Ottawa, Ottawa, Ontario, Canada
| | - Kevin L Schwartz
- Public Health Ontario, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Unity Health Network, St. Joseph Health Centre, Toronto, Ontario, Canada
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Campitelli MA, Abrahao A, Maclagan LC, Fu L, Maxwell CJ, Swartz RH, Zinman L, Bronskill SE. Health services utilization prior to amyotrophic lateral sclerosis diagnosis: A province-wide study of individuals treated with riluzole in Ontario, Canada. Muscle Nerve 2021; 64:691-700. [PMID: 34437716 DOI: 10.1002/mus.27405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 11/06/2022]
Abstract
INTRODUCTION/AIMS Amyotrophic lateral sclerosis (ALS) symptoms mimic those of other conditions and often require multiple physician and healthcare contacts for investigation and accurate diagnosis. We examined the type and frequency of healthcare service utilization prior to ALS diagnosis and tracheostomy-free survival by sex and rurality among individuals treated with riluzole in Ontario, Canada. METHODS This population-based cohort study used administrative databases to identify patients aged 18+ y diagnosed with ALS and started on riluzole between April 2002-March 2018. Using Poisson regression, rate ratios of healthcare utilization and atypical diagnostic tests and unnecessary therapeutic interventions 5 y prior to ALS diagnosis were compared by sex and rurality. Tracheostomy-free survival after diagnosis was compared between groups using Kaplan-Meier estimators and proportional hazards models. RESULTS A total of 1071 patients with ALS were identified with a mean age of 70 y; 563 (52.6%) were men and 134 (12.5%) were rural residents. The number of physician visits increased in the 18 mo prior to ALS diagnosis. We observed modest sex differences in healthcare utilization. Rural patients had lower neurologist visit rates (rate ratio [RR], 0.78; 95% confidence interval [CI], 0.70-0.87) and were significantly more likely to receive an atypical diagnostic test or unnecessary therapeutic intervention (RR, 1.80; 95% CI, 1.04-3.10). Tracheostomy-free survival did not differ by sex (log-rank P-value = .78) or rurality (log-rank P-value = .84). DISCUSSION Given disparities observed in healthcare of rural ALS patients, policy strategies are needed to ensure all patients have timely access to care along the pathway from symptom onset to ALS diagnosis, to enable access to new therapeutics and clinical trials.
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Affiliation(s)
| | - Agessandro Abrahao
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | | | - Colleen J Maxwell
- ICES, Toronto, Ontario, Canada.,School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada.,School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Richard H Swartz
- ICES, Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Lorne Zinman
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Susan E Bronskill
- ICES, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
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Campitelli MA, Bronskill SE, Maclagan LC, Harris DA, Cotton CA, Tadrous M, Gruneir A, Hogan DB, Maxwell CJ. Comparison of Medication Prescribing Before and After the COVID-19 Pandemic Among Nursing Home Residents in Ontario, Canada. JAMA Netw Open 2021; 4:e2118441. [PMID: 34338794 PMCID: PMC8329744 DOI: 10.1001/jamanetworkopen.2021.18441] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/21/2021] [Indexed: 12/24/2022] Open
Abstract
Importance COVID-19 has had devastating effects on the health and well-being of older adult residents and health care professionals in nursing homes. Uncertainty about the associated consequences of these adverse effects on the use of medications common to this care setting remains. Objective To examine the association between the COVID-19 pandemic and prescription medication changes among nursing home residents. Design, Setting, and Participants This population-based cohort study with an interrupted time-series analysis used linked health administrative data bases for residents of all nursing homes (N = 630) in Ontario, Canada. During the observation period, residents were divided into consecutive weekly cohorts. The first observation week was March 5 to 11, 2017; the last observation week was September 20 to 26, 2020. Exposures Onset of the COVID-19 pandemic on March 1, 2020. Main Outcomes and Measures Weekly proportion of residents dispensed antipsychotics, benzodiazepines, antidepressants, anticonvulsants, opioids, antibiotics, angiotensin receptor blockers (ARBs), and angiotensin-converting enzyme (ACE) inhibitors. Autoregressive integrated moving average models with step and ramp intervention functions tested for level and slope changes in weekly medication use after the onset of the pandemic and were fit on prepandemic data for projected trends. Results Across study years, the annual cohort size ranged from 75 850 to 76 549 residents (mean [SD] age, 83.4 [10.8] years; mean proportion of women, 68.9%). A significant increased slope change in the weekly proportion of residents who were dispensed antipsychotics (parameter estimate [β] = 0.051; standard error [SE] = 0.010; P < .001), benzodiazepines (β = 0.026; SE = 0.003; P < .001), antidepressants (β = 0.046; SE = 0.013; P < .001), trazodone hydrochloride (β = 0.033; SE = 0.010; P < .001), anticonvulsants (β = 0.014; SE = 0.006; P = .03), and opioids (β = 0.038; SE = 0.007; P < .001) was observed. The absolute difference in observed vs estimated use in the last week of the pandemic period ranged from 0.48% (for anticonvulsants) to 1.52% (for antipsychotics). No significant level or slope changes were found for antibiotics, ARBs, or ACE inhibitors. Conclusions and Relevance In this population-based cohort study, statistically significant increases in the use of antipsychotics, benzodiazepines, antidepressants, anticonvulsants, and opioids followed the onset of the COVID-19 pandemic, although absolute differences were small. There were no significant changes for antibiotics, ARBs, or ACE inhibitors. Studies are needed to monitor whether changes in pharmacotherapy persist, regress, or accelerate during the course of the pandemic and how these changes affect resident-level outcomes.
