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Souesme G, Poulin V, Ethier A, Grenier M, Sirois MJ, Beaulieu-Bonneau S, De Guise É, Lamontagne ME, Hudon C, Émond M, Ouellet MC. Challenges and facilitators in the experience of caregiving for an older adult with traumatic brain injury: A longitudinal qualitative study in the first-year postinjury. Rehabil Psychol 2024:2024-46932-001. [PMID: 38271016 DOI: 10.1037/rep0000531] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
PURPOSE To obtain a better understanding of the factors which complicate or facilitate the adjustment of caregivers after traumatic brain injury (TBI) in older adults. RESEARCH METHOD At 4, 8, and 12 months post-TBI (mild to severe), 65 caregivers answered two open-ended questions regarding facilitators and challenges linked to the injury of their loved one. A thematic analysis was performed. RESULTS Participants mentioned almost as many facilitators as challenges at each time point. Among the facilitators, we found the following themes: receiving social support, having access to rehabilitation, improvement of the injured loved one's health condition, returning to live at home, having access to home services, feeling useful, effective communication, and having time for oneself. The challenges identified were: health issues in the injured loved one, psychological impact on the caregiver, assuming a new role, relationship strain, and decrease in activities and outings. CONCLUSIONS During the first year following TBI in older adults, caregivers were able to identify several facilitators despite the presence of challenging factors, suggesting effective coping and resilience. This knowledge can guide potential caregivers in their adaptation after TBI in an older adult, and we propose a simple tool to support this process. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Guillaume Souesme
- Centre interdisciplinaire de recherche en readaptation et integration sociale (Cirris), Institut de readaptation en deficience physique de Quebec
| | - Valérie Poulin
- Centre interdisciplinaire de recherche en readaptation et integration sociale (Cirris), Institut de readaptation en deficience physique de Quebec
| | - Agnès Ethier
- Centre interdisciplinaire de recherche en readaptation et integration sociale (Cirris), Institut de readaptation en deficience physique de Quebec
| | - Marianne Grenier
- Centre interdisciplinaire de recherche en readaptation et integration sociale (Cirris), Institut de readaptation en deficience physique de Quebec
| | | | - Simon Beaulieu-Bonneau
- Centre interdisciplinaire de recherche en readaptation et integration sociale (Cirris), Institut de readaptation en deficience physique de Quebec
| | | | - Marie-Eve Lamontagne
- Centre interdisciplinaire de recherche en readaptation et integration sociale (Cirris), Institut de readaptation en deficience physique de Quebec
| | | | - Marcel Émond
- Centre de recherche du Centre hospitalier universitaire de Quebec
| | - Marie-Christine Ouellet
- Centre interdisciplinaire de recherche en readaptation et integration sociale (Cirris), Institut de readaptation en deficience physique de Quebec
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Couture V, Germain N, Côté É, Lavoie L, Robitaille J, Morin M, Chouinard J, Couturier Y, Légaré F, Hardy MS, Chartier LB, Brousseau AA, Sourial N, Mercier É, Dallaire C, Fleet R, Leblanc A, Melady D, Roy D, Sinha S, Sirois MJ, Witteman HO, Émond M, Rivard J, Pelletier I, Turcotte S, Samb R, Giguère R, Abrougui L, Smith PY, Archambault PM. Transitions of care for older adults discharged home from the emergency department: an inductive thematic content analysis of patient comments. BMC Geriatr 2024; 24:8. [PMID: 38172725 PMCID: PMC10763115 DOI: 10.1186/s12877-023-04482-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 11/13/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE Improving care transitions for older adults can reduce emergency department (ED) visits, adverse events, and empower community autonomy. We conducted an inductive qualitative content analysis to identify themes emerging from comments to better understand ED care transitions. METHODS The LEARNING WISDOM prospective longitudinal observational cohort includes older adults (≥ 65 years) who experienced a care transition after an ED visit from both before and during COVID-19. Their comments on this transition were collected via phone interview and transcribed. We conducted an inductive qualitative content analysis with randomly selected comments until saturation. Themes that arose from comments were coded and organized into frequencies and proportions. We followed the Standards for Reporting Qualitative Research (SRQR). RESULTS Comments from 690 patients (339 pre-COVID, 351 during COVID) composed of 351 women (50.9%) and 339 men (49.1%) were analyzed. Patients were satisfied with acute emergency care, and the proportion of patients with positive acute care experiences increased with the COVID-19 pandemic. Negative patient comments were most often related to communication between health providers across the care continuum and the professionalism of personnel in the ED. Comments concerning home care became more neutral with the COVID-19 pandemic. CONCLUSION Patients were satisfied overall with acute care but reported gaps in professionalism and follow-up communication between providers. Comments may have changed in tone from positive to neutral regarding home care over the COVID-19 pandemic due to service slowdowns. Addressing these concerns may improve the quality of care transitions and provide future pandemic mitigation strategies.
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Affiliation(s)
- Vanessa Couture
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
| | - Nathalie Germain
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
- Faculty of Medicine, Université Laval, Québec, Québec Canada
| | - Émilie Côté
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
| | - Lise Lavoie
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
| | - Joanie Robitaille
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
| | - Michèle Morin
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
- Faculty of Medicine, Université Laval, Québec, Québec Canada
| | - Josée Chouinard
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
| | - Yves Couturier
- Department of Social Work, Université de Sherbrooke, Sherbrooke, Québec Canada
| | - France Légaré
- Faculty of Medicine, Université Laval, Québec, Québec Canada
- VITAM - Centre de recherche en santé durable, Québec, Québec Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Québec Canada
- Centre de recherche du CHU de Québec - Université Laval, Axe santé des populations et pratiques optimales en santé, Université Laval, Québec, Québec Canada
| | - Marie-Soleil Hardy
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
| | - Lucas B. Chartier
- Department of Emergency Medicine, University Health Network, Toronto, ON Canada
| | | | - Nadia Sourial
- Department of Health Management, Evaluation and Policy, School of Public Health, Université de Montréal, Montréal, Québec Canada
| | - Éric Mercier
- Faculty of Medicine, Université Laval, Québec, Québec Canada
- Centre de recherche du CHU de Québec - Université Laval, Axe santé des populations et pratiques optimales en santé, Université Laval, Québec, Québec Canada
| | - Clémence Dallaire
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
- Faculty of Nursing Science, Université Laval, Québec, Québec Canada
| | - Richard Fleet
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
- Faculty of Medicine, Université Laval, Québec, Québec Canada
- VITAM - Centre de recherche en santé durable, Québec, Québec Canada
| | - Annie Leblanc
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
- Faculty of Medicine, Université Laval, Québec, Québec Canada
- VITAM - Centre de recherche en santé durable, Québec, Québec Canada
| | - Don Melady
- Department of Family and Community Medicine, University of Toronto, Ontario, Canada
- Schwartz-Reisman Emergency Medicine Institute, Mount Sinai Hospital, Toronto, ON Canada
| | - Denis Roy
- Commissaire à la santé et au bien-être (CSBE), Québec, Québec Canada
| | - Samir Sinha
- Department of Family and Community Medicine, University of Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Department of Medicine, Sinai Health System and University Health Network, Toronto, ON Canada
| | - Marie-Josée Sirois
- Faculty of Medicine, Université Laval, Québec, Québec Canada
- Département de réadaptation, Faculté de médecine, Université Laval, Québec, Québec Canada
| | - Holly O. Witteman
- Faculty of Medicine, Université Laval, Québec, Québec Canada
- VITAM - Centre de recherche en santé durable, Québec, Québec Canada
| | - Marcel Émond
- Faculty of Medicine, Université Laval, Québec, Québec Canada
- VITAM - Centre de recherche en santé durable, Québec, Québec Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Québec Canada
| | - Josée Rivard
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
| | - Isabelle Pelletier
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
| | - Stéphane Turcotte
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
| | - Rawane Samb
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
| | - Raphaëlle Giguère
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
- Faculty of Science and Engineering, Université Laval, Québec, Québec Canada
| | - Lyna Abrougui
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
- Faculty of Science and Engineering, Université Laval, Québec, Québec Canada
| | - Pascal Y. Smith
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
| | - Patrick M. Archambault
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
- Faculty of Medicine, Université Laval, Québec, Québec Canada
- VITAM - Centre de recherche en santé durable, Québec, Québec Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Québec Canada
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Dawes P, Pool J, Charalambous AP, Côté M, David R, Helmer C, Laforce R, Politis A, Russell G, Sirois MJ, Thodi C, Yeung WK, Leroi I. Assessing the pool activity level (PAL) checklist for use with people with hearing and vision loss. Geriatr Nurs 2023; 53:1-5. [PMID: 37393752 DOI: 10.1016/j.gerinurse.2023.06.001] [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: 01/15/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND The PAL is a career-completed assessment that indexes cognitive functional ability to inform individualised support. As hearing and vision loss are prevalent, we assessed the PAL for potential bias with hearing or vision impairment. METHODS We collected PAL responses for 333 adults aged over 60 years in the UK, France, Canada, Greece and Cyprus. All participants had normal cognition based on self-reported status and normal range scores on a cognitive screening test. Using a Kruskal-Wallis test, we compared PAL item response distributions for people with assessed hearing or vision loss compared to those with normal sensory function. RESULTS There were no differences in response distributions between hearing or vision impaired groups versus those with normal sensory function on any PAL item. CONCLUSION The PAL reliably indexes cognitive functional ability and may be used to inform support tailored to individual cognitive level amongst older adults with prevalent hearing and vision impairments.
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Affiliation(s)
- Piers Dawes
- University of Queensland Centre for Hearing Research (CHEAR), School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia; Manchester Centre for Audiology and Deafness, The University of Manchester, Manchester, UK
| | | | | | - Mathieu Côté
- Department of Otorhinolaryngology, Head and Neck Surgery, CHU de Québec-Université Laval, Canada
| | - Renaud David
- Centre Hospitalier Universitaire de Nice, France
| | - Catherine Helmer
- University of Bordeaux, INSERM, Bordeaux Population Health Research Center, UMR U1219, Bordeaux, France
| | - Robert Laforce
- Clinique Interdisciplinaire de la Mémoire, CHU de Québec, Université Laval, Canada
| | - Antonis Politis
- Division of Geriatric Psychiatry,1st Department of Psychiatry, Eginition Hospital,National and Kapodistrian University of Athens, Greece
| | - Gregor Russell
- Bradford District Care NHS Foundation Trust, Bradford, UK
| | - Marie-Josée Sirois
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Canada
| | | | - Wai Kent Yeung
- Division of Psychology and Mental Health, The University of Manchester, Manchester UK
| | - Iracema Leroi
- Global Brain Health Institute, Trinity College Dublin, Ireland
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Giroux M, Sirois MJ, Gagnon MA, Émond M, Bérubé M, Morin M, Moore L. Identifying Quality Indicators for the Care of Hospitalized Injured Older Adults: A Scoping Review of the Literature. J Am Med Dir Assoc 2023; 24:929-936. [PMID: 37094747 DOI: 10.1016/j.jamda.2023.03.019] [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: 11/29/2022] [Revised: 03/01/2023] [Accepted: 03/12/2023] [Indexed: 04/26/2023]
Abstract
OBJECTIVES Older adults represent more than 50% of trauma admissions in many high-income countries. Furthermore, they are at increased risk for complications, resulting in worse health outcomes than younger adults and a significant health care utilization burden. Quality indicators (QIs) are used to assess the quality of care in trauma systems, but few QIs reflect responses to older patients' specific needs. We aimed to (1) identify QIs used to assess acute hospital care for injured older patients, (2) assess support for identified QIs and, (3) identify gaps in existing QIs. DESIGN Scoping review of the scientific and gray literature. METHODS Selection and data extraction were performed by 2 independent reviewers. The level of support was assessed by the number of sources reporting QIs and whether they were developed according to scientific evidence, expert consensus, and patients' perspectives. RESULTS Of 10,855 identified studies, 167 were eligible. Among 257 different QIs identified, 52% were hip fracture specific. Gaps were identified for head injuries, rib, and pelvic ring fractures. Although 61% of QIs assessed care processes, 21% and 18% focused on structures and outcomes, respectively. Although most QIs were based on literature reviews and/or expert consensus, patients' perspective was rarely accounted for. The 15 QIs with the highest level of support included minimum time between emergency department arrival and ward admission, minimum time to surgery for fractures, assessment by a geriatrician, orthogeriatric review for hip fracture patients, delirium screening, prompt and appropriate analgesia, early mobilizations, and physiotherapy. CONCLUSION AND IMPLICATIONS Multiple QIs were identified, but their level of support was limited, and important gaps were identified. Future work should focus on achieving consensus for a set of QIs to assess the quality of trauma care to older adults. Such QIs could be used for quality improvement and ultimately improve outcomes for injured older adults.
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Affiliation(s)
- Marianne Giroux
- Faculté de médecine, Université Laval, Québec City, Quebec, Canada; Centre de recherche du CHU de Québec-Université Laval - Axe Santé des Populations et pratiques optimales en santé, Quebec City, Quebec, Canada.
| | - Marie-Josée Sirois
- Faculté de médecine, Université Laval, Québec City, Quebec, Canada; Centre de recherche du CHU de Québec-Université Laval - Axe Santé des Populations et pratiques optimales en santé, Quebec City, Quebec, Canada; Centre de recherche en santé durable VITAM - Centre intégré de santé et service sociaux de la capitale nationale, Quebec City, Quebec, Canada
| | - Marc-Aurèle Gagnon
- Centre de recherche du CHU de Québec-Université Laval - Axe Santé des Populations et pratiques optimales en santé, Quebec City, Quebec, Canada
| | - Marcel Émond
- Faculté de médecine, Université Laval, Québec City, Quebec, Canada; Centre de recherche du CHU de Québec-Université Laval - Axe Santé des Populations et pratiques optimales en santé, Quebec City, Quebec, Canada; Centre de recherche en santé durable VITAM - Centre intégré de santé et service sociaux de la capitale nationale, Quebec City, Quebec, Canada
| | - Méanie Bérubé
- Centre de recherche du CHU de Québec-Université Laval - Axe Santé des Populations et pratiques optimales en santé, Quebec City, Quebec, Canada; Faculty of Nursing, Université Laval, Québec City, Quebec, Canada
| | - Michèle Morin
- Faculté de médecine, Université Laval, Québec City, Quebec, Canada; Centre de recherche du CISSS de Chaudière-Appalaches, Lévis, Québec, Canada
| | - Lynne Moore
- Faculté de médecine, Université Laval, Québec City, Quebec, Canada; Centre de recherche du CHU de Québec-Université Laval - Axe Santé des Populations et pratiques optimales en santé, Quebec City, Quebec, Canada
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5
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Villeneuve K, Beaulieu-Bonneau S, Hudon C, Souesme G, Lévesque M, Predovan D, Sirois MJ, de Guise É, Lamontagne MÈ, Poulin V, Le Sage N, Émond M, Ouellet MC. Subjective and objective burden and psychological distress in care partners of older adults with traumatic brain injury. Rehabil Psychol 2023:2023-85628-001. [PMID: 37384485 DOI: 10.1037/rep0000500] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
PURPOSE/OBJECTIVE In care partners of older persons (65 years and older) having sustained traumatic brain injury (TBI), the objectives were (a) to describe subjective burden (emotional, social, financial, and physical burden), objective burden (new roles and responsibilities), and psychological distress at 4 months postinjury, and (b) to explore the predictors of subjective burden and psychological distress. RESEARCH METHOD/DESIGN This is an observational study of care partners of older adults with TBI (n = 46; Mage = 65.2 years, SD = 11.2, 87% female). Participants completed the Zarit Burden Interview, the Hospital Anxiety and Depression Scale, the Brain Injury Complaint Questionnaire (measuring difficulties of the injured older adult perceived by the care partner), and the modified Medical Outcomes Study Social Support Survey. RESULTS A majority of care partners (88%) reported at least one form of objective burden (e.g., increased/decreased time spent in certain activities post-TBI), 29% perceived at least mild subjective burden, and 27% reported either significant anxiety or depressive symptoms. Linear regressions indicated that a higher number of difficulties reported regarding the injured person and poorer perceived social support predicted higher subjective burden and psychological distress. A younger age of the care partner also predicted a higher subjective burden. CONCLUSIONS/IMPLICATIONS This study provides a better understanding of the potential impacts of TBI in older age for care partners. Future research should examine how to support adequately care partners in their psychological adaptation after TBI in an elderly person. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | | | | | - Guillaume Souesme
- Centre Interdisciplinaire de Recherche en Readaptation et Integration Sociale (CIRRIS)
| | | | - David Predovan
- Centre Interdisciplinaire de Recherche en Readaptation et Integration Sociale (CIRRIS)
| | | | | | - Marie-Ève Lamontagne
- Centre Interdisciplinaire de Recherche en Readaptation et Integration Sociale (CIRRIS)
| | - Valérie Poulin
- Centre Interdisciplinaire de Recherche en Readaptation et Integration Sociale (CIRRIS)
| | | | - Marcel Émond
- Centre de recherche du CHU de Quebec, Universite Laval
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6
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Fanaki C, Fortin J, Sirois MJ, Kröger E, Elliott J, Stolee P, Gregg S, Sims-Gould J, Giguere A. Potential Factors Influencing Adoption of a Primary Care Pathway to Prevent Functional Decline in Older Adults. Can Geriatr J 2023; 26:227-238. [PMID: 37265986 PMCID: PMC10198677 DOI: 10.5770/cgj.26.646] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Introduction To help recognize and care for community-dwelling older adults living with frailty, we plan to implement a primary care pathway consisting of frailty screening, shared decision-making to select a preventive intervention, and facilitated referral to community-based services. In this study, we examined the potential factors influencing adoption of this pathway. Methods In this qualitative, descriptive study, we conducted semi-structured interviews and focus groups with patients aged 70 years and older, health professionals (HPs), and managers from four primary care practices in the province of Quebec, representatives of community-based services and geriatric clinics located near the practices. Two researchers conducted an inductive/deductive thematic analysis, by first drawing on the Consolidated Framework for Implementation Research and then adding emergent subthemes. Results We recruited 28 patients, 29 HPs, and 8 managers from four primary care practices, 16 representatives from community-based services, and 10 representatives from geriatric clinics. Participants identified several factors that could influence adoption of the pathway: the availability of electronic and printed versions of the decision aids; the complexity of including a screening form in the electronic health record; public policies that limit the capacity of community-based services; HPs' positive attitudes toward shared decision-making and their work overload; and lack of funding. Conclusions These findings will inform the implementation of the care pathway, so that it meets the needs of key stakeholders and can be scaled up.
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Affiliation(s)
- Chaimaa Fanaki
- VITAM—Research Centre On Sustainable Health, Quebec, QC
- Quebec Centre for Excellence on Aging, Quebec, QC
| | - Julie Fortin
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC
| | - Marie-Josée Sirois
- VITAM—Research Centre On Sustainable Health, Quebec, QC
- Quebec Centre for Excellence on Aging, Quebec, QC
- Research Centre of the CHU de Québec, Quebec, QC
- Department of Readaptation, Université Laval, Quebec, QC
| | - Edeltraut Kröger
- VITAM—Research Centre On Sustainable Health, Quebec, QC
- Quebec Centre for Excellence on Aging, Quebec, QC
- Faculty of Pharmacy, Université Laval, Quebec, QC
| | - Jacobi Elliott
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON
| | - Paul Stolee
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON
| | - Susie Gregg
- Canadian Mental Health Association Waterloo Wellington Dufferin, Waterloo, ON
| | - Joanie Sims-Gould
- Department of Family Practice, University of British Columbia, Vancouver, BC
| | - Anik Giguere
- VITAM—Research Centre On Sustainable Health, Quebec, QC
- Quebec Centre for Excellence on Aging, Quebec, QC
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC
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7
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Peyrusqué E, Kergoat MJ, Sirois MJ, Veillette N, Fonseca R, Aubertin-Leheudre M. Implementation, Feasibility, and Acceptability of MATCH to Prevent Iatrogenic Disability in Hospitalized Older Adults: A Question of Geriatric Care Program? Healthcare (Basel) 2023; 11:healthcare11081186. [PMID: 37108022 PMCID: PMC10138309 DOI: 10.3390/healthcare11081186] [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: 03/06/2023] [Revised: 04/12/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
Senior adults (>age 65) represent almost 20% of the population but account for 48% of hospital bed occupancy. In older adults, hospitalization often results in functional decline (i.e., iatrogenic disability) and, consequently, the loss of autonomy. Physical activity (PA) has been shown to counteract these declines effectively. Nevertheless, PA is not implemented in standard clinical practice. We previously showed that MATCH, a pragmatic, specific, adapted, and unsupervised PA program, was feasible and acceptable in a geriatric assessment unit (GAU) and a COVID-19 geriatric unit. This feasibility study aims to confirm that this tool could be implemented in other geriatric care programs, notably a geriatric rehabilitation unit (GRU) and a post-acute care unit (PACU), in order to reach the maximum number of older patients. Eligibility and consent were assessed by the physician for all the patients admitted to the three units (GAU, GRU, and PACU). The rehabilitation therapist taught each participant one of the five PA programs based on their mobility score on the decisional tree. Implementation (eligibility (%): patients eligible/number admitted and delay of implementation: number of days until prescription); feasibility (adherence (%): number sessions completed/number sessions prescribed and walking time (%): total walking time/time prescribed time); and acceptability (healthcare team (%): tool adequacy (yes/no) and patient: System Usability Scale questionnaire (SUS: x/100)) were evaluated and analyzed using a Kruskal-Wallis ANOVA or Fisher's exact test. Eligibility was different between the units (GRU = 32.5% vs. PACU = 26.6% vs. GAU = 56.0%; p < 0.001), but the time before implementation was similar (days: GRU = 5.91 vs. PACU = 5.88 vs. GAU = 4.78; p > 0.05). PA adherence (GRU = 83.5% vs. PACU = 71.9% vs. GAU = 74.3%) and walking time (100% in all units) were similar (p > 0.05). Patients (SUS: GRU = 74.6 vs. PACU = 77.2 vs. GAU = 77.2; p > 0.05) and clinicians (adequacy (yes; %): GRU = 78.3%; PACU = 76.0%; GAU = 72.2%; p > 0.05) found MATCH acceptable. Overall, MATCH was implementable, feasible, and acceptable in a GAU, GRU, and PACU. Randomized controlled trials are needed to confirm our results and evaluate the health benefits of MATCH compared with usual care.
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Affiliation(s)
- Eva Peyrusqué
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montreal, QC H3W 1W4, Canada
- Département des Sciences de l'Activité Physique, Université du Québec à Montréal, Montreal, QC H3C 3P8, Canada
| | - Marie-Jeanne Kergoat
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montreal, QC H3W 1W4, Canada
- Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Marie-Josée Sirois
- Département de Réadaptation, Université de Laval, Quebec, QC G1V 0A6, Canada
- Centre d'Excellence sur le Vieillissement de Québec, Quebec, QC G1S 4L8, Canada
| | - Nathalie Veillette
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montreal, QC H3W 1W4, Canada
- Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Raquel Fonseca
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montreal, QC H3W 1W4, Canada
- Département de Sciences Économique, École des Sciences de la Gestion, Université du Québec à Montréal, Montreal, QC H2X 1L4, Canada
| | - Mylène Aubertin-Leheudre
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montreal, QC H3W 1W4, Canada
- Département des Sciences de l'Activité Physique, Université du Québec à Montréal, Montreal, QC H3C 3P8, Canada
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8
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Granet J, Peyrusqué E, Ruiz F, Buckinx F, Abdelkader LB, Dang-Vu TT, Sirois MJ, Gouin JP, Pageaux B, Aubertin-Leheudre M. Online physical exercise intervention in older adults during lockdown: Can we improve the recipe? Aging Clin Exp Res 2023; 35:551-560. [PMID: 36635450 PMCID: PMC9838396 DOI: 10.1007/s40520-022-02329-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/16/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Recorded and live online physical exercise (PE) interventions are known to provide health benefits. However, the effects of prioritizing the number of live or recorded sessions remain unclear. AIMS To explore which recorded-live sessions ratio leads to the best implementation and benefits in older adults. METHODS Forty-six community-dwelling adults (> 60y.o.) were randomized into two groups completing a 12-week online PE intervention. Each group had a different ratio of live-recorded online sessions as follows: Live-Recorded-Live sessions (LRL; n = 22) vs. Recorded-Live-Recorded sessions (RLR; n = 24). RESULTS Drop-out rates did not reach significance (LRL:14% vs. RLR: 29%, p = 0.20), and adherence was similar (> 85%) between groups. Both groups reported similar levels of satisfaction (> 70%), enjoyment (> 75%), and perceived exertion (> 60%). Both groups increased physical health and functional capacities, with greater improvements in muscle power (LRL: LRL: + 35 ± 16.1% vs. RLR: + 7 ± 13.9%; p = 0.010) and endurance (LRL: + 34.7 ± 15.4 vs. RLR: + 27.0 ± 26.5, p < 0.001) in the LRL group. DISCUSSION Both online PE intervention modalities were adapted to the participants' capacities and led to a high level of enjoyment and retention. The greater physical improvements observed in the LRL group are likely due to the higher presence of the instructor compared to the RLR group. Indeed, participants received likely more feedback to appropriately adjust postures and movements, increasing the quality of the exercises. CONCLUSION When creating online PE interventions containing both recorded and live sessions, priority should be given to maximizing the number of live sessions and not the number of recorded sessions.
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Affiliation(s)
- J Granet
- Départment des sciences de l'activité physique, Faculté des sciences, Université du Québec à Montréal (UQAM), Montréal, Québec, Canada
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Montréal, Québec, Canada
| | - E Peyrusqué
- Départment des sciences de l'activité physique, Faculté des sciences, Université du Québec à Montréal (UQAM), Montréal, Québec, Canada
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Montréal, Québec, Canada
| | - F Ruiz
- Départment des sciences de l'activité physique, Faculté des sciences, Université du Québec à Montréal (UQAM), Montréal, Québec, Canada
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Montréal, Québec, Canada
| | - F Buckinx
- Départment des sciences de l'activité physique, Faculté des sciences, Université du Québec à Montréal (UQAM), Montréal, Québec, Canada
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Montréal, Québec, Canada
| | - L Ben Abdelkader
- Départment des sciences de l'activité physique, Faculté des sciences, Université du Québec à Montréal (UQAM), Montréal, Québec, Canada
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Montréal, Québec, Canada
| | - T T Dang-Vu
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Montréal, Québec, Canada
- Department of Health, Kinesiology and Applied Physiology, PERFFORM Centre and Center for Studies in Behavioral Neurobiology, Concordia University, Montréal, Québec, Canada
| | - M J Sirois
- Department of Physiotherapy, Laval University, Québec city, Québec, Canada
| | - J P Gouin
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Montréal, Québec, Canada
- Department of Psychology, Concordia University, Montréal, Québec, Canada
| | - B Pageaux
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Montréal, Québec, Canada
- Faculté de médecine, École de kinésiologie et des sciences de l'activité physique (EKSAP), Université de Montréal, Montréal, Québec, Canada
| | - M Aubertin-Leheudre
- Départment des sciences de l'activité physique, Faculté des sciences, Université du Québec à Montréal (UQAM), Montréal, Québec, Canada.
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Montréal, Québec, Canada.
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9
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Dawes P, Reeves D, Yeung WK, Holland F, Charalambous AP, Côté M, David R, Helmer C, Laforce R, Martins RN, Politis A, Pye A, Russell G, Sheikh S, Sirois MJ, Sohrabi HR, Thodi C, Gallant K, Nasreddine Z, Leroi I. Development and validation of the Montreal cognitive assessment for people with hearing impairment (MoCA-H). J Am Geriatr Soc 2023; 71:1485-1494. [PMID: 36722180 DOI: 10.1111/jgs.18241] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/12/2022] [Accepted: 12/18/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Hearing impairment is common among older adults and affects cognitive assessments for identification of dementia which rely on good hearing function. We developed and validated a version of the Montreal Cognitive Assessment (MoCA) for people with hearing impairment. METHODS We adapted existing MoCA 8.1 items for people with hearing impairment by presenting instructions and stimuli in written rather than spoken format. One Attention domain and two Language domain items required substitution by alternative items. Three and four candidate items respectively were constructed and field-tested along with the items adapted to written form. We used a combination of individual item analysis and item substitution to select the set of alternative items to be included in the final form of the MoCA-H in place of the excluded original items. We then evaluated the performance and reliability of the final tool, including making any required adjustments for demographic factors. RESULTS One hundred and fifty-nine hearing-impaired participants, including 76 with normal cognition and 83 with dementia, completed the adapted version of the MoCA. A further 97 participants with normal hearing completed the standard MoCA as well as the novel items developed for the MoCA-H to assess score equivalence between the existing and alternative MoCA items and for independence from hearing impairment. Twenty-eight participants were retested between 2-4 weeks after initial testing. After the selection of optimal item set, the final MoCA-H had an area under the curve of 0.973 (95% CI 0.952-0.994). At a cut-point of 24 points or less sensitivity and specificity for dementia was 92.8% and 90.8%, respectively. The intraclass correlation for test-retest reliability was 0.92 (95%CI 0.78-0.97). CONCLUSION The MoCA-H is a sensitive and reliable means of identifying dementia among adults with acquired hearing impairment.