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Affiliation(s)
- Michael A. Campitelli
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
| | - Susan E. Bronskill
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
| | - Laura C. Maclagan
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
| | - Daniel A. Harris
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Cecilia A. Cotton
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Mina Tadrous
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Andrea Gruneir
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Department of Family Medicine, University of Alberta, Edmonton, Canada
| | - David B. Hogan
- Division of Geriatric Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Colleen J. Maxwell
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
- Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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McGilton KS, Campitelli MA, Bethell J, Guan J, Vellani S, Krassikova A, Omar A, Maxwell CJ, Bronskill SE. Impact of Dementia on Patterns of Home Care After Inpatient Rehabilitation Discharge for Older Adults After Hip Fractures. Arch Phys Med Rehabil 2021; 102:1972-1981. [PMID: 34242626 DOI: 10.1016/j.apmr.2021.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 06/02/2021] [Accepted: 06/24/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To describe differences in home care use in the 30 days after discharge from inpatient rehabilitation after a hip fracture among older adults with dementia compared with those without dementia. DESIGN Retrospective cohort study of individually linked health administrative data. SETTING Community-dwelling older adults after discharge from inpatient rehabilitation facilities in Ontario, Canada. PARTICIPANTS A total of 17,263 older adults (N=17,263), of whom 2489 had dementia (14.4%), who were treated for hip fracture in acute care and then admitted to inpatient rehabilitation facilities between January 1, 2011 and March 31, 2017. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The proportion receiving home care services and number of visits (physiotherapy, occupational therapy, nursing, personal/homemaking) in the 30 days after discharge were compared by dementia status with multivariate models, stratified by sex. RESULTS Compared with those without dementia, adults with dementia were older, had lower functional scores, and were more likely to receive home care services in the 30 days after discharge from inpatient rehabilitation (87.0% vs 79.0%, P<.001), including personal/homemaking services (66.1% vs 46.4%, P<.001) and occupational therapy (45.3% vs 37.4, P<.001) but not physiotherapy (55.8% vs 56.2%, P=.677) or nursing (19.6% vs 18.7%, P=.268). After adjustment, older adults with dementia were more likely to receive home care in both men (odds ratio [OR] =2.01; 95% confidence interval [CI], 1.57-2.57) and women (OR=1.50; 95% CI, 1.30-1.74) as well as more services (rate ratio men=1.60; 95% CI, 1.44-1.79; rate ratio women=1.50; 95% CI, 1.41-1.60). CONCLUSIONS Among older adults discharged from inpatient rehabilitation, older adults with dementia received home care services more often than older adults without dementia. However, irrespective of sex and dementia status, almost half of this population (44%) did not receive physiotherapy. We recommend that, resources permitting, all older adults receive physiotherapy to facilitate recovery.
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Affiliation(s)
- Katherine S McGilton
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario; Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, Toronto, Ontario.
| | | | - Jennifer Bethell
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario; Institute for Clinical Evaluative Science, Toronto, Ontario; Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
| | - Jun Guan
- Institute for Clinical Evaluative Science, Toronto, Ontario
| | - Shirin Vellani
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario; Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, Toronto, Ontario
| | - Alexandra Krassikova
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario; Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Abeer Omar
- Trent/Fleming School of Nursing, Trent University, Peterborough, Ontario
| | - Colleen J Maxwell
- Institute for Clinical Evaluative Science, Toronto, Ontario; Schools of Pharmacy and Public Health & Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Susan E Bronskill
- Institute for Clinical Evaluative Science, Toronto, Ontario; Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
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Maxwell CJ, Mondor L, Pefoyo Koné AJ, Hogan DB, Wodchis WP. Sex differences in multimorbidity and polypharmacy trends: A repeated cross-sectional study of older adults in Ontario, Canada. PLoS One 2021; 16:e0250567. [PMID: 33901232 PMCID: PMC8075196 DOI: 10.1371/journal.pone.0250567] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/09/2021] [Indexed: 11/25/2022] Open
Abstract
Background Multimorbidity is increasing among older adults, but the impact of these recent trends on the extent and complexity of polypharmacy and possible variation by sex remains unknown. We examined sex differences in multimorbidity, polypharmacy (5+ medications) and hyper-polypharmacy (10+ medications) in 2003 vs 2016, and the interactive associations between age, multimorbidity level, and time on polypharmacy measures. Methods and findings We employed a repeated cross-sectional study design with linked health administrative databases for all persons aged ≥66 years eligible for health insurance in Ontario, Canada at the two index dates. Descriptive analyses and multivariable logistic regression models were conducted; models included interaction terms between age, multimorbidity level, and time period to estimate polypharmacy and hyper-polypharmacy probabilities, risk differences and risk ratios for 2016 vs 2003. Multimorbidity, polypharmacy and hyper-polypharmacy increased significantly over the 13 years. At both index dates prevalence estimates for all three were higher in women, but a greater absolute increase in polypharmacy over time was observed in men (6.6% [from 55.7% to 62.3%] vs 0.9% [64.2%-65.1%] for women) though absolute increases in multimorbidity were similar for men and women (6.9% [72.5%-79.4%] vs 6.2% [75.9%-82.1%], respectively). Model findings showed that polypharmacy decreased over time among women aged < 90 years (especially for younger ages and those with fewer conditions), whereas it increased among men at all ages and multimorbidity levels (with larger absolute increases typically at older ages and among those with 4 or fewer conditions). Conclusions There are sex and age differences in the impact of increasing chronic disease burden on changes in measures of multiple medication use among older adults. Though the drivers and health consequences of these trends warrant further investigation, the findings support the heterogeneity and complexity in the evolving association between multimorbidity and polypharmacy measures in older populations.