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Affiliation(s)
- Piers Dawes
- School of Health and Rehabilitation Sciences, University of Queensland Centre for Hearing Research (CHEAR), The University of Queensland, Brisbane, Australia.,Manchester Centre for Audiology and Deafness, The University of Manchester, Manchester, UK
| | - David Reeves
- Centre for Biostatistics, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,National Institute for Health Research School for Primary Care Research, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Wai Kent Yeung
- Centre for Biostatistics, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Fiona Holland
- Centre for Biostatistics, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | | | - Mathieu Côté
- Department of Otorhinolaryngology, Head and Neck Surgery, CHU de Québec-Université Laval, Québec, Canada
| | - Renaud David
- Centre Hospitalier Universitaire de Nice, Nice, France
| | - Catherine Helmer
- University of Bordeaux, INSERM, Bordeaux Population Health Research Center, Bordeaux, France
| | - Robert Laforce
- Clinique Interdisciplinaire de la mémoire, CHU de Québec, Université Laval
| | - Ralph N Martins
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia.,Macquarie Medical School, Macquarie University, Sydney, Australia
| | - Antonis Politis
- Division of Geriatric Psychiatry,1st Department of Psychiatry, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Annie Pye
- Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
| | - Gregor Russell
- Bradford District Care NHS Foundation Trust, Bradford, UK
| | - Saima Sheikh
- Institute for Global Health, School of Medicine, Keele University, Keele, UK
| | - Marie-Josée Sirois
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Hamid R Sohrabi
- Centre for Healthy Ageing, College of Science, Health, Engineering and Education (SHEE), Murdoch University, Perth, Australia
| | - Chyrssoula Thodi
- Department of Health Sciences, European University, Nicosia, Cyprus
| | | | | | - Iracema Leroi
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
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10
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Caron L, Ouellet MC, Hudon C, Predovan D, Sirois MJ, de Guise É, Lamontagne MÈ, Émond M, Le Sage N, Beaulieu-Bonneau S. Cognitive functioning following traumatic brain injury in older adults: associations with social participation and health-related quality of life. Brain Inj 2022; 36:1099-1108. [PMID: 35994259 DOI: 10.1080/02699052.2022.2110284] [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] [Indexed: 11/02/2022]
Abstract
OBJECTIVES To describe objective and subjective cognitive functioning older adults who sustained TBI at age 65 or over, and to determine whether cognitive functioning is associated with health-related quality of life (HRQoL) and social participation. METHOD The sample consisted of 40 individuals with TBI (mean age = 73 years; 65% mild, 35% moderate/severe TBI). On average 15 months post-injury, they completed measures of objective and subjective cognitive functioning (Telephone Interview for Cognitive Status-Modified, Alphaflex, Medical Outcomes Study Cognitive Functioning Scale), HRQoL (SF-12), and social participation (Participation Assessment with Recombined Tools - Objective). RESULTS Mean score for objective cognitive functioning was lower than normative values, while mean scores for executive functioning and subjective cognitive functioning were comparable to normative values. There was no relationship between objective and subjective measures. Subjective cognitive functioning and (to a lesser extent) global objective cognitive functioning were significantly associated with mental HRQoL but not with physical HRQoL or social participation. CONCLUSION These results underscore the importance of considering both subjective perception and objective performance when assessing and intervening on cognition to promote better mental HRQoL in older adults with TBI.
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Affiliation(s)
- Laurence Caron
- École de Psychologie, Faculté des Sciences Sociales, Université Laval, Québec, QC, Canada.,Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, CIUSSS de la Capitale-Nationale, Québec, QC, Canada
| | - Marie-Christine Ouellet
- École de Psychologie, Faculté des Sciences Sociales, Université Laval, Québec, QC, Canada.,Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, CIUSSS de la Capitale-Nationale, Québec, QC, Canada.,Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Carol Hudon
- École de Psychologie, Faculté des Sciences Sociales, Université Laval, Québec, QC, Canada.,Centre de Recherche CERVO Brain Research Center, Québec, QC, Canada
| | - David Predovan
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, CIUSSS de la Capitale-Nationale, Québec, QC, Canada
| | - Marie-Josée Sirois
- Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada.,Département de Réadaptation, Faculté de Médecine, Université Laval, Québec, QC, Canada
| | - Élaine de Guise
- Département de Psychologie, Université de Montréal, Québec, QC, Canada
| | - Marie-Ève Lamontagne
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, CIUSSS de la Capitale-Nationale, Québec, QC, Canada.,Département de Réadaptation, Faculté de Médecine, Université Laval, Québec, QC, Canada
| | - Marcel Émond
- Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada.,Département de Médecine Familiale et de Médecine d'urgence, Faculté de Médecine, Université Laval, Québec, QC, Canada
| | - Natalie Le Sage
- Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada.,Département de Médecine Familiale et de Médecine d'urgence, Faculté de Médecine, Université Laval, Québec, QC, Canada
| | - Simon Beaulieu-Bonneau
- École de Psychologie, Faculté des Sciences Sociales, Université Laval, Québec, QC, Canada.,Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, CIUSSS de la Capitale-Nationale, Québec, QC, Canada
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11
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Lee JS, Tong T, Chignell M, Tierney MC, Goldstein J, Eagles D, Perry JJ, McRae A, Lang E, Hefferon D, Rose L, Kiss A, Borgundvaag B, McLeod S, Melady D, Boucher V, Sirois MJ, Émond M. Prevalence, management and outcomes of unrecognized delirium in a National Sample of 1,493 older emergency department patients: how many were sent home and what happened to them? Age Ageing 2022; 51:6527377. [PMID: 35150585 DOI: 10.1093/ageing/afab214] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 05/31/2021] [Revised: 07/15/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Retrospective studies estimate Emergency Department (ED) delirium recognition at <20%; few prospective studies have assessed delirium recognition and outcomes for patients with unrecognized delirium. OBJECTIVES To prospectively measure delirium recognition by ED nurses and physicians, document their confidence in diagnosis and disposition, actual dispositions, and patient outcomes. METHODS Prospective observational study of people ≥65 years. We assessed delirium using the Confusion Assessment Method, then asked ED staff if the patient had delirium, confidence in their assessment, if the patient could be discharged, and contacted patients 1 week postdischarge. We report proportions and 95% confidence intervals (Cls). RESULTS We enrolled 1,493 participants; mean age was 77.9 years; 49.2% were female, 79 (5.3%, 95% CI 4.2-6.5%) had delirium. ED nurses missed delirium in 43/78 cases (55.1%, 95% CI 43.4-66.4%). Nurses considered 12/43 (27.9%) patients with unrecognized delirium safe to discharge. Median confidence in their delirium diagnosis for patients with unrecognized delirium was 7.0/10. Physicians missed delirium in 10/20 (50.0%, 95% CI 27.2-72.8) cases and considered 2/10 (20.0%) safe to discharge. Median confidence in their delirium diagnosis for patients with unrecognized delirium was 8.0/10. Fifteen patients with unrecognized delirium were sent home: 6.7% died at 1 week follow-up vs. none in those with recognized delirium and 1.1% in the rest of the cohort. CONCLUSION Delirium recognition by nurses and physicians was sub-optimal at ~50% and may be associated with increased mortality. Research should explore root causes of unrecognized delirium, and novel strategies to systematically improve delirium recognition and patient outcomes.
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Affiliation(s)
- Jacques S Lee
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tiffany Tong
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Mark Chignell
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Mary C Tierney
- Department of Family and Community Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Judah Goldstein
- Division of EMS, Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Debra Eagles
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jeffrey J Perry
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Andrew McRae
- Division of EMS, Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Eddy Lang
- Division of EMS, Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Darren Hefferon
- Department of Emergency Services, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, UK
| | - Alex Kiss
- Department of Epidemiology and Biostatistics, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Bjug Borgundvaag
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shelley McLeod
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Don Melady
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Valérie Boucher
- Axe santé des populations et pratiques optimales en santé (SP-POS), CHU de Québec-Université Laval Research Centre, Québec City, QC, Canada
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale, Québec City, QC, Canada
| | - Marie-Josée Sirois
- Axe santé des populations et pratiques optimales en santé (SP-POS), CHU de Québec-Université Laval Research Centre, Québec City, QC, Canada
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale, Québec City, QC, Canada
- Département de réadaptation, Faculté de medécine, Université Laval, Quebec City, QC, Canada
| | - Marcel Émond
- Axe santé des populations et pratiques optimales en santé (SP-POS), CHU de Québec-Université Laval Research Centre, Québec City, QC, Canada
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale, Québec City, QC, Canada
- Département de medécine familiale et de medécine d'urgence, Faculté de medécine, Université Laval, Québec City, QC, Canada
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12
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Hegg S, Sirois MJ, Carmichael PH, Truchot J, Jouhair EM, Nadeau A, Emond M. [Relation between grip strength of independent elders and functional decline following an emergency department visit : a pan-Canadian study]. Rev Med Liege 2021; 76:868-874. [PMID: 34881830] [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: 06/13/2023]
Abstract
OBJECTIVE To determine whether grip strength and fear of falling are associated with functional decline at 3 or 6 months after a minor trauma assessed in the emergency department. METHOD Prospective multicenter cohort study of patient's aged 65 years and older, independent for activities of daily living, consulting the emergency department for minor trauma. Functional status, fear of falling, and grip strength measurements were collected. Functional decline was measured at 3 and 6 months. STATISTICS Two groups were compared : one with functional decline, the other without. A ROC curve explored the predictive power of grip strength and initial fear of falling on the occurrence of functional decline. RESULTS Participants were 74.7 years old, 52 % men. Initial peak grip strengths were identical (p superior to 0.05). Grip strength and fear of falling were not predictive of functional decline (p = 0.55 and p = 0.53). However, fear of falling was associated with functional decline (OR: 1.141 95 % CI [1.032-1.261]; p = 0.009). CONCLUSION In the autonomous elder with minor trauma in the emergency department, grip strength is not associated with subsequent functional decline. But fear of falling is associated with decline at 6 months.
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Affiliation(s)
- S Hegg
- Axe Santé des Populations, CHU, Québec, Canada
- Centre Excellence sur le Vieillissement, Québec, Canada
- Université Laval, Québec, Canada
| | - M J Sirois
- Axe Santé des Populations, CHU, Québec, Canada
- Centre Excellence sur le Vieillissement, Québec, Canada
- Université Laval, Québec, Canada
| | | | | | | | - A Nadeau
- Axe Santé des Populations, CHU, Québec, Canada
- Centre Excellence sur le Vieillissement, Québec, Canada
| | - M Emond
- Axe Santé des Populations, CHU, Québec, Canada
- Centre Excellence sur le Vieillissement, Québec, Canada
- Université Laval, Québec, Canada
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13
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Lamontagne G, Belleville G, Beaulieu-Bonneau S, Souesme G, Savard J, Sirois MJ, Giguère M, Tessier D, Le Sage N, Ouellet MC. Anxiety symptoms and disorders in the first year after sustaining mild traumatic brain injury. Rehabil Psychol 2021; 67:90-99. [PMID: 34843337 DOI: 10.1037/rep0000422] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE/OBJECTIVE The goals of the present study were (a) to document the prevalence of anxiety-related disorders and anxiety symptoms at 4, 8, and 12 months postinjury in individuals with mild traumatic brain injury (mTBI) while considering preinjury history of anxiety disorders and (b) to verify whether the presence of anxiety in the first months after mTBI was associated with more symptoms present 1 year after the injury. Research Method/Design: One hundred and twenty participants hospitalized after an accident and having sustained mTBI were assessed at 4, 8, and 12 months postaccident with the Mini-International Neuropsychiatric Interview, the Hospital Anxiety and Depression Scale, and questionnaires assessing fatigue, irritability, perceived stress, cognitive difficulties, depression, insomnia, and pain. RESULTS At 4 months, 23.8% of participants presented with at least one anxiety-related disorder compared with 15.2% at 8 months and 11.2% at 12 months. Overall, 32.5% presented with at least one anxiety disorder over the first 12 months post-mTBI. Participants with a history of anxiety (20.5%) were significantly more anxious after their accident. Individuals who were anxious 4 months after the accident presented with more symptoms in different areas 12 months postinjury compared with nonanxious individuals. CONCLUSIONS/IMPLICATIONS The present results highlight that anxiety should be evaluated and managed carefully as it appears to be a key factor in the persistence of other mTBI-related symptoms. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | | | | | - Guillaume Souesme
- Centre Interdisciplinaire de Recherche en Readaptation et Integration Sociale (Cirris)
| | | | | | - Myriam Giguère
- Centre Interdisciplinaire de Recherche en Readaptation et Integration Sociale (Cirris)
| | | | - Natalie Le Sage
- Centre de Recherche du Centre Hospitalier Universitaire de Quebec
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14
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Provencher V, D'Amours M, Menear M, Obradovic N, Veillette N, Sirois MJ, Kergoat MJ. Understanding the positive outcomes of discharge planning interventions for older adults hospitalized following a fall: a realist synthesis. BMC Geriatr 2021; 21:84. [PMID: 33514326 PMCID: PMC7844968 DOI: 10.1186/s12877-020-01980-3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 12/21/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Older adults hospitalized following a fall often encounter preventable adverse events when transitioning from hospital to home. Discharge planning interventions developed to prevent these events do not all produce the expected effects to the same extent. This realist synthesis aimed to better understand when, where, for whom, why and how the components of these interventions produce positive outcomes. METHODS Nine indexed databases were searched to identify scientific papers and grey literature on discharge planning interventions for older adults (65+) hospitalized following a fall. Manual searches were also conducted. Documents were selected based on relevance and rigor. Two reviewers extracted and compiled data regarding intervention components, contextual factors, underlying mechanisms and positive outcomes. Preliminary theories were then formulated based on an iterative synthesis process. RESULTS Twenty-one documents were included in the synthesis. Four Intervention-Context-Mechanism-Outcome configurations were developed as preliminary theories, based on the following intervention components: 1) Increase two-way communication between healthcare providers and patients/caregivers using a family-centered approach; 2) Foster interprofessional communication within and across healthcare settings through both standardized and unofficial information exchange; 3) Provide patients/caregivers with individually tailored fall prevention education; and 4) Designate a coordinator to manage discharge planning. These components should be implemented from patient admission to return home and be supported at the organizational level (contexts) to trigger knowledge, understanding and trust of patients/caregivers, adjusted expectations, reduced family stress, and sustained engagement of families and professionals (mechanisms). These optimal conditions improve patient satisfaction, recovery, functional status and continuity of care, and reduce hospital readmissions and fall risk (outcomes). CONCLUSIONS Since transitions are critical points with potential communication gaps, coordinated interventions are vital to support a safe return home for older adults hospitalized following a fall. Considering the organizational challenges, simple tools such as pictograms and drawings, combined with computer-based communication channels, may optimize discharge interventions based on frail patients' needs, habits and values. Empirically testing our preliminary theories will help to develop effective interventions throughout the continuum of transitional care to enhance patients' health and reduce the economic burden of avoidable care.
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Affiliation(s)
- Véronique Provencher
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada.
- Research Centre on Aging, Sherbrooke, QC, Canada.
| | | | - Matthew Menear
- Department of Family Medicine and Emergency Medicine, Laval University, Québec, Canada
- Centre de recherche sur les soins et les services de première ligne, Université Laval, Québec, Canada
| | - Natasa Obradovic
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
- Research Centre on Aging, Sherbrooke, QC, Canada
| | - Nathalie Veillette
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Marie-Josée Sirois
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Québec, Canada
| | - Marie-Jeanne Kergoat
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
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Giroux M, Émond M, Nadeau A, Boucher V, Carmichael PH, Voyer P, Pelletier M, Gouin É, Daoust R, Berthelot S, Lamontagne ME, Morin M, Lemire S, Sirois MJ. Functional and cognitive decline in older delirious adults after an emergency department visit. Age Ageing 2021; 50:135-140. [PMID: 32894748 DOI: 10.1093/ageing/afaa128] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 12/18/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND the aim of this study was to evaluate the impact of emergency department (ED) stay-associated delirium on older patient's functional and cognitive status at 60 days post ED visit. METHODS this study was part of the multi-centre prospective cohort INDEED study. This project took place between March 2015 and July 2016 in five participating EDs across the province of Quebec. Independent non-delirious patients aged ≥65, with an ED stay ≥8 hours, were monitored for delirium until 24 hours post ward admission. A 60-day follow-up phone assessment was conducted. Participants were screened for delirium using the Confusion Assessment Method. Functional and cognitive statuses were assessed at baseline and at the 60-day follow-up using OARS and TICS-m. RESULTS a total of 608 patients were recruited, 393 of which completed the 60-day follow-up. The Confusion Assessment Method was positive in 69 patients (11.8%) during ED stay or within the first 24 hours following ward admission. At 60 days, delirium patients experienced an adjusted loss of -2.9/28 [95%CI: -3.9, -2.0] points on the OARS scale compared to non-delirious patients who lost -1.6 [95%CI: -1.9, -1.3] (P = 0.006). A significant adjusted difference in cognitive function was also noted at 60 days, as TICS-m scores in delirious patients decreased by -1.6 [95%CI: -3.5, 0.2] compared to non-delirious patients, who showed a minor improvement of 0.5 [95%CI: -0.1, 1.1] (P = 0.03). CONCLUSION seniors who developed ED stay-associated delirium have lower baseline functional and cognitive status than non-delirious patients, and they will experience a more significant decline at 60 days post ED visit.
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Affiliation(s)
- Marianne Giroux
- Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Université Laval, Québec, Canada
- Centre d'excellence sur le vieillissement de Québec, Québec, Canada
| | - Marcel Émond
- Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Université Laval, Québec, Canada
- Centre d'excellence sur le vieillissement de Québec, Québec, Canada
- Département de médecine d'urgence, CHU de Québec-Université Laval, Québec, Canada
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Québec, Canada
| | - Alexandra Nadeau
- Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Université Laval, Québec, Canada
- Centre d'excellence sur le vieillissement de Québec, Québec, Canada
| | - Valérie Boucher
- Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Université Laval, Québec, Canada
- Centre d'excellence sur le vieillissement de Québec, Québec, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Québec, Canada
| | | | - Philippe Voyer
- Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Université Laval, Québec, Canada
- Centre d'excellence sur le vieillissement de Québec, Québec, Canada
| | - Mathieu Pelletier
- Université Laval, Québec, Canada
- Centre Intégré de Santé et de Services Sociaux de Lanaudière, Joliette, Canada
| | - Émilie Gouin
- Centre Hospitalier Régional de Trois-Rivières, Trois-Rivières, Canada
| | - Raoul Daoust
- Centre de recherche de l'Hôpital du Sacré-Cœur de Montréal, Montréal, Canada
- Université de Montréal, Montréal, Canada
| | - Simon Berthelot
- Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Université Laval, Québec, Canada
- Département de médecine d'urgence, CHU de Québec-Université Laval, Québec, Canada
| | - Marie-Eve Lamontagne
- Université Laval, Québec, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Québec, Canada
| | - Michèle Morin
- Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Université Laval, Québec, Canada
- Centre d'excellence sur le vieillissement de Québec, Québec, Canada
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Québec, Canada
| | - Stéphane Lemire
- Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Université Laval, Québec, Canada
- Centre d'excellence sur le vieillissement de Québec, Québec, Canada
| | - Marie-Josée Sirois
- Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Université Laval, Québec, Canada
- Centre d'excellence sur le vieillissement de Québec, Québec, Canada
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Québec, Canada
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16
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Archambault PM, Rivard J, Smith PY, Sinha S, Morin M, LeBlanc A, Couturier Y, Pelletier I, Ghandour EK, Légaré F, Denis JL, Melady D, Paré D, Chouinard J, Kroon C, Huot-Lavoie M, Bert L, Witteman HO, Brousseau AA, Dallaire C, Sirois MJ, Émond M, Fleet R, Chandavong S. Learning Integrated Health System to Mobilize Context-Adapted Knowledge With a Wiki Platform to Improve the Transitions of Frail Seniors From Hospitals and Emergency Departments to the Community (LEARNING WISDOM): Protocol for a Mixed-Methods Implementation Study. JMIR Res Protoc 2020; 9:e17363. [PMID: 32755891 PMCID: PMC7439141 DOI: 10.2196/17363] [Citation(s) in RCA: 4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/17/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Elderly patients discharged from hospital experience fragmented care, repeated and lengthy emergency department (ED) visits, relapse into their earlier condition, and rapid cognitive and functional decline. The Acute Care for Elders (ACE) program at Mount Sinai Hospital in Toronto, Canada uses innovative strategies, such as transition coaches, to improve the care transition experiences of frail elderly patients. The ACE program reduced the lengths of hospital stay and readmission for elderly patients, increased patient satisfaction, and saved the health care system over Can $4.2 million (US $2.6 million) in 2014. In 2016, a context-adapted ACE program was implemented at one hospital in the Centre intégré de santé et de services sociaux de Chaudière-Appalaches (CISSS-CA) with a focus on improving transitions between hospitals and the community. The quality improvement project used an intervention strategy based on iterative user-centered design prototyping and a "Wiki-suite" (free web-based database containing evidence-based knowledge tools) to engage multiple stakeholders. OBJECTIVE The objectives of this study are to (1) implement a context-adapted CISSS-CA ACE program in four hospitals in the CISSS-CA and measure its impact on patient-, caregiver-, clinical-, and hospital-level outcomes; (2) identify underlying mechanisms by which our context-adapted CISSS-CA ACE program improves care transitions for the elderly; and (3) identify underlying mechanisms by which the Wiki-suite contributes to context-adaptation and local uptake of knowledge tools. METHODS Objective 1 will involve staggered implementation of the context-adapted CISSS-CA ACE program across the four CISSS-CA sites and interrupted time series to measure the impact on hospital-, patient-, and caregiver-level outcomes. Objectives 2 and 3 will involve a parallel mixed-methods process evaluation study to understand the mechanisms by which our context-adapted CISSS-CA ACE program improves care transitions for the elderly and by which our Wiki-suite contributes to adaptation, implementation, and scaling up of geriatric knowledge tools. RESULTS Data collection started in January 2019. As of January 2020, we enrolled 1635 patients and 529 caregivers from the four participating hospitals. Data collection is projected to be completed in January 2022. Data analysis has not yet begun. Results are expected to be published in 2022. Expected results will be presented to different key internal stakeholders to better support the effort and resources deployed in the transition of seniors. Through key interventions focused on seniors, we are expecting to increase patient satisfaction and quality of care and reduce readmission and ED revisit. CONCLUSIONS This study will provide evidence on effective knowledge translation strategies to adapt best practices to the local context in the transition of care for elderly people. The knowledge generated through this project will support future scale-up of the ACE program and our wiki methodology in other settings in Canada. TRIAL REGISTRATION ClinicalTrials.gov NCT04093245; https://clinicaltrials.gov/ct2/show/NCT04093245. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/17363.
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Affiliation(s)
- Patrick Michel Archambault
- Department of Family and Emergency Medicine, Université Laval, Québec, QC, Canada
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Ste-Marie, QC, Canada
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec, QC, Canada
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Josée Rivard
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Ste-Marie, QC, Canada
| | - Pascal Y Smith
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Samir Sinha
- Department of Medicine, Sinai Health System, Toronto, ON, Canada
- Department of Medicine, University Health Network, Toronto, QC, Canada
- Department of Medicine, University of Toronto, Toronto, QC, Canada
| | - Michèle Morin
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Ste-Marie, QC, Canada
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Department of Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Annie LeBlanc
- Department of Family and Emergency Medicine, Université Laval, Québec, QC, Canada
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada
| | - Yves Couturier
- Department of Social Work, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Isabelle Pelletier
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Ste-Marie, QC, Canada
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - El Kebir Ghandour
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Institut national d'excellence en sante et en services sociaux, Québec, QC, Canada
| | - France Légaré
- Department of Family and Emergency Medicine, Université Laval, Québec, QC, Canada
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada
- Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Québec, QC, Canada
| | - Jean-Louis Denis
- Département de gestion, d'évaluation et de politique de santé, École de santé publique, Université de Montréal, Montreal, QC, Canada
| | - Don Melady
- Schwartz-Reisman Emergency Medicine Institute, Mount Sinai Hospital, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Daniel Paré
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Ste-Marie, QC, Canada
| | - Josée Chouinard
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Ste-Marie, QC, Canada
| | - Chantal Kroon
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Ste-Marie, QC, Canada
| | - Maxime Huot-Lavoie
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Laetitia Bert
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Faculty of Nursing, Université Laval, Québec, QC, Canada
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Université Laval, Québec, QC, Canada
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada
- Office of Education and Professional Development, Faculty of Medicine, Université Laval, Québec, QC, Canada
- CHU de Québec-Université Laval, Québec, QC, Canada
| | - Audrey-Anne Brousseau
- Centre intégré universitaire de santé et de services sociaux de l'Estrie - CHUS, Sherbrooke, QC, Canada
| | - Clémence Dallaire
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Faculty of Nursing, Université Laval, Québec, QC, Canada
| | - Marie-Josée Sirois
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada
- Centre d'excellence sur le vieillissement du Québec, Hôpital du Saint-Sacrement, Québec, QC, Canada
- Département de réadaptation, Faculté de médecine, Université Laval, Québec, QC, Canada
| | - Marcel Émond
- Department of Family and Emergency Medicine, Université Laval, Québec, QC, Canada
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada
- CHU de Québec-Université Laval, Québec, QC, Canada
| | - Richard Fleet
- Department of Family and Emergency Medicine, Université Laval, Québec, QC, Canada
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Sam Chandavong
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
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Abstract
BACKGROUND. The Lifestyle Redesign® (LR) aims to support health, functioning, and quality of life of older adults through the development of healthy and meaningful routines. However, evidence concerning the effectiveness and cost-effectiveness of this intervention is scattered. PURPOSE. This study aimed to synthetize the clinical effects and cost-effectiveness of the LR as well as to verify the applicability of the results in a community-based setting in Quebec. METHOD. A systematic review of the literature was conducted, followed by a focus group with four occupational therapists. FINDINGS. Considered as cost-effective (under $50,000 in quality-adjusted life-years), the LR offers benefits for both mental and physical health. According to occupational therapists, the LR is clearly relevant for their practice but involves some challenges. IMPLICATIONS. The LR is an occupational therapy intervention with promising clinical effects and cost-effectiveness for older adults living in the community.
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Kröger E, Simard M, Sirois MJ, Giroux M, Sirois C, Kouladjian-O'Donnell L, Reeve E, Hilmer S, Carmichael PH, Émond M. Is the Drug Burden Index Related to Declining Functional Status at Follow-up in Community-Dwelling Seniors Consulting for Minor Injuries? Results from the Canadian Emergency Team Initiative Cohort Study. Drugs Aging 2019; 36:73-83. [PMID: 30378088 DOI: 10.1007/s40266-018-0604-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The Canadian Emergency Team Initiative (CETI) cohort showed that minor injuries like sprained ankles or small fractures trigger a downward spiral of functional decline in 16% of independent seniors up to 6 months post-injury. Such seniors frequently receive medications with sedative or anticholinergic properties. The Drug Burden Index (DBI), which summarises the drug burden of these specific medications, has been associated with decreased physical and cognitive functioning in previous research. OBJECTIVES We aimed to assess the contribution of the DBI to functional decline in the CETI cohort. METHODS CETI participants were assessed physically and cognitively at baseline during their consultations at emergency departments (EDs) for their injuries and up to 6 months thereafter. The medication data were used to calculate baseline DBI and functional status was measured with the Older Americans Resources and Services (OARS) scale. Multivariate linear regression models assessed the association between baseline DBI and functional status at 6 months, adjusting for age, sex, baseline OARS, frailty level, comorbidity count, and mild cognitive impairment. RESULTS The mean age of the 846 participants was 77 years and their mean DBI at baseline was 0.24. Complete follow-up data at 3 or 6 months was available for 718 participants among whom a higher DBI at the time of injury contributed to a lower functional status at 6 months. Each additional point in the DBI lead to a loss of 0.5 points on the OARS functional scale, p < 0.001. Among those with a DBI ≥ 1, 27.4% were considered 'patients who decline' at 3 or 6 months' follow-up, compared with 16.0% of those with a DBI of 0 (p = 0.06). CONCLUSIONS ED visits are considered missed opportunities for optimal care interventions in seniors; Identifying their DBI and adjusting treatment accordingly may help limit functional decline in those at risk after minor injury.