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Affiliation(s)
- Colleen J. Maxwell
- Schools of Pharmacy and Public Health & Health Systems, University of Waterloo, Waterloo, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Health System Performance Network (HSPN), Toronto, Ontario, Canada
- * E-mail:
| | - Luke Mondor
- ICES, Toronto, Ontario, Canada
- Health System Performance Network (HSPN), Toronto, Ontario, Canada
| | - Anna J. Pefoyo Koné
- Health System Performance Network (HSPN), Toronto, Ontario, Canada
- Department of Health Sciences, Lakehead University, Thunder Bay, Ontario, Canada
| | - David B. Hogan
- Division of Geriatric Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Walter P. Wodchis
- ICES, Toronto, Ontario, Canada
- Health System Performance Network (HSPN), Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Toronto, Ontario, Canada
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Campitelli MA, Bronskill SE, Huang A, Maclagan LC, Atzema CL, Hogan DB, Lapane KL, Harris DA, Maxwell CJ. Trends in Anticoagulant Use at Nursing Home Admission and Variation by Frailty and Chronic Kidney Disease Among Older Adults with Atrial Fibrillation. Drugs Aging 2021; 38:611-623. [PMID: 33880747 DOI: 10.1007/s40266-021-00859-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is relatively common among nursing home residents, and decisions regarding anticoagulant therapy in this setting may be complicated by resident frailty and other factors. OBJECTIVES The aim of this study was to examine trends and correlates of oral anticoagulant use among newly admitted nursing home residents with AF following the approval of direct-acting oral anticoagulants (DOACs). METHODS We conducted a retrospective cohort study of all adults aged > 65 years with AF who were newly admitted to nursing homes in Ontario, Canada, between 2011 and 2018 (N = 36,466). Health administrative databases were linked with comprehensive clinical assessment data captured shortly after admission, to ascertain resident characteristics. Trends in prevalence of anticoagulant use (any, warfarin, DOAC) at admission were captured with prescription claims and examined by frailty and chronic kidney disease (CKD). Log-binomial regression models estimated crude percentage changes in use over time and modified Poisson regression models assessed factors associated with anticoagulant use and type. RESULTS The prevalence of anticoagulant use at admission increased from 41.1% in 2011/2012 to 58.0% in 2017/2018 (percentage increase = 41.1%, p < 0.001). Warfarin use declined (- 67.7%, p < 0.001), while DOAC use increased. Anticoagulant use was less likely among residents with a prior hospitalization for hemorrhagic stroke (adjusted risk ratio [aRR] 0.65, 95% confidence interval [CI] 0.60-0.70) or gastrointestinal bleed (aRR 0.80, 95% CI 0.78-0.83), liver disease (aRR 0.78, 95% CI 0.69-0.89), severe cognitive impairment (aRR 0.89, 95% CI 0.85-0.94), and non-steroidal anti-inflammatory drug (aRR 0.76, 95% CI 0.71-0.81) or antiplatelet (aRR 0.25, 95% CI 0.23-0.27) use, but more likely for those with a prior hospitalization for ischemic stroke or thromboembolism (aRR 1.30, 95% CI 1.27-1.33). CKD was associated with a reduced likelihood of DOAC versus warfarin use in both the early (aRR 0.62, 95% CI 0.54-0.71) and later years (aRR 0.79, 95% CI 0.76-0.83) of our study period. Frail residents were significantly less likely to receive an anticoagulant at admission, although this association was modest (aRR 0.95, 95% CI 0.92-0.98). Frailty was not associated with anticoagulant type. CONCLUSIONS While the proportion of residents with AF receiving oral anticoagulants at admission increased following the approval of DOACs, over 40% remained untreated. Among those treated, use of a DOAC increased, while warfarin use declined. The impact of these recent treatment patterns on the balance between benefit and harm among residents warrant further investigation.