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Affiliation(s)
- Edeltraut Kröger
- Faculté de pharmacie, Université Laval, Québec, Canada. .,Centre d'excellence sur le vieillissement de Québec du Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSSCN), Québec, Canada. .,Axe santé des populations et pratiques optimales en santé, Centre de recherche du Centre Hospitalier Universitaire (CHU) de Québec, Québec, Canada.
| | - Marilyn Simard
- Centre d'excellence sur le vieillissement de Québec du Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSSCN), Québec, Canada.,Faculté de médecine, Université Laval, Québec, Canada
| | - Marie-Josée Sirois
- Centre d'excellence sur le vieillissement de Québec du Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSSCN), Québec, Canada.,Faculté de médecine, Université Laval, Québec, Canada.,Axe santé des populations et pratiques optimales en santé, Centre de recherche du Centre Hospitalier Universitaire (CHU) de Québec, Québec, Canada
| | - Marianne Giroux
- Centre d'excellence sur le vieillissement de Québec du Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSSCN), Québec, Canada.,Axe santé des populations et pratiques optimales en santé, Centre de recherche du Centre Hospitalier Universitaire (CHU) de Québec, Québec, Canada
| | - Caroline Sirois
- Centre d'excellence sur le vieillissement de Québec du Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSSCN), Québec, Canada.,Faculté de médecine, Université Laval, Québec, Canada.,Axe santé des populations et pratiques optimales en santé, Centre de recherche du Centre Hospitalier Universitaire (CHU) de Québec, Québec, Canada
| | - Lisa Kouladjian-O'Donnell
- NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.,Kolling Institute of Medical Research, University of Sydney and Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Emily Reeve
- NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.,Kolling Institute of Medical Research, University of Sydney and Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Sarah Hilmer
- NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.,Kolling Institute of Medical Research, University of Sydney and Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Pierre-Hugues Carmichael
- Centre d'excellence sur le vieillissement de Québec du Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSSCN), Québec, Canada.,Axe santé des populations et pratiques optimales en santé, Centre de recherche du Centre Hospitalier Universitaire (CHU) de Québec, Québec, Canada
| | - Marcel Émond
- Centre d'excellence sur le vieillissement de Québec du Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSSCN), Québec, Canada.,Faculté de médecine, Université Laval, Québec, Canada.,Axe santé des populations et pratiques optimales en santé, Centre de recherche du Centre Hospitalier Universitaire (CHU) de Québec, Québec, Canada
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19
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Fillion V, Sirois MJ, Gamache P, Guertin JR, Morin SN, Jean S. Frailty and health services use among Quebec seniors with non-hip fractures: a population-based study using adminsitrative databases. BMC Health Serv Res 2019; 19:70. [PMID: 30683094 PMCID: PMC6347825 DOI: 10.1186/s12913-019-3865-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 10/12/2017] [Accepted: 01/02/2019] [Indexed: 01/12/2023] Open
Abstract
Background The number of frail elderly will increase as the world population ageing accelerates. Since frail elders are at risk of falls, hospitalizations and disabilities, they will require more health care and services. To assess frailty prevalence using health administrative databases, to examine the association between frailty and the use of medical services and to measure the excess use of health services following a non-hip fracture across frailty levels among community-dwelling seniors. Methods A population-based cohort study was built from the Quebec Integrated Chronic Disease Surveillance System, including men and women ≥65 years old, non-institutionalized in the pre-fracture year. Frailty was measured using the Elders Risk Assessment (ERA) index. Multivariate Generalized Estimating Equation models were used to examine the relationship between frailty levels and health services while adjusting for covariates. The excess numbers of visits to Emergency Departments (ED) and to Primary Care Practitioners (PCP) as well as hospitalizations were also estimated. Results The cohort included 178,304 fractures. There were 13.6 and 5.2% frail and robust seniors, respectively. In the post-fracture year, the risks of ED visits, PCP visits and hospitalizations, were significantly higher in frail vs. non-frail seniors: adjusted relative risk (RR) = 2.69 [95% CI: 2.50–2.90] for ED visits, RR = 1.28 [95% CI: 1.23–1.32] for PCP visits and RR = 2.34 [95% CI: 2.14–2.55] for hospitalizations. Conclusion Our results suggest that it is possible to characterize seniors’ frailty status at a population level using health administrative databases. Furthermore, this study shows that non-institutionalized frail seniors require more health services after an incident fracture. Screening for frailty in seniors should be part of clinical management in order to identify those at a higher risk of needing health services. Electronic supplementary material The online version of this article (10.1186/s12913-019-3865-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Vanessa Fillion
- Centre d'Excellence sur le Vieillissement de Québec (CEVQ), Québec, Canada. .,Centre de recherche du CHU de Québec, Québec, Canada. .,The Canadian Emergency Team Initiative (CETI), Québec, Canada. .,Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec (INSPQ), 945, avenue Wolfe, Québec, QC, G1V 5B3, Canada.
| | - Marie-Josée Sirois
- Centre d'Excellence sur le Vieillissement de Québec (CEVQ), Québec, Canada.,Centre de recherche du CHU de Québec, Québec, Canada.,The Canadian Emergency Team Initiative (CETI), Québec, Canada.,Université Laval, Québec, Canada.,Hôpital de l'Enfant-Jésus, 1401 18e rue, H-602, Québec, QC, G1J 1Z4, Canada
| | - Philippe Gamache
- Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec (INSPQ), 945, avenue Wolfe, Québec, QC, G1V 5B3, Canada
| | - Jason Robert Guertin
- Centre de recherche du CHU de Québec, Québec, Canada.,Université Laval, Québec, Canada.,Hôpital Saint-Sacrement, 1050 Chemin Sainte-Foy, Bureau J0-01, Québec, QC, G1S 4L8, Canada
| | - Suzanne N Morin
- Université McGill, Québec, Canada.,Montreal General Hospital, 1650 Cedar Avenue, Room B2.118, Montréal, QC, H3G 1A4, Canada
| | - Sonia Jean
- Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec (INSPQ), 945, avenue Wolfe, Québec, QC, G1V 5B3, Canada.,Université Laval, Québec, Canada
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20
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Giroux M, Sirois MJ, Boucher V, Daoust R, Gouin É, Pelletier M, Berthelot S, Voyer P, Émond M. Frailty Assessment to Help Predict Patients at Risk of Delirium When Consulting the Emergency Department. J Emerg Med 2018; 55:157-164. [DOI: 10.1016/j.jemermed.2018.02.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 01/31/2018] [Accepted: 02/22/2018] [Indexed: 12/20/2022]
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21
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Martel D, Lauzé M, Agnoux A, Fruteau de Laclos L, Daoust R, Émond M, Sirois MJ, Aubertin-Leheudre M. Comparing the effects of a home-based exercise program using a gerontechnology to a community-based group exercise program on functional capacities in older adults after a minor injury. Exp Gerontol 2018; 108:41-47. [DOI: 10.1016/j.exger.2018.03.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 03/06/2018] [Accepted: 03/18/2018] [Indexed: 11/27/2022]
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Ouellet MC, Beaulieu-Bonneau S, Sirois MJ, Savard J, Turgeon AF, Moore L, Swaine B, Roy J, Giguère M, Laviolette V. Depression in the First Year after Traumatic Brain Injury. J Neurotrauma 2018; 35:1620-1629. [PMID: 29566597 DOI: 10.1089/neu.2017.5379] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The aims of this study were to document the frequency of major and minor depressive episodes in the first year after traumatic brain injury (TBI), taking into account TBI severity and pre-morbid history of major depression, and to describe trajectories of depressive episodes. Participants were 227 adults who were hospitalized post-TBI (76% male; mean age = 41 years; 50% mild, 33% moderate, and 17% severe TBI). Major and minor depressive episodes were assessed with the Mini International Neuropsychiatric Interview at three time points (4, 8, and 12 months after TBI). Overall, 29% of participants had a major depressive episode in at least one of the three assessments, with fairly stable rates across assessments. Participants with mild TBI were more likely than those with moderate/severe TBI to be diagnosed with major depression, as were individuals with a positive pre-morbid history of depression compared to those without such history. In addition, 13% of participants had a minor depressive episode in at least one of the three assessments. Rates of minor depression significantly decreased from 4 to 8-12 months post-injury. Results also revealed a wide variety of trajectories of depressive episodes across assessments. Of note, 52% of major depression cases still fulfilled diagnostic criteria 4 months later, whereas 38% of minor depression cases deteriorated to major depression at the following assessment. These findings suggest that depression is highly prevalent after TBI, and monitoring of patients with subthreshold depressive symptoms is warranted in order to prevent the development of full-blown major depressive episodes.
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Affiliation(s)
- Marie-Christine Ouellet
- 1 Centre interdisciplinaire de recherche en réadaptation et intégration sociale , Québec City, Québec, Canada .,2 École de psychologie, Université Laval , Québec City, Québec, Canada .,3 Centre de recherche du CHU de Québec-Université Laval , Axe Santé des populations et Pratiques optimales en santé, Québec City, Québec, Canada
| | - Simon Beaulieu-Bonneau
- 1 Centre interdisciplinaire de recherche en réadaptation et intégration sociale , Québec City, Québec, Canada .,2 École de psychologie, Université Laval , Québec City, Québec, Canada
| | - Marie-Josée Sirois
- 3 Centre de recherche du CHU de Québec-Université Laval , Axe Santé des populations et Pratiques optimales en santé, Québec City, Québec, Canada
| | - Josée Savard
- 2 École de psychologie, Université Laval , Québec City, Québec, Canada .,3 Centre de recherche du CHU de Québec-Université Laval , Axe Santé des populations et Pratiques optimales en santé, Québec City, Québec, Canada
| | - Alexis F Turgeon
- 3 Centre de recherche du CHU de Québec-Université Laval , Axe Santé des populations et Pratiques optimales en santé, Québec City, Québec, Canada .,4 Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval , Québec City, Québec, Canada
| | - Lynne Moore
- 3 Centre de recherche du CHU de Québec-Université Laval , Axe Santé des populations et Pratiques optimales en santé, Québec City, Québec, Canada
| | - Bonnie Swaine
- 5 École de réadaptation, Faculté de médecine, Université de Montréal , Montréal, Québec, Canada .,6 Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain , Montréal, Québec City, Québec, Canada
| | - Joanne Roy
- 7 CHU de Québec-Université Laval , Québec City, Québec, Canada
| | - Myriam Giguère
- 1 Centre interdisciplinaire de recherche en réadaptation et intégration sociale , Québec City, Québec, Canada
| | - Valérie Laviolette
- 1 Centre interdisciplinaire de recherche en réadaptation et intégration sociale , Québec City, Québec, Canada .,2 École de psychologie, Université Laval , Québec City, Québec, Canada
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Gagnon-Roy M, Hami B, Généreux M, Veillette N, Sirois MJ, Egan M, Provencher V. Preventing emergency department (ED) visits and hospitalisations of older adults with cognitive impairment compared with the general senior population: what do we know about avoidable incidents? Results from a scoping review. BMJ Open 2018; 8:e019908. [PMID: 29666129 PMCID: PMC5905733 DOI: 10.1136/bmjopen-2017-019908] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Older cognitively impaired adults present a higher risk of hospitalisation and mortality following a visit to the emergency department (ED). Better understanding of avoidable incidents is needed to prevent them and the associated ED presentations in community-dwelling adults. This study aimed to synthetise the actual knowledge concerning these incidents leading this population to ED presentation, as well as possible preventive measures to reduce them. DESIGN A scoping review was performed according to the Arksey and O'Malley framework. METHODS Scientific and grey literature published between 1996 and 2017 were examined in databases (Medline, Cumulative Index of Nursing and Allied Health, Ageline, Scopus, ProQuest Dissertations/theses, Evidence-based medecine (EBM) Reviews, Healthstar), online library catalogues, governmental websites and published statistics. Sources discussing avoidable incidents leading to ED presentations were included and then extended to those discussing hospitalisation and mortality due to a lack of sources. Data (type, frequency, severity and circumstances of incidents, preventive measures) was extracted using a thematic chart, then analysed with content analysis. RESULTS 67 sources were included in this scoping review. Five types of avoidable incidents (falls, burns, transport accidents, harm due to self-negligence and due to wandering) emerged, and all but transport accidents were more frequent in cognitively impaired seniors. Differences regarding circumstances were only reported for burns, as scalding was the most prevalent mechanism of injury for this population compared with flames for the general senior population. Multifactorial interventions and implications of other professionals (eg, pharmacist, firefighters) were reported as potential interventions to reduce avoidable incidents. However, few preventive measures were specifically tested in this population. CONCLUSIONS Primary research that screens for cognitive impairment and involves actors (eg, paramedics) to improve our understanding of avoidable incidents leading to ED visits is greatly needed. This knowledge is essential to develop preventive measures tailored to the needs of older cognitively impaired adults.
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Affiliation(s)
- Mireille Gagnon-Roy
- École de réadaptation, Faculté de médecine, Université de Montréal, Montréal, Quebec, Canada
| | - Benyahia Hami
- Faculty of Medicine and Health Sciences, University of Sherbrooke, Research Centre on Aging, Sherbrooke, Quebec, Canada
| | - Mélissa Généreux
- Faculty of Medicine and Health Sciences, University of Sherbrooke, Direction de la Santé Publique de l'Estrie-CIUSS de l'Estrie-CHUS, Sherbrooke, Quebec, Canada
| | - Nathalie Veillette
- École de réadaptation, Faculté de médecine, Université de Montréal, Montréal, Quebec, Canada
| | - Marie-Josée Sirois
- Département de réadaptation, Faculté de médecine, Université Laval, CHU de Québec, Québec, Canada
| | - Mary Egan
- Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Bruyere Institute, Ottawa, Ontario, Canada
| | - Véronique Provencher
- Faculty of Medicine and Health Sciences, University of Sherbrooke, Research Centre on Aging, Sherbrooke, Quebec, Canada
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Gagné M, Moore L, Sirois MJ, Simard M, Beaudoin C, Kuimi BLB. Performance of International Classification of Diseases-based injury severity measures used to predict in-hospital mortality and intensive care admission among traumatic brain-injured patients. J Trauma Acute Care Surg 2017; 82:374-382. [PMID: 28107311 DOI: 10.1097/ta.0000000000001319] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The International Classification of Diseases (ICD) is the main classification system used for population-based traumatic brain injury (TBI) surveillance activities but does not contain direct information on injury severity. International Classification of Diseases-based injury severity measures can be empirically derived or mapped to the Abbreviated Injury Scale, but no single approach has been formally recommended for TBI. OBJECTIVE The aim of this study was to compare the accuracy of different ICD-based injury severity measures for predicting in-hospital mortality and intensive care unit (ICU) admission in TBI patients. METHODS We conducted a population-based retrospective cohort study. We identified all patients 16 years or older with a TBI diagnosis who received acute care between April 1, 2006, and March 31, 2013, from the Quebec Hospital Discharge Database. The accuracy of five ICD-based injury severity measures for predicting mortality and ICU admission was compared using measures of discrimination (area under the receiver operating characteristic curve [AUC]) and calibration (calibration plot and the Hosmer-Lemeshow goodness-of-fit statistic). RESULTS Of 31,087 traumatic brain-injured patients in the study population, 9.0% died in hospital, and 34.4% were admitted to the ICU. Among ICD-based severity measures that were assessed, the multiplied derivative of ICD-based Injury Severity Score (ICISS-Multiplicative) demonstrated the best discriminative ability for predicting in-hospital mortality (AUC, 0.858; 95% confidence interval, 0.852-0.864) and ICU admissions (AUC, 0.813; 95% confidence interval, 0.808-0.818). Calibration assessments showed good agreement between observed and predicted in-hospital mortality for ICISS measures. All severity measures presented high agreement between observed and expected probabilities of ICU admission for all deciles of risk. CONCLUSIONS The ICD-based injury severity measures can be used to accurately predict in-hospital mortality and ICU admission in TBI patients. The ICISS-Multiplicative generally outperformed other ICD-based injury severity measures and should be preferred to control for differences in baseline characteristics between TBI patients in surveillance activities or injury research when only ICD codes are available. LEVEL OF EVIDENCE Prognostic study, level III.
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Affiliation(s)
- Mathieu Gagné
- From the Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Québec City, Québec, Canada (M.G., M.S., C.B.); Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Québec City, Québec, Canada (M.G., L.M., C.B., B.L.B.K.); Axe Santé des Populations et pratiques Optimales en Santé (Population Health and Optimal Health Practices Research Unit, and Traumatologie-Urgence-Soins intensifs (Trauma-Emergency-Critical Care Medicine), Centre de Recherche du Centre Hospitalier Universitaire (CHU) de Québec (Hôpital de l'Enfant-Jésus), Québec City, Québec, Canada (L.M., B.L.B.K.); Centre d'Excellence sur le Vieillissement de Québec; and Centre de Recherche du Centre Hospitalier Universitaire (CHU) de Québec (Hépital de l'Enfant-Jésus); and the Département de réadaptation, Faculté de médecine, Université Laval, Québec City, Québec, Canada (M.-J.S.)
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25
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Eagles D, Perry JJ, Sirois MJ, Lang E, Daoust R, Lee J, Griffith L, Wilding L, Neveu X, Emond M. Timed Up and Go predicts functional decline in older patients presenting to the emergency department following minor trauma†. Age Ageing 2017; 46:214-218. [PMID: 28399218 DOI: 10.1093/ageing/afw184] [Citation(s) in RCA: 14] [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: 05/10/2016] [Accepted: 09/27/2016] [Indexed: 11/13/2022] Open
Abstract
Background there is no standardised test for assessing mobility in the Emergency Department (ED). Objective we wished to evaluate the relationship between the Timed Up and Go (TUG) and frailty, functional decline and falls in community dwelling elders that present to the ED following minor trauma. Methods this was a secondary analysis of a prospective cohort study conducted at eight Canadian hospitals. Evaluations included: TUG; Study of Osteoporotic Fractures Frailty Index; Older American Resources and Service Functional Scale; and self-reported falls. Of note, 3- and 6-month follow-up was conducted. Generalised linear model with log-binomial distribution was utilised. Relative risks (RR) and 95% CI were calculated. Results TUG scores were available for 911/2918 patients, mean age 76.2 (SD 7.8) and 57.9% female. There was an association between TUG scores and frailty (P < 0.05) and functional decline at 3 (P < 0.05) and 6 (P < 0.05) months but not self-reported falls. For TUG scores 10-19 seconds, 20-29 seconds and ≥30 seconds, respectively: (i) frailty RR (95% CI): 1.8 (1.3-2.4), 3.0 (2.2-4.2) and 3.7 (2.6-5.1); (ii) functional decline RR (95% CI): 2.7 (1.1-6.4), 5.5 (2.1-14.3) and 8.9 (3.0-25.8); (iii) falls RR (95% CI): 0.9 (0.5-1.5), 1.3 (0.6-2.5) and 1.1 (0.4-3.5). Conclusion in community dwelling elders presenting to the ED following minor trauma, TUG scores were associated with frailty and strongly associated with functional decline at 3 and 6 months post injury. TUG scores were not associated with self-reported falls. Use of the TUG in the ED will help identify frail patients at risk of functional decline.
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Affiliation(s)
- Debra Eagles
- Université Laval, Québec City, Québec, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jeffrey J Perry
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Eddy Lang
- Alberta Health Science Center, Calgary, Alberta, Canada
| | - Raoul Daoust
- Hôpital du Sacre-Coeur de Montreal, Montreal, Québec, Canada
| | - Jacques Lee
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | | | - Laura Wilding
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Xavier Neveu
- Research Center, CHU de Québec, Québec City, Québec, Canada
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26
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Fougère B, Sirois MJ, Carmichael PH, Batomen-Kuimi BL, Chicoulaa B, Escourrou E, Nourhashémi F, Oustric S, Vellas B, Ané S, Baillou-Découard M, Barberan E, Bayart M, Becq JP, Bismuth M, Blanco J, Bourgeois O, Boyer V, Boyer P, Boyes JP, Burguier C, Chicoulaa B, Gendre C, Combier M, Cot S, Dutech M, Escourou B, Gaillard C, Oustric S, Rastrelli JL, Rico B, Souyri JL, Stillmunkes A, Subra J, Vergnes E, Vidal M, Boccalon H, Bouchon L, Delrieu J, Fougère B, Lagourdette C, Nourhashémi F, Pédra M, Rolland Y, Soto M, Vellas B. General Practitioners' Clinical Impression in the Screening for Frailty: Data From the FAP Study Pilot. J Am Med Dir Assoc 2017; 18:193.e1-193.e5. [DOI: 10.1016/j.jamda.2016.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 11/09/2016] [Accepted: 11/09/2016] [Indexed: 02/03/2023]
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27
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Swaine B, Cullen N, Messier F, Bayley M, Lavoie A, Marshall S, Sirois MJ, Turgeon-Fournier A, Lamoureux J, Lam Wai Shun P. Post-acute care referral and inpatient rehabilitation admission criteria for persons with brain injury across two Canadian provinces. Disabil Rehabil 2016; 40:697-704. [DOI: 10.1080/09638288.2016.1262911] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Bonnie Swaine
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Québec, Canada
| | - Nora Cullen
- Toronto Rehabilitation Institute, Ontario, Canada
| | - Frédéric Messier
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Québec, Canada
| | - Mark Bayley
- Toronto Rehabilitation Institute, Ontario, Canada
| | - André Lavoie
- Centre hospitalier affilié universitaire de Québec, Pavillon Enfant-Jésus, Québec, Canada
| | | | - Marie-Josée Sirois
- Centre hospitalier affilié universitaire de Québec, Pavillon Enfant-Jésus, Québec, Canada
| | | | | | - Priscilla Lam Wai Shun
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Québec, Canada
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28
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Tong T, Chignell M, Tierney MC, Sirois MJ, Goldstein J, Émond M, Rockwood K, Lee J. Tablet-Based Frailty Assessments in Emergency Care for Older Adults. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/1541931213601140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The rise in aging populations worldwide places a focus on shifting healthcare needs to match changing demographics. Older adults have a higher risk of becoming frail and losing functional abilities (e.g., walking and bathing) as well as the ability to perform daily activities such as shopping and cooking. Providing care and appropriate interventions to assist older adults with frailty is contingent upon identifying these individuals through effective screening. Frailty is often characterized by self-reports of exhaustion, weakness, slowing, and low physical activity. Older adults at risk of becoming frail often enter the healthcare system through emergency services (e.g., calling 911 or presenting at an emergency department), and screening should target these entry points. This paper discusses the design process, and usability findings associated with a tablet-based battery of frailty measures for assessing functional and cognitive states in elderly adults while being admitted to emergency care. This research is focusing on the use of digital technologies as a medium for physical and mental frailty assessment in emergency care. A diverse group of healthcare users is envisaged including paramedics, physicians, and research personnel, as well as end-users such as elderly patients and their caregivers. We describe the development and usability of the tablet-based frailty assessment system and we report on the concurrent validity of frailty measures.
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Affiliation(s)
| | | | | | - Marie-Josée Sirois
- – Centre Hospitalier Universitaire de Québec, Centre d’Excellence sur le Vieillissement de Québec - CIUSSS
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29
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Abdulaziz KE, Brehaut J, Taljaard M, Émond M, Sirois MJ, Lee JS, Wilding L, Perry JJ. National survey of family physicians to define functional decline in elderly patients with minor trauma. BMC Fam Pract 2016; 17:117. [PMID: 27550226 PMCID: PMC4994293 DOI: 10.1186/s12875-016-0520-1] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 08/16/2016] [Indexed: 01/01/2023]
Abstract
Background Failing to assess elderly patients for functional decline at the time around a minor injury may result in adverse health outcomes. This study was conducted to define what constitutes clinically significant functional decline and the sensitivity required for a clinical decision instrument to identify such functional decline after an injury in previously independent elderly patients. Methods After a thorough development process, a survey questionnaire was administered to a random sample of 178 family physicians. The surveys were distributed using a modified Dillman technique. Results From 143 eligible surveys, we received 67 completed surveys (response rate, 46.9 %). Respondents indicated that a drop of at least 3 points on the 28-point Older Americans Resources and Services (OARS) ADL Scale was considered clinically significant by 90 % of physicians. Ninety percent (90 %) of physicians would be satisfied with a sensitivity of 90 % or more for a clinical decision instrument to detect patients at risk of functional decline at 6 months following an injury. The majority of family physicians do not routinely assess the majority of the tasks on the OARS scale for injured elderly patients. Conclusions A high proportion of physicians (90 %) would consider a drop of 3 points on the OARS ADL Scale as significant to define functional decline and would be satisfied with a sensitivity of 90 % for a clinical decision instrument to detect such a decline. Any instrument to identify patients at elevated risk for subsequent decline should consider these outcome measures to be clinically useful. Electronic supplementary material The online version of this article (doi:10.1186/s12875-016-0520-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kasim E Abdulaziz
- Department of Epidemiology and Community Medicine, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada
| | - Jamie Brehaut
- Department of Epidemiology and Community Medicine, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada
| | - Monica Taljaard
- Department of Epidemiology and Community Medicine, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada
| | - Marcel Émond
- Department of Family and Emergency Medicine, Université Laval, Laval, QC, Canada.,Unité de recherche en traumatologie-urgence-soins intensifs du Centre de recherche FRQ-S du CHA de Québec, Laval, QC, Canada
| | - Marie-Josée Sirois
- Département de réadaptation, Université Laval, Laval, QC, Canada.,Unité de recherche en traumatologie-urgence-soins intensifs du Centre de recherche FRQ-S du CHA de Québec, Laval, QC, Canada
| | - Jacques S Lee
- Department of Emergency Medicine, University of Toronto, Clinical Epidemiology Unit, Sunnybrook Health Sciences Center, Toronto, ON, Canada
| | - Laura Wilding
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Jeffrey J Perry
- Department of Epidemiology and Community Medicine, Ottawa Hospital Research Institute, Ottawa, ON, Canada. .,Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada. .,Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada. .,Epidemiology Program, F6, The Ottawa Hospital, Civic Campus 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada.
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30
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Abdulaziz K, Perry JJ, Taljaard M, Émond M, Lee JS, Wilding L, Sirois MJ, Brehaut J. National Survey of Geriatricians to Define Functional Decline in Elderly People with Minor Trauma. Can Geriatr J 2016; 19:2-8. [PMID: 27076859 PMCID: PMC4815935 DOI: 10.5770/cgj.19.192] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 11/22/2022] Open
Abstract
Background This study was designed to determine a clinically significant point drop in function to define functional decline and the required sensitivity for a clinical decision tool to identify elderly patients at high risk of functional decline following a minor injury. Methods After a rigorous development process, a survey questionnaire was administered to a random sample of 178 geriatricians selected from those registered in a national medical directory. The surveys were distributed using a modified Dillman technique. Results We obtained a satisfactory response rate of 70.5%. Ninety percent of the geriatricians required a sensitivity of 90% or less for a clinical decision tool to identify injured seniors at high risk of functional decline 6 months post injury. Our results indicate that 90% of the respondents considered a drop in function of at least 2 points in activities of daily living (ADL) as clinically significant when considering all 14 ADL items. Considering only the 7 basic ADL items, 90% of physicians considered a 1 point drop as clinically significant. Conclusions A tool with a sensitivity of 90% to detect patients at risk of functional decline at 6 months post minor injury would meet or exceed the sensitivity required by 90% of geriatric specialists. These findings clearly define what is a clinically significant decline following a “minor injury.”
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Affiliation(s)
- Kasim Abdulaziz
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON;; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON
| | - Jeffrey J Perry
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON;; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON;; Department of Emergency Medicine, University of Ottawa, Ottawa, ON
| | - Monica Taljaard
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON;; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON
| | - Marcel Émond
- Department of Family and Emergency Medicine, Université Laval, Laval, QC;; Unité de recherche en traumatologie-urgence-soins intensifs du Centre de recherche FRQ-S du CHA de Québec, Laval, QC
| | - Jacques S Lee
- Department of Emergency Medicine, University of Toronto, Clinical Epidemiology Unit, Sunnybrook Health Sciences Center, Toronto
| | - Laura Wilding
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON
| | - Marie-Josée Sirois
- Département de réadaptation, Université Laval, Laval, QC;; Unité de recherche en traumatologie-urgence-soins intensifs du Centre de recherche FRQ-S du CHA de Québec, Laval, QC
| | - Jamie Brehaut
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON;; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON
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31
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Provencher V, Sirois MJ, Émond M, Perry JJ, Daoust R, Lee JS, Griffith LE, Batomen Kuimi BL, Despeignes LR, Wilding L, Allain-Boulé N, Lebon J. Frail older adults with minor fractures show lower health-related quality of life (SF-12) scores up to six months following emergency department discharge. Health Qual Life Outcomes 2016; 14:40. [PMID: 26956158 PMCID: PMC4782387 DOI: 10.1186/s12955-016-0441-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 02/29/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Minor fractures (e.g. wrist, ankle) are risk factors for lower physical health-related quality of life (HRQoL) in seniors. Recent studies found that measures of frailty were associated with decreased physical and mental HRQoL in older people. As most people with minor fractures go to emergency departments (EDs) for treatment, measuring their frailty status in EDs may help stratify their level of HRQoL post-injury and provide them with appropriate health care and services after discharge. This study thus examines the HRQoL of seniors visiting EDs for minor fractures at 3 and 6 months after discharge, according to their frailty status. METHODS This prospective sub-study was conducted within the larger Canadian Emergency Team Initiative (CETI) cohort. Independent seniors (≥65 years) were recruited in 7 Canadian EDs after treatment for various minor fractures. Frailty status in the ED phase was assessed by the Canadian Study of Health and Aging--Clinical Frailty Scale (CSHA-CFS). The SF-12 questionnaire was completed at 3 and 6 months after ED discharge to ascertain HRQoL. Demographic and clinical data were collected. Linear mixed models were used to test for differences between frailty levels and HRQoL outcomes, controlling for confounding variables and repeated measures over time. RESULTS The sample comprised 334 participants with minor fractures. Prevalence of frailty was as follows: 56.6 % very fit-well; 32.3 % well with treated comorbidities-apparently vulnerable; and 11.1 % mildly-moderately frail. After adjusting for confounding variables, the frailest group showed significantly lower mean HRQoL scores than the fittest group on the physical scale at 3 months (49.3 ± 3.7 vs 60.9 ± 2.0) and 6 months (48.7 ± 3.8 vs 61.1 ± 1.8), as well as on the mental scale at 3 months (59.5 ± 4.4 vs 69.6 ± 1.9). Analyses exploring differences in proportion of patients with HRQoL < 50/100 between the three groups produced similar results. CONCLUSIONS Older adults with minor fractures who were frail had lower physical and mental HRQoL scores at 3 and 6 months after ED discharge than their fittest counterparts. Measuring the frailty status of older adults who suffered a minor fracture in ED might help clinical decision-making at the time of discharge by providing them with appropriate health care and services to improve their HRQoL in the following months.