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Affiliation(s)
| | - Susan E Bronskill
- ICES, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | | | | | - Clare L Atzema
- ICES, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - David B Hogan
- Division of Geriatric Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kate L Lapane
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Daniel A Harris
- ICES, Toronto, ON, Canada.,Public Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Colleen J Maxwell
- ICES, Toronto, ON, Canada. .,Division of Geriatric Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. .,Schools of Pharmacy and Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
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Liu M, Maxwell CJ, Armstrong P, Schwandt M, Moser A, McGregor MJ, Bronskill SE, Dhalla IA. La COVID-19 dans les foyers de soins de longue durée en Ontario et en Colombie-Britannique. CMAJ 2021; 193:E263-E269. [PMID: 33593958 PMCID: PMC8034325 DOI: 10.1503/cmaj.201860-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Michael Liu
- Faculté de médecine de Harvard (Liu), Boston, Mass.; Département de politiques et d'interventions sociales (Liu), Université d'Oxford, Oxford, R.-U.; Écoles de pharmacie, de santé publique et de système de santé (Maxwell), Université de Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Département de sociologie (Armstrong), Université York; Département de médecine familiale et communautaire (Moser); Institut de politiques, de gestion et d'évaluation de la santé (Bronskill, Dhalla), École de santé publique Dalla Lana, et Département de médecine (Dhalla), Université de Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculté de médecine (Schwandt), École de la santé publique et des populations, et Département de pratique familiale (McGregor), Université de la Colombie-Britannique; Vancouver Coastal Health (Schwandt); Vancouver, C.-B
| | - Colleen J Maxwell
- Faculté de médecine de Harvard (Liu), Boston, Mass.; Département de politiques et d'interventions sociales (Liu), Université d'Oxford, Oxford, R.-U.; Écoles de pharmacie, de santé publique et de système de santé (Maxwell), Université de Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Département de sociologie (Armstrong), Université York; Département de médecine familiale et communautaire (Moser); Institut de politiques, de gestion et d'évaluation de la santé (Bronskill, Dhalla), École de santé publique Dalla Lana, et Département de médecine (Dhalla), Université de Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculté de médecine (Schwandt), École de la santé publique et des populations, et Département de pratique familiale (McGregor), Université de la Colombie-Britannique; Vancouver Coastal Health (Schwandt); Vancouver, C.-B
| | - Pat Armstrong
- Faculté de médecine de Harvard (Liu), Boston, Mass.; Département de politiques et d'interventions sociales (Liu), Université d'Oxford, Oxford, R.-U.; Écoles de pharmacie, de santé publique et de système de santé (Maxwell), Université de Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Département de sociologie (Armstrong), Université York; Département de médecine familiale et communautaire (Moser); Institut de politiques, de gestion et d'évaluation de la santé (Bronskill, Dhalla), École de santé publique Dalla Lana, et Département de médecine (Dhalla), Université de Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculté de médecine (Schwandt), École de la santé publique et des populations, et Département de pratique familiale (McGregor), Université de la Colombie-Britannique; Vancouver Coastal Health (Schwandt); Vancouver, C.-B
| | - Michael Schwandt
- Faculté de médecine de Harvard (Liu), Boston, Mass.; Département de politiques et d'interventions sociales (Liu), Université d'Oxford, Oxford, R.-U.; Écoles de pharmacie, de santé publique et de système de santé (Maxwell), Université de Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Département de sociologie (Armstrong), Université York; Département de médecine familiale et communautaire (Moser); Institut de politiques, de gestion et d'évaluation de la santé (Bronskill, Dhalla), École de santé publique Dalla Lana, et Département de médecine (Dhalla), Université de Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculté de médecine (Schwandt), École de la santé publique et des populations, et Département de pratique familiale (McGregor), Université de la Colombie-Britannique; Vancouver Coastal Health (Schwandt); Vancouver, C.-B
| | - Andrea Moser
- Faculté de médecine de Harvard (Liu), Boston, Mass.; Département de politiques et d'interventions sociales (Liu), Université d'Oxford, Oxford, R.-U.; Écoles de pharmacie, de santé publique et de système de santé (Maxwell), Université de Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Département de sociologie (Armstrong), Université York; Département de médecine familiale et communautaire (Moser); Institut de politiques, de gestion et d'évaluation de la santé (Bronskill, Dhalla), École de santé publique Dalla Lana, et Département de médecine (Dhalla), Université de Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculté de médecine (Schwandt), École de la santé publique et des populations, et Département de pratique familiale (McGregor), Université de la Colombie-Britannique; Vancouver Coastal Health (Schwandt); Vancouver, C.-B
| | - Margaret J McGregor
- Faculté de médecine de Harvard (Liu), Boston, Mass.; Département de politiques et d'interventions sociales (Liu), Université d'Oxford, Oxford, R.-U.; Écoles de pharmacie, de santé publique et de système de santé (Maxwell), Université de Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Département de sociologie (Armstrong), Université York; Département de médecine familiale et communautaire (Moser); Institut de politiques, de gestion et d'évaluation de la santé (Bronskill, Dhalla), École de santé publique Dalla Lana, et Département de médecine (Dhalla), Université de Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculté de médecine (Schwandt), École de la santé publique et des populations, et Département de pratique familiale (McGregor), Université de la Colombie-Britannique; Vancouver Coastal Health (Schwandt); Vancouver, C.-B
| | - Susan E Bronskill
- Faculté de médecine de Harvard (Liu), Boston, Mass.; Département de politiques et d'interventions sociales (Liu), Université d'Oxford, Oxford, R.-U.; Écoles de pharmacie, de santé publique et de système de santé (Maxwell), Université de Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Département de sociologie (Armstrong), Université York; Département de médecine familiale et communautaire (Moser); Institut de politiques, de gestion et d'évaluation de la santé (Bronskill, Dhalla), École de santé publique Dalla Lana, et Département de médecine (Dhalla), Université de Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculté de médecine (Schwandt), École de la santé publique et des populations, et Département de pratique familiale (McGregor), Université de la Colombie-Britannique; Vancouver Coastal Health (Schwandt); Vancouver, C.-B