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Affiliation(s)
- Véronique Provencher
- Université de Sherbrooke, and Centre de recherche sur le vieillissement, Sherbrooke, QC, Canada.
| | - Marie-Josée Sirois
- Université Laval, and Centre de Recherche du CHU de Québec, Quebec, QC, Canada.
| | - Marcel Émond
- Université Laval, and Centre de Recherche du CHU de Québec, Quebec, QC, Canada.
| | - Jeffrey J Perry
- University of Ottawa, and Ottawa Hospital Research Institute, Ottawa, ON, Canada.
| | - Raoul Daoust
- Université de Montréal, and Research Center, Hôpital du Sacré-Cœur de Montréal , Montréal, QC, Canada.
| | - Jacques S Lee
- University of Toronto, and Sunnybrook Health Science Center, Toronto, ON, Canada.
| | | | | | | | - Laura Wilding
- University of Ottawa, and Ottawa Hospital Research Institute, Ottawa, ON, Canada.
| | - Nadine Allain-Boulé
- Université Laval, and Centre de Recherche du CHU de Québec, Quebec, QC, Canada.
| | - Johan Lebon
- Université Laval, and Centre de Recherche du CHU de Québec, Quebec, QC, Canada.
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Provencher V, Généreux M, Gagnon-Roy M, Veillette N, Egan M, Sirois MJ, Lacasse F, Rose K, Stocco S. Preventing avoidable incidents leading to a presentation to the emergency department (ED) by older adults with cognitive impairment: protocol for a scoping review. BMJ Open 2016; 6:e009818. [PMID: 26873049 PMCID: PMC4762095 DOI: 10.1136/bmjopen-2015-009818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 11/23/2015] [Accepted: 12/09/2015] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Older adults with cognitive impairment represent a large portion (21-42%) of people (65+) who consult at an emergency department (ED). Because this sub-group is at higher risk for hospitalisation and mortality following an ED visit, awareness about 'avoidable' incidents should be increased in order to prevent presentations to the ED due to such incidents. This study aims to synthetise the actual knowledge related to 'avoidable' incidents (ie, traumatic injuries, poisoning and other consequences of external causes) (WHO, 2016) leading to ED presentations in older people with cognitive impairment. METHODOLOGY AND ANALYSIS A scoping review will be performed. Scientific and grey literature (1996-2016) will be searched using a combination of key words pertaining to avoidable incidents, ED presentations, older adults and cognitive impairment. A variety of databases (MEDLINE, CINAHL, Ageline, SCOPUS, ProQuest Dissertations/theses, EBM Reviews, Healthstar), online library catalogues, governmental websites and published statistics will be examined. Included sources will pertain to community-dwelling older adults presenting to the ED as a result of an avoidable incident, with the main focus on those with cognitive impairment. Data (eg, type, frequency, severity, circumstances of incidents, preventive measures) will be extracted and analysed using a thematic chart and content analysis. DISCUSSION AND DISSEMINATION This scoping review will provide a picture of the actual knowledge on the subject and identify knowledge gaps in existing literature to be filled by future primary researches. Findings will help stakeholders to develop programmes in order to promote safe and healthy environments and behaviours aimed at reducing avoidable incidents in seniors, especially those with cognitive impairment.
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Affiliation(s)
- Véronique Provencher
- Research Centre on Aging, Eastern Townships Integrated University Centre for Health & Social Services - Sherbrooke Hospital University Centre, Sherbrooke, Québec, Canada
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Mélissa Généreux
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
- Public Health Directory, Eastern Townships Integrated University Centre for Health & Social Services - Sherbrooke Hospital University Centre, Sherbrooke, Québec, Canada
| | - Mireille Gagnon-Roy
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Nathalie Veillette
- Faculty of Medicine, Université de Montreal, Montreal, Québec, Canada
- Research Centre – Institut universitaire de gériatrie de Montréal, Montreal, Québec, Canada
| | - Mary Egan
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Bruyere Institute, Ottawa, Ontario, Canada
| | - Marie-Josée Sirois
- Faculty of Medicine, Université Laval, Quebec city, Québec, Canada
- CHU de Québec Research Center, Quebec city, Québec, Canada
| | - Francis Lacasse
- Research Centre on Aging, Eastern Townships Integrated University Centre for Health & Social Services - Sherbrooke Hospital University Centre, Sherbrooke, Québec, Canada
| | - Kathy Rose
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Stéphanie Stocco
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
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Sirois MJ, Provencher V, Neveu X, Émond M. Response to Canbaz and Colleagues. J Am Geriatr Soc 2016; 64:241-2. [DOI: 10.1111/jgs.13903] [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: 12/01/2022]
Affiliation(s)
- Marie-Josée Sirois
- Faculté de Medicine; Université Laval; Québec Québec Canada
- Centre de Recherche; Centre Hospitalair Universitaire de Québec; Québec Québec Canada
| | | | - Xavier Neveu
- Centre de Recherche; Centre Hospitalair Universitaire de Québec; Québec Québec Canada
| | - Marcel Émond
- Centre de Recherche; Centre Hospitalair Universitaire de Québec; Québec Québec Canada
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Sirois MJ, Griffith L, Perry J, Daoust R, Veillette N, Lee J, Pelletier M, Wilding L, Émond M. Measuring Frailty Can Help Emergency Departments Identify Independent Seniors at Risk of Functional Decline After Minor Injuries. J Gerontol A Biol Sci Med Sci 2015; 72:68-74. [PMID: 26400735 DOI: 10.1093/gerona/glv152] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [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: 12/01/2014] [Accepted: 08/04/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND This study aims to (i) describe frailty in the subgroup of independent community-dwelling seniors consulting emergency departments (EDs) for minor injuries, (ii) examine the association between frailty and functional decline 3 months postinjury, (iii) ascertain the predictive accuracy of frailty measures and emergency physicians' for functional decline. METHOD Prospective cohort in 2011-2013 among 1,072 seniors aged 65 years or older, independent in basic daily activities, evaluated in Canadian EDs for minor injuries.Frailty was assessed at EDs using the Canadian Study of Health and Aging-Clinical Frailty scale (CSHA-CFS) and the Study of Osteoporotic Fracture frailty index (SOF). Functional decline was defined as a loss ≥2/28 on the Older American Resources Services scale 3 months postinjury. Generalized mixed models were used to explore differences in functional decline across frailty levels. Areas under the receiver operating characteristic curve were used to ascertain the predictive accuracy of frailty measures and emergency physicians' clinical judgment. RESULTS The SOF and CSHA-CFS were available in 342 and 1,058 participants, respectively. The SOF identified 55.6%, 32.7%, 11.7% patients as robust, prefrail, and frail. These CSHA-CFS (n = 1,058) proportions were 51.9%, 38.3%, and 9.9%. The 3-month incidence of functional decline was 12.1% (10.0%-14.6%). The Areas under the receiver operating characteristic curves of the CSHA-CFS and the emergency physicians' were similar (0.548-0.777), while the SOF was somewhat higher (0.704-0.859). CONCLUSION Measuring frailty in community-dwelling seniors with minor injuries in EDs may enhance current risk screening for functional decline. However, before implementation in usual care, feasibility issues such as inter-rater reliability and acceptability of frailty tools in the EDs have to be addressed.
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Affiliation(s)
- Marie-Josée Sirois
- Centre d'excellence sur le vieillissement de Québec, Québec, Canada. .,Département de réadaptation, Université Laval, Québec, Canada
| | - Lauren Griffith
- Department of Clinical Epidemilogy & Biostatistics, McMaster University, Hamilton, Canada
| | - Jeffrey Perry
- Emergency Department, Ottawa Hospital Research Institute, Canada
| | - Raoul Daoust
- Départment d'urgence, Hôpital du Sacré-Coeur de Montréal, Canada
| | | | - Jacques Lee
- Emergency Department, Sunnybrooke Health Sciences Center, Toronto, Canada
| | | | - Laura Wilding
- Emergency Department, Ottawa Hospital Research Institute, Canada
| | - Marcel Émond
- Centre d'excellence sur le vieillissement de Québec, Québec, Canada.,Département de médecine familiale et de médecine d'urgence, Université Laval, Québec, Canada
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Provencher V, Sirois MJ, Ouellet MC, Camden S, Neveu X, Allain-Boulé N, Emond M. Decline in Activities of Daily Living After a Visit to a Canadian Emergency Department for Minor Injuries in Independent Older Adults: Are Frail Older Adults with Cognitive Impairment at Greater Risk? J Am Geriatr Soc 2015; 63:860-8. [DOI: 10.1111/jgs.13389] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Véronique Provencher
- Department of Rehabilitation; Université Laval; Québec Québec Canada
- Centre de recherche du CHU de Québec; Axe Santé des Populations-Pratiques Optimales en Santé; Québec Québec Canada
| | - Marie-Josée Sirois
- Department of Rehabilitation; Université Laval; Québec Québec Canada
- Centre de recherche du CHU de Québec; Axe Santé des Populations-Pratiques Optimales en Santé; Québec Québec Canada
| | - Marie-Christine Ouellet
- Centre de recherche du CHU de Québec; Axe Santé des Populations-Pratiques Optimales en Santé; Québec Québec Canada
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale; Institut de Réadaptation en Déficience Physique de Québec; Québec Québec Canada
| | - Stéphanie Camden
- Centre de recherche du CHU de Québec; Axe Santé des Populations-Pratiques Optimales en Santé; Québec Québec Canada
| | - Xavier Neveu
- Centre de recherche du CHU de Québec; Axe Santé des Populations-Pratiques Optimales en Santé; Québec Québec Canada
| | - Nadine Allain-Boulé
- Centre de recherche du CHU de Québec; Axe Santé des Populations-Pratiques Optimales en Santé; Québec Québec Canada
| | - Marcel Emond
- Centre de recherche du CHU de Québec; Axe Santé des Populations-Pratiques Optimales en Santé; Québec Québec Canada
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Abdulaziz K, Brehaut J, Taljaard M, Émond M, Sirois MJ, Lee JS, Wilding L, Perry JJ. National survey of physicians to determine the effect of unconditional incentives on response rates of physician postal surveys. BMJ Open 2015; 5:e007166. [PMID: 25694460 PMCID: PMC4336460 DOI: 10.1136/bmjopen-2014-007166] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Physicians are a commonly targeted group in health research surveys, but their response rates are often relatively low. The goal of this paper was to evaluate the effect of unconditional incentives in the form of a coffee card on physician postal survey response rates. DESIGN Following 13 key informant interviews and eight cognitive interviews a survey questionnaire was developed. PARTICIPANTS A random sample of 534 physicians, stratified by physician group (geriatricians, family physicians, emergency physicians) was selected from a national medical directory. SETTING Using computer generated random numbers; half of the physicians in each stratum were allocated to receive a coffee card to a popular national coffee chain together with the first survey mailout. INTERVENTIONS The intervention was a $10 Tim Hortons gift card given to half of the physicians who were randomly allocated to receive the incentive. RESULTS 265 (57.0%) physicians completed the survey. The response rate was significantly higher in the group allocated to receive the incentive (62.7% vs 51.3% in the control group; p=0.01). CONCLUSIONS Our results indicate that an unconditional incentive in the form of a coffee gift card can substantially improve physician response rates. Future research can look at the effect of varying amounts of cash on the gift cards on response rates.
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Affiliation(s)
- Kasim Abdulaziz
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Jamie Brehaut
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Monica Taljaard
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Marcel Émond
- Department of Family and Emergency Medicine, Université Laval, Laval, Quebec, Canada
- Unité de recherche en traumatologie-urgence-soins intensifs du Centre de recherche FRQ-S du CHA de Québec, Laval, Quebec, Canada
| | - Marie-Josée Sirois
- Unité de recherche en traumatologie-urgence-soins intensifs du Centre de recherche FRQ-S du CHA de Québec, Laval, Quebec, Canada
- Département de réadaptation, Université Laval, Laval, Quebec, Canada
| | - Jacques S Lee
- Clinical Epidemiology Unit, Department of Emergency Medicine, University of Toronto, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Laura Wilding
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jeffrey J Perry
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Ouellet MC, Sirois MJ, Beaulieu-Bonneau S, Morin J, Perry J, Daoust R, Wilding L, Provencher V, Camden S, Allain-Boulé N, Émond M. Is cognitive function a concern in independent elderly adults discharged home from the emergency department in Canada after a minor injury? J Am Geriatr Soc 2014; 62:2130-5. [PMID: 25366657 DOI: 10.1111/jgs.13081] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To describe the cognitive functioning of independent community-dwelling elderly adults visiting the emergency department (ED) for minor injuries and at 3- and 6-month follow-up assessments and to document the occurrence of falls, return to the ED, and hospital visits over time according to cognitive level. DESIGN Prospective cohort study. SETTING Three Canadian EDs. PARTICIPANTS Individuals aged 65 and older who were independent in basic activities of daily living, visiting the ED for minor injuries, and discharged home within 48 hours (N = 320). MEASUREMENTS Participants completed the Montreal Cognitive Assessment (MoCA). New falls involving pain and ED or hospital visits were documented at 3 and 6 months. RESULTS At baseline, 62.4% of participants scored below the recommended cutoff of 26 on the MoCA, suggesting cognitive dysfunction, and 22.9% scored below a more-stringent cutoff of 21. MoCA scores had improved significantly at 3 and 6 months. Items showing the most improvement were delayed recall and verbal fluency. Persons with MoCA scores of less than 21 reported significantly more new falls and hospital visits 3 to 6 months after injury. CONCLUSION Cognition is not optimal in many community-dwelling elderly adults visiting an ED for a minor injury, which may affect their capacity to comprehend, recall, and adhere to medical recommendations after their injury and put them at risk of further negative health events such as falls.
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Affiliation(s)
- Marie-Christine Ouellet
- Unité de recherche en traumatologie- urgence- soins intensifs, Axe de Recherche en Santé des Populations et Pratiques Optimales en Santé, Centre de recherche du Centre Hospitalier Universitaire de Québec, Québec, Québec, Canada; Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Québec, Québec, Canada; School of Psychology, Université Laval, Québec, Québec, Canada
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Sirois MJ, Émond M, Ouellet MC, Perry J, Daoust R, Morin J, Dionne C, Camden S, Moore L, Allain-Boulé N. Cumulative Incidence of Functional Decline After Minor Injuries in Previously Independent Older Canadian Individuals in the Emergency Department. J Am Geriatr Soc 2013; 61:1661-8. [DOI: 10.1111/jgs.12482] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Marie-Josée Sirois
- Department of Rehabilitation; Université Laval; Québec Canada
- Centre de Recherche and Centre Hospitalier Universitaire de Québec; Québec Canada
| | - Marcel Émond
- Centre de Recherche and Centre Hospitalier Universitaire de Québec; Québec Canada
- Hôpital Enfant-Jésus; Centre Hospitalier Universitaire de Québec; Québec Canada
| | - Marie-Christine Ouellet
- Centre de Recherche and Centre Hospitalier Universitaire de Québec; Québec Canada
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale; Institut de Réadaptation en Déficience Physique de Québec; Québec Canada
| | | | - Raoul Daoust
- Hôpital du Sacré-Cœur de Montréal; Montreal Canada
| | - Jacques Morin
- Hôpital Enfant-Jésus; Centre Hospitalier Universitaire de Québec; Québec Canada
| | - Clermont Dionne
- Department of Rehabilitation; Université Laval; Québec Canada
- Centre de Recherche and Centre Hospitalier Universitaire de Québec; Québec Canada
| | - Stéphanie Camden
- Centre de Recherche and Centre Hospitalier Universitaire de Québec; Québec Canada
| | - Lynne Moore
- Centre de Recherche and Centre Hospitalier Universitaire de Québec; Québec Canada
| | - Nadine Allain-Boulé
- Centre de Recherche and Centre Hospitalier Universitaire de Québec; Québec Canada
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Lamontagne ME, Poncet F, Careau E, Sirois MJ, Boucher N. Life habits performance of individuals with brain injury in different living environments. Brain Inj 2013; 27:135-44. [PMID: 23384212 DOI: 10.3109/02699052.2012.722253] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Little is known about variations in social participation among individuals with traumatic brain injury (TBI) living in different environments. OBJECTIVE To examine the social participation of individuals with moderate-to-severe TBI across various living arrangements. METHODS One hundred and thirty-six individuals with moderate-to-severe TBI, living either in natural settings (e.g. home), intermediate settings (e.g. group homes or foster families) or structured settings (e.g. nursing home or long-term care facilities) and requiring daily assistance, were interviewed using the LIFE-H tool, which measures the level of difficulty and the assistance required to carry out life habits and resulting social participation. Participation in six categories of life habits pertaining to Activities of Daily Living and five categories pertaining to Social Roles were examined. RESULTS The level of difficulty and the assistance required to carry out the life habits and the overall level of social participation were associated with living arrangements. Participation scores in Activities of Daily Living varied across living arrangements while Social Roles scores did not. CONCLUSION Living arrangements (such as intermediate settings) may better support social participation in individuals with TBI. There is a need to further study the issue of living arrangements as they seem to facilitate the performance of life habits, which impacts the social participation of individuals with TBI.