| | - Irfan A Dhalla
- Faculté de médecine de Harvard (Liu), Boston, Mass.; Département de politiques et d'interventions sociales (Liu), Université d'Oxford, Oxford, R.-U.; Écoles de pharmacie, de santé publique et de système de santé (Maxwell), Université de Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Département de sociologie (Armstrong), Université York; Département de médecine familiale et communautaire (Moser); Institut de politiques, de gestion et d'évaluation de la santé (Bronskill, Dhalla), École de santé publique Dalla Lana, et Département de médecine (Dhalla), Université de Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculté de médecine (Schwandt), École de la santé publique et des populations, et Département de pratique familiale (McGregor), Université de la Colombie-Britannique; Vancouver Coastal Health (Schwandt); Vancouver, C.-B
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Watt JA, Campitelli MA, Maxwell CJ, Guan J, Maclagan LC, Gomes T, Bokhari M, Straus SE, Bronskill SE. Fall-Related Hospitalizations in Nursing Home Residents Co-Prescribed a Cholinesterase Inhibitor and Beta-Blocker. J Am Geriatr Soc 2021; 68:2516-2524. [PMID: 33460072 DOI: 10.1111/jgs.16710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/12/2020] [Accepted: 06/16/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND/OBJECTIVES To examine the association between hospitalization for a fall-related injury and the co-prescription of a cholinesterase inhibitor (ChEI) among persons with dementia receiving a beta-blocker, and whether this potential drug-drug interaction is modified by frailty. DESIGN Nested case-control study using population-based administrative databases. SETTING All nursing homes in Ontario, Canada. PARTICIPANTS Persons with dementia aged 66 and older who received at least one beta-blocker between April 2013 and March 2018 following nursing home admission (n = 19,060). MEASUREMENTS Cases were persons with dementia with a hospitalization (emergency department visit or acute care admission) for a fall-related injury with concurrent beta-blocker use. Each case (n = 3,038) was matched 1:1 to a control by age (±1 year), sex, cohort entry year, frailty, and history of fall-related injuries. The association between fall-related injury and exposure to a ChEI in the 90 days prior was examined using multivariable conditional logistic regression. Secondary exposures included ChEI type, daily dose, incident versus prevalent use, and use in the prior 30 days. Subgroup analyses considered frailty, age group, sex, and history of hospitalization for fall-related injuries. RESULTS Exposure to a ChEI in the prior 90 days occurred among 947 (31.2%) cases and 940 (30.9%) controls. In multivariable models, no association was found between hospitalization for a fall-related injury and prior exposure to a ChEI in persons with dementia dispensed beta-blockers (adjusted odds ratio = .96, 95% confidence interval = .85-1.08). Findings were consistent across secondary exposures and subgroup analyses. CONCLUSION Among nursing home residents with dementia receiving beta-blockers, co-prescription of a ChEI was not associated with an increased risk of hospitalization for a fall-related injury. However, we did not assess for its association with falls not leading to hospitalization. This finding could inform clinical guidelines and shared decision making between persons with dementia, caregivers, and clinicians concerning ChEI initiation and/or discontinuation.
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Affiliation(s)
- Jennifer A Watt
- St. Michael's Hospital-Unity Health Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | | | - Colleen J Maxwell
- ICES, Toronto, Ontario, Canada.,School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada.,School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | | | | | - Tara Gomes
- St. Michael's Hospital-Unity Health Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Mahmoud Bokhari
- Toronto General Hospital, Toronto, Ontario, Canada.,Mount Sinai Medical Center, New York, New York City, USA
| | - Sharon E Straus
- St. Michael's Hospital-Unity Health Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Susan E Bronskill
- ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
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Affiliation(s)
- Colleen J Maxwell
- Schools of Pharmacy and Public Health & Health Systems, University of Waterloo, Waterloo, Ontario, Canada (C.J.M.)
| | - Bill M Jesdale
- Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts (B.M.J., K.L.L.)
| | - Kate L Lapane
- Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts (B.M.J., K.L.L.)
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Huang V, Hogan DB, Ismail Z, Maxwell CJ, Smith EE, Callahan BL. Evaluating the Real-World Representativeness of Participants with Mild Cognitive Impairment in Canadian Research Protocols: a Comparison of the Characteristics of a Memory Clinic Patients and Research Samples. Can Geriatr J 2020; 23:297-328. [PMID: 33282050 PMCID: PMC7704078 DOI: 10.5770/cgj.23.416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Studies of mild cognitive impairment (MCI) employ rigorous eligibility criteria, resulting in sampling that may not be representative of the broader clinical population. Objective To compare the characteristics of MCI patients in a Calgary memory clinic to those of MCI participants in published Canadian studies. Methods Clinic participants included 555 MCI patients from the PROspective Registry of Persons with Memory SyMPToms (PROMPT) registry in Calgary. Research participants included 4,981 individuals with MCI pooled from a systematic literature review of 112 original, English-language peer-reviewed Canadian studies. Both samples were compared on baseline sociodemographic variables, medical and psychiatric comorbidities, and cognitive performance for MCI due to Alzheimer’s disease and Parkinson’s disease. Results Overall, clinic patients tended to be younger, more often male, and more educated than research participants. Psychiatric disorders, traumatic brain injury, and sensory impairment were commonplace in PROMPT (up to 83% affected) but > 80% studies in the systematic review excluded these conditions. PROMPT patients also performed worse on global cognition measures than did research participants. Conclusion Stringent eligibility criteria in Canadian research studies excluded a considerable subset of MCI patients with comorbid medical or psychiatric conditions. This exclusion may contribute to differences in cognitive performance and outcomes compared to real-world clinical samples.
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Affiliation(s)
- Vivian Huang
- Department of Psychology, Ryerson University, Toronto, ON
| | - David B Hogan
- Cumming School of Medicine, University of Calgary, Calgary, AB.,Hotchkiss Brain Institute, Calgary, AB
| | - Zahinoor Ismail
- Cumming School of Medicine, University of Calgary, Calgary, AB.,Hotchkiss Brain Institute, Calgary, AB.,Mathison Centre for Mental Health Research & Education, Calgary, AB.,Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Colleen J Maxwell
- Hotchkiss Brain Institute, Calgary, AB.,Schools of Pharmacy and Public Health & Health Systems, University of Waterloo, Waterloo, ON
| | - Eric E Smith
- Cumming School of Medicine, University of Calgary, Calgary, AB.,Hotchkiss Brain Institute, Calgary, AB
| | - Brandy L Callahan
- Hotchkiss Brain Institute, Calgary, AB.,Mathison Centre for Mental Health Research & Education, Calgary, AB.,Department of Psychology, University of Calgary, Calgary, AB
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Ohman AA, Maxwell CJ, Tyas SL, Oremus M. The association between overall social support availability and memory by age and sex: An analysis of the Canadian Longitudinal Study on Aging. Alzheimers Dement 2020. [DOI: 10.1002/alz.041167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Maclagan LC, Bronskill SE, Campitelli MA, Yao S, Dharma C, Hogan DB, Herrmann N, Amuah JE, Maxwell CJ. Resident-Level Predictors of Dementia Pharmacotherapy at Long-Term Care Admission: The Impact of Different Drug Reimbursement Policies in Ontario and Saskatchewan: Prédicteurs de la pharmacothérapie de la démence au niveau des résidents lors de l'hospitalisation dans des soins de longue durée : l'impact de différentes politiques de remboursement des médicaments en Ontario et en Saskatchewan. Can J Psychiatry 2020; 65:790-801. [PMID: 32274934 PMCID: PMC7564697 DOI: 10.1177/0706743720909293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Cholinesterase inhibitors (ChEIs) and memantine are approved for Alzheimer disease in Canada. Regional drug reimbursement policies are associated with cross-provincial variation in ChEI use, but it is unclear how these policies influence predictors of use. Using standardized data from two provinces with differing policies, we compared resident-level characteristics associated with dementia pharmacotherapy at long-term care (LTC) admission. METHODS Using linked clinical and administrative databases, we examined characteristics associated with dementia pharmacotherapy use among residents with dementia and/or significant cognitive impairment admitted to LTC facilities in Saskatchewan (more restrictive reimbursement policies; n = 10,599) and Ontario (less restrictive; n = 93,331) between April 1, 2009, and March 31, 2015. Multivariable logistic regression models were utilized to assess resident demographic, functional, and clinical characteristics associated with dementia pharmacotherapy. RESULTS On admission, 8.1% of Saskatchewan residents were receiving dementia pharmacotherapy compared to 33.2% in Ontario. In both provinces, residents with severe cognitive impairment, aggressive behaviors, and recent antipsychotic use were more likely to receive dementia pharmacotherapy; while those who were unmarried, admitted in later years, had a greater degree of frailty, and recent hospitalizations were less likely. The direction of the association for older age, rural residency, medication number, and anticholinergic therapy differed between provinces. CONCLUSIONS While more restrictive criteria for dementia pharmacotherapy coverage in Saskatchewan resulted in fewer residents entering LTC on dementia pharmacotherapy, there were relatively few differences in the factors associated with use across provinces. Longitudinal studies are needed to assess how differences in prevalence and characteristics associated with use impact patient outcomes.
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Affiliation(s)
| | - Susan E. Bronskill
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
- Evaluative Clinical Sciences and Hurvitz Brain Sciences Research Programs, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
| | | | - Shenzhen Yao
- Saskatchewan Health Quality Council, Saskatoon, Saskatchewan, Canada
| | | | - David B. Hogan
- Division of Geriatric Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nathan Herrmann
- Evaluative Clinical Sciences and Hurvitz Brain Sciences Research Programs, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Joseph E. Amuah
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Colleen J. Maxwell
- ICES, Toronto, Ontario, Canada
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
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Oremus M, Konnert C, Law J, Maxwell CJ, O'Connell ME, Tyas SL. Social support and cognitive function in middle- and older-aged adults: descriptive analysis of CLSA tracking data. Eur J Public Health 2020; 29:1084-1089. [PMID: 30932148 DOI: 10.1093/eurpub/ckz047] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Cognitive function is important for healthy aging. Social support availability (SSA) may modify cognitive function. We descriptively examined the association between SSA and cognitive function in a population-level sample of middle- and older-aged adults. METHODS We analyzed the tracking dataset of the Canadian Longitudinal Study on Aging. Participants aged between 45 and 85 years answered questions about SSA and performed three cognitive tests (Rey Auditory Verbal Learning Test, Animal Fluency Test and Mental Alternation Test) via telephone. We divided global SSA and global cognitive function scores into tertiles and generated contingency tables for comparisons across strata defined by sex, age group, region of residence, urban vs. rural residence and education. RESULTS The proportion of participants with low global cognitive function was often greater among persons who reported low global SSA. The proportion of persons with high cognitive function was greater in participants with high SSA. The findings were most pronounced for females, 45- to 54-year olds, all regions (especially Québec) except Atlantic Canada, urban dwellers and persons with less than high school education. CONCLUSIONS Our results can help public health officials focus on providing social supports to subgroups of the population who would benefit the most from policy interventions.
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Affiliation(s)
- Mark Oremus
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Candace Konnert
- Department of Psychology, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Jane Law
- Department of Psychology, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Colleen J Maxwell
- School of Planning and School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Megan E O'Connell
- Department of Psychology, University of Saskatchewan, Saskatoon, SK S7N 5A2, Canada
| | - Suzanne L Tyas
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1, Canada
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Liu M, Maxwell CJ, Armstrong P, Schwandt M, Moser A, McGregor MJ, Bronskill SE, Dhalla IA. COVID-19 in long-term care homes in Ontario and British Columbia. CMAJ 2020; 192:E1540-E1546. [PMID: 32998943 DOI: 10.1503/cmaj.201860] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Michael Liu
- Harvard Medical School (Liu), Boston, Mass.; Department of Social Policy and Intervention (Liu), University of Oxford, Oxford, UK; Schools of Pharmacy and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Department of Sociology (Armstrong), York University; Department of Family and Community Medicine (Moser); Institute of Health Policy, Management and Evaluation (Bronskill, Dhalla), Dalla Lana School of Public Health, and Department of Medicine (Dhalla), University of Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculty of Medicine (Schwandt), School of Population and Public Health, and Department of Family Practice (McGregor), University of British Columbia; Vancouver Coastal Health (Schwandt); Vancouver, BC
| | - Colleen J Maxwell
- Harvard Medical School (Liu), Boston, Mass.; Department of Social Policy and Intervention (Liu), University of Oxford, Oxford, UK; Schools of Pharmacy and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Department of Sociology (Armstrong), York University; Department of Family and Community Medicine (Moser); Institute of Health Policy, Management and Evaluation (Bronskill, Dhalla), Dalla Lana School of Public Health, and Department of Medicine (Dhalla), University of Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculty of Medicine (Schwandt), School of Population and Public Health, and Department of Family Practice (McGregor), University of British Columbia; Vancouver Coastal Health (Schwandt); Vancouver, BC
| | - Pat Armstrong
- Harvard Medical School (Liu), Boston, Mass.; Department of Social Policy and Intervention (Liu), University of Oxford, Oxford, UK; Schools of Pharmacy and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Department of Sociology (Armstrong), York University; Department of Family and Community Medicine (Moser); Institute of Health Policy, Management and Evaluation (Bronskill, Dhalla), Dalla Lana School of Public Health, and Department of Medicine (Dhalla), University of Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculty of Medicine (Schwandt), School of Population and Public Health, and Department of Family Practice (McGregor), University of British Columbia; Vancouver Coastal Health (Schwandt); Vancouver, BC
| | - Michael Schwandt
- Harvard Medical School (Liu), Boston, Mass.; Department of Social Policy and Intervention (Liu), University of Oxford, Oxford, UK; Schools of Pharmacy and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Department of Sociology (Armstrong), York University; Department of Family and Community Medicine (Moser); Institute of Health Policy, Management and Evaluation (Bronskill, Dhalla), Dalla Lana School of Public Health, and Department of Medicine (Dhalla), University of Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculty of Medicine (Schwandt), School of Population and Public Health, and Department of Family Practice (McGregor), University of British Columbia; Vancouver Coastal Health (Schwandt); Vancouver, BC
| | - Andrea Moser
- Harvard Medical School (Liu), Boston, Mass.; Department of Social Policy and Intervention (Liu), University of Oxford, Oxford, UK; Schools of Pharmacy and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Department of Sociology (Armstrong), York University; Department of Family and Community Medicine (Moser); Institute of Health Policy, Management and Evaluation (Bronskill, Dhalla), Dalla Lana School of Public Health, and Department of Medicine (Dhalla), University of Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculty of Medicine (Schwandt), School of Population and Public Health, and Department of Family Practice (McGregor), University of British Columbia; Vancouver Coastal Health (Schwandt); Vancouver, BC
| | - Margaret J McGregor
- Harvard Medical School (Liu), Boston, Mass.; Department of Social Policy and Intervention (Liu), University of Oxford, Oxford, UK; Schools of Pharmacy and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Department of Sociology (Armstrong), York University; Department of Family and Community Medicine (Moser); Institute of Health Policy, Management and Evaluation (Bronskill, Dhalla), Dalla Lana School of Public Health, and Department of Medicine (Dhalla), University of Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculty of Medicine (Schwandt), School of Population and Public Health, and Department of Family Practice (McGregor), University of British Columbia; Vancouver Coastal Health (Schwandt); Vancouver, BC
| | - Susan E Bronskill
- Harvard Medical School (Liu), Boston, Mass.; Department of Social Policy and Intervention (Liu), University of Oxford, Oxford, UK; Schools of Pharmacy and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Department of Sociology (Armstrong), York University; Department of Family and Community Medicine (Moser); Institute of Health Policy, Management and Evaluation (Bronskill, Dhalla), Dalla Lana School of Public Health, and Department of Medicine (Dhalla), University of Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculty of Medicine (Schwandt), School of Population and Public Health, and Department of Family Practice (McGregor), University of British Columbia; Vancouver Coastal Health (Schwandt); Vancouver, BC
| | - Irfan A Dhalla
- Harvard Medical School (Liu), Boston, Mass.; Department of Social Policy and Intervention (Liu), University of Oxford, Oxford, UK; Schools of Pharmacy and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Department of Sociology (Armstrong), York University; Department of Family and Community Medicine (Moser); Institute of Health Policy, Management and Evaluation (Bronskill, Dhalla), Dalla Lana School of Public Health, and Department of Medicine (Dhalla), University of Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculty of Medicine (Schwandt), School of Population and Public Health, and Department of Family Practice (McGregor), University of British Columbia; Vancouver Coastal Health (Schwandt); Vancouver, BC
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Maclagan LC, Maxwell CJ, Harris DA, Campitelli MA, Diong C, Lapane KL, Hogan DB, Rochon P, Herrmann N, Bronskill SE. Sex Differences in Antipsychotic and Benzodiazepine Prescribing Patterns: A Cohort Study of Newly Admitted Nursing Home Residents with Dementia in Ontario, Canada. Drugs Aging 2020; 37:817-827. [PMID: 32978758 DOI: 10.1007/s40266-020-00799-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND In nursing homes, residents with dementia frequently receive potentially inappropriate medications that are associated with an increased risk of adverse events. Despite known sex differences in clinical presentation and sociodemographic characteristics among persons with dementia, few studies have examined sex differences in patterns and predictors of potentially inappropriate medication use. OBJECTIVES The objectives of this study were to examine sex differences in the patterns of antipsychotic and benzodiazepine use in the 180 days following admission to a nursing home, estimate clinical and sociodemographic predictors of antipsychotic and benzodiazepine use in male and female residents, and explore the effects of modification by sex on the predictors of using these drug therapies. METHODS We conducted a retrospective cohort study of 35,169 adults aged 66 years and older with dementia who were newly admitted to nursing homes in Ontario, Canada between 2011 and 2014. Health administrative databases were linked to detailed clinical assessment data collected using the Resident Assessment Instrument (RAI-MDS 2.0). Cox proportional hazards models were adjusted for clinical and sociodemographic covariates to estimate the rate of antipsychotic and benzodiazepine initiation and discontinuation in the 180 days following nursing home admission in the total sample and stratified by sex. Sex-covariate interaction terms were used to assess whether sex modified the association between covariates and the rate of drug therapy initiation or discontinuation following nursing home entry. RESULTS Across 638 nursing homes, our analytical sample included 22,847 females and 12,322 males. At admission, male residents were more likely to be prevalent antipsychotic users than female residents (33.8% vs 28.3%; p < 0.001), and female residents were more likely to be prevalent benzodiazepine users than male residents (17.2% vs 15.3%, p < 0.001). In adjusted models, female residents were less likely to initiate an antipsychotic after admission (hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.73-0.86); however, no sex difference was observed in the rate of benzodiazepine initiation (HR 1.04, 95% CI 0.96-1.12). Female residents were less likely than males to discontinue antipsychotics (HR 0.89, 95% CI 0.81-0.98) and benzodiazepines (HR 0.82, 95% CI 0.75-0.89). Sex modified the association between some covariates and the rate of changes in drug use (e.g., widowed males exhibited an increased rate of antipsychotic discontinuation (p-interaction = 0.03) compared with married males), but these associations were not statistically significant among females. Sex did not modify the effect of frailty on the rates of initiation and discontinuation. CONCLUSIONS Males and females with dementia differed in their exposure to antipsychotics and benzodiazepines at nursing home admission and their patterns of use following admission. A greater understanding of factors driving sex differences in potentially inappropriate medication use may help tailor interventions to reduce exposure in this vulnerable population.
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Affiliation(s)
| | - Colleen J Maxwell
- ICES, Toronto, ON, M4N 3M5, Canada.,School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Daniel A Harris
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | | | - Kate L Lapane
- University of Massachusetts School of Medicine, Worcester, MA, USA
| | - David B Hogan
- Divison of Geriatric Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Paula Rochon
- ICES, Toronto, ON, M4N 3M5, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Nathan Herrmann
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Susan E Bronskill
- ICES, Toronto, ON, M4N 3M5, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. .,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada. .,Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada.
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