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Affiliation(s)
- Marie-Eve Lamontagne
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Québec, Canada.
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Moore L, Lavoie A, Sirois MJ, Amini R, Belcaïd A, Sampalis JS. Evaluating trauma center process performance in an integrated trauma system with registry data. J Emerg Trauma Shock 2013; 6:95-105. [PMID: 23723617 PMCID: PMC3665078 DOI: 10.4103/0974-2700.110754] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [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: 03/09/2012] [Accepted: 06/04/2012] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The evaluation of trauma center performance implies the use of indicators that evaluate clinical processes. Despite the availability of routinely collected clinical data in most trauma systems, quality improvement efforts are often limited to hospital-based audit of adverse patient outcomes. OBJECTIVE To identify and evaluate a series of process performance indicators (PPI) that can be calculated using routinely collected trauma registry data. MATERIALS AND METHODS PPI were identified using a review of published literature, trauma system documentation, and expert consensus. Data from the 59 trauma centers of the Quebec trauma system (1999, 2006; N = 99,444) were used to calculate estimates of conformity to each PPI for each trauma center. Outliers were identified by comparing each center to the global mean. PPI were evaluated in terms of discrimination (between-center variance), construct validity (correlation with designation level and patient volume), and forecasting (correlation over time). RESULTS Fifteen PPI were retained. Global proportions of conformity ranged between 6% for reduction of a major dislocation within 1 h and 97% for therapeutic laparotomy. Between-center variance was statistically significant for 13 PPI. Five PPI were significantly associated with designation level, 7 were associated with volume, and 11 were correlated over time. CONCLUSION In our trauma system, results suggest that a series of 15 PPI supported by literature review or expert opinion can be calculated using routinely collected trauma registry data. We have provided evidence of their discrimination, construct validity, and forecasting properties. The between-center variance observed in this study highlights the importance of evaluating process performance in integrated trauma systems.
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Affiliation(s)
- Lynne Moore
- Department of Social and Preventative Medicine, Québec (Qc), Canada
- Unité de traumatologie-urgence-soins intensifs, Centre de Recherche du CHA (Hôpital de l’Enfant-Jésus), Québec (Qc), Canada
| | - André Lavoie
- Unité de traumatologie-urgence-soins intensifs, Centre de Recherche du CHA (Hôpital de l’Enfant-Jésus), Québec (Qc), Canada
| | - Marie-Josée Sirois
- Unité de traumatologie-urgence-soins intensifs, Centre de Recherche du CHA (Hôpital de l’Enfant-Jésus), Québec (Qc), Canada
- Department of Rehabilitation, Laval University, Québec (Qc), Canada
| | - Rachid Amini
- Unité de traumatologie-urgence-soins intensifs, Centre de Recherche du CHA (Hôpital de l’Enfant-Jésus), Québec (Qc), Canada
| | - Amina Belcaïd
- Unité de traumatologie-urgence-soins intensifs, Centre de Recherche du CHA (Hôpital de l’Enfant-Jésus), Québec (Qc), Canada
| | - John S Sampalis
- McGill University Health Centre, Montréal, Québec (Qc), Canada
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Moore L, Lavoie A, Sirois MJ, Swaine B, Murat V, Sage NL, Emond M. Evaluating trauma center structural performance: The experience of a Canadian provincial trauma system. J Emerg Trauma Shock 2013; 6:3-10. [PMID: 23492970 PMCID: PMC3589856 DOI: 10.4103/0974-2700.106318] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [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: 03/14/2012] [Accepted: 04/08/2012] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Indicators of structure, process, and outcome are required to evaluate the performance of trauma centers to improve the quality and efficiency of care. While periodic external accreditation visits are part of most trauma systems, a quantitative indicator of structural performance has yet to be proposed. The objective of this study was to develop and validate a trauma center structural performance indicator using accreditation report data. MATERIALS AND METHODS Analyses were based on accreditation reports completed during on-site visits in the Quebec trauma system (1994-2005). Qualitative report data was retrospectively transposed onto an evaluation grid and the weighted average of grid items was used to quantify performance. The indicator of structural performance was evaluated in terms of test-retest reliability (kappa statistic), discrimination between centers (coefficient of variation), content validity (correlation with accreditation decision, designation level, and patient volume) and forecasting (correlation between visits performed in 1994-1999 and 1998-2005). RESULTS Kappa statistics were >0.8 for 66 of the 73 (90%) grid items. Mean structural performance score over 59 trauma centers was 47.4 (95% CI: 43.6-51.1). Two centers were flagged as outliers and the coefficient of variation was 31.2% (95% CI: 25.5% to 37.6%), showing good discrimination. Correlation coefficients of associations with accreditation decision, designation level, and volume were all statistically significant (r = 0.61, -0.40, and 0.24, respectively). No correlation was observed over time (r = 0.03). CONCLUSION This study demonstrates the feasibility of quantifying trauma center structural performance using accreditation reports. The proposed performance indicator shows good test-retest reliability, between-center discrimination, and construct validity. The observed variability in structural performance across centers and over-time underlines the importance of evaluating structural performance in trauma systems at regular intervals to drive quality improvement efforts.
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Affiliation(s)
- Lynne Moore
- Department of Social and Preventive Medicine, Laval University, Quebec (Qc), Canada ; Unité de Traumatologie-urgence-soins Intensifs, Center de Recherche du CHA (Hôpital de l'Enfant-Jésus), Laval University, Quebec (Qc), Canada
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Moore L, Turgeon AF, Sirois MJ, Lavoie A. Trauma centre outcome performance: a comparison of young adults and geriatric patients in an inclusive trauma system. Injury 2012; 43:1580-5. [PMID: 21382620 DOI: 10.1016/j.injury.2011.02.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [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: 01/11/2011] [Accepted: 02/14/2011] [Indexed: 02/02/2023]
Abstract
BACKGROUND Elderly trauma patients represent a unique clientele requiring specialised care but they rarely benefit from standardised care strategies within trauma systems. We aimed to evaluate whether trauma centres with lower/higher than expected mortality amongst patients <65 years of age have similar results for geriatric patients. A secondary objective was to compare transfer to level I/II trauma centres across age groups. METHODS The study was based on data from a Canadian provincial trauma registry (1999-2006). Outcome performance was evaluated with estimates of risk-adjusted 30-day mortality generated for each of the system's 57 adult trauma centres. Agreement in performance results was evaluated with correlation coefficients. RESULTS The study sample comprised 55,283 young adults (3.5% mortality) and 30,960 geriatric patients (8.2% mortality). The two age groups only had one out of six outliers in common. Hospital ranks amongst young adults were not correlated to those assigned amongst geriatric patients (r = 0.01, 95%CI -0.25;0.27). Correlation was also low for patients with major trauma (r = 0.20, 95%CI -0.06;0.44). Amongst patients with severe head injuries initially received in a level III/IV centre, 81% of young adults versus 71% of geriatric patients were transferred to a level I/II centre (p<0.0001). CONCLUSIONS Trauma centres that have low risk-adjusted mortality for young adults do not necessarily do so for geriatric patients. In addition, geriatric patients with severe head injuries are less likely to be treated in neurosurgical trauma centres. Further research is needed to identify determinants of inter-hospital variation in outcome for geriatric trauma patients.
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Affiliation(s)
- Lynne Moore
- Unite de Traumatologie-Urgence-Soins Intensifs, Centre de Recherche du CHA, Hôpital de l'Enfant-Jésus, Université Laval, Quebec City, Quebec, Canada.
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Amini R, Lavoie A, Moore L, Sirois MJ, Emond M. Pediatric trauma mortality by type of designated hospital in a mature inclusive trauma system. J Emerg Trauma Shock 2011; 4:12-9. [PMID: 21633561 PMCID: PMC3097560 DOI: 10.4103/0974-2700.76824] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [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: 12/15/2009] [Accepted: 09/06/2010] [Indexed: 11/22/2022] Open
Abstract
Background: Previous studies have shown divergent results regarding the survival of injured children treated at pediatric trauma centers (PTC) and adult trauma centers (ATC). Aims: (1) To document, in a regionalized inclusive trauma system, at which level of trauma centers were the injured children treated and (2) to compare the in-hospital mortality over five levels of trauma care, ranging from pediatric level I trauma centers (PTC) to designated local trauma hospitals (level IV) for the whole study sample and for subgroups of severely injured children and head trauma. Materials and Methods: A retrospective analysis included data on 11,053 injured children (age ≤16 years) treated between April 1998 and March 2005 in 58 designated trauma hospitals in the province of Quebec, Canada. Multiple imputation was used to handle missing physiological data and multivariate logistic regression was used to compare mortality over levels of care. Results: PTC treated 52.2% of the children. Children treated at PTC were more often transferred from another hospital (73%) and were more severely injured. ATC level I, II, III and IV centers treated, respectively, 3.0%, 16.2%, 24.3% and 4.3% of children. Compared with children treated at a PTC, the risk of mortality was higher for children treated at each other ATC, i.e. level I (adjusted odds ratio [OR] = 3.1; 95% confidence interval [CI]: 1.3–7.5), level II (OR = 2.5; 95% CI: 1.3–5.0), level III (OR = 5.2; 95% CI: 2.1–13.1) and level IV (OR = 9.9; 95% CI: 2.4–41.3). Similar findings were observed among the subsamples of children who were more severely injured (Injury Severity Score >15) and who sustained head injuries. Conclusions: In our trauma system, PTC cared for more than half of the injured children and patients treated there have better survival than those treated at all other levels of ATC.
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Affiliation(s)
- Rachid Amini
- Unit of Traumatology, Emergency Medicine and Intensive Care, Research Centre of CHA (Enfant-Jésus Hospital), Quebec (QC), Canada
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Ouellet MC, Sirois MJ, Vaillancourt J, Lavoie A, Sampalis JS. Article 16: Long-term Levels of Depression, Anxiety, Perceived Stress and Social Support in Survivors of Traumatic Injuries With and Without Head Injury: A Comparison With Surgical Controls. Arch Phys Med Rehabil 2009. [DOI: 10.1016/j.apmr.2009.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sirois MJ, Lecours A, Ouellet MC. Poster 43: Elderly Traumatic Brain Injury Survivors Requiring Rehabilitation in Quebec: Who Are They, What Services Do They Need, Where Do They Go After Rehabilitation? Arch Phys Med Rehabil 2009. [DOI: 10.1016/j.apmr.2009.08.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sirois MJ, Lecours A, Ouellet MC. Poster 42: Long-Term Outcomes After a Traumatic Brain Injury Among Older Adults in Quebec. Arch Phys Med Rehabil 2009. [DOI: 10.1016/j.apmr.2009.08.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ouellet MC, Sirois MJ, Lavoie A. Perceived mental health and needs for mental health services following trauma with and without brain injury. J Rehabil Med 2009; 41:179-86. [DOI: 10.2340/16501977-0306] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Abstract
OBJECTIVES To conduct a population-based survey among trauma survivors on accessibility to rehabilitation services in metropolitan, urban, and rural areas in Quebec (Canada), we attempted to use trauma registries as a sampling frame of subjects discharged to rehabilitation. Discharge destinations were inaccurate in many registries, preventing straightforward identification of the survey subjects. Using the best registry data, we aimed to identify predictors of rehabilitation discharge and to use them to specify a reliable sampling frame for the survey. DESIGN A logistic predictive model of rehabilitation discharge was developed. This model was applied to data from metropolitan, urban, and rural trauma centers to identify all subjects predicted to be discharged to a rehabilitation facility. RESULTS Age, acute-care length of stay, injury-severity score, lower-limb injuries, and seven other predictors were included in the model that generated an area under the ROC curve (AUC) of 0.83 and a classification accuracy of 76.6%. The metropolitan, urban, and rural frames were slightly different. They included, respectively, 808, 798, and 929 subjects. CONCLUSIONS The procedure helped us bypass largely inaccurate data from trauma registries. The sampling frames reflected severely injured trauma survivors who were likely to have been referred to postacute rehabilitation.
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Affiliation(s)
- Marie-Josée Sirois
- Research Center of the Centre hospitalier affilié universitaire de Québec, Quebec City, Canada
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Sirois MJ, Lavoie A, Dionne CE. Poster 3. Arch Phys Med Rehabil 2005. [DOI: 10.1016/j.apmr.2005.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
OBJECTIVE To measure the effect on rehabilitation outcomes of administrative delays in transferring patients from a level I trauma center to inpatient rehabilitation. DESIGN Retrospective cohort study. SETTINGS Level I trauma center and an inpatient rehabilitation center in Quebec, Canada. PARTICIPANTS A total of 289 patients with severe trauma admitted to inpatient rehabilitation from a level I trauma center between 1994 and 1999. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Length of stay (LOS) in rehabilitation, motor and cognitive function at discharge from rehabilitation, interruptions in rehabilitation, and disposition at discharge. RESULTS Shorter administrative delays were associated with shorter rehabilitation LOS (P<.01) improved cognitive function (P=.02) and had a negative but statistically nonsignificant association with motor function at discharge. No effect was observed for rehabilitation interruptions or dispositions at discharge. CONCLUSIONS Transferring trauma patients more quickly to inpatient rehabilitation can affect rehabilitation outcomes positively. It can also lead to an economy of resource use in both acute and rehabilitation settings.
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Affiliation(s)
- Marie-Josée Sirois
- Research Center, Laval University Affiliated Hospitals, Laval University, Quebec City, QC, Canada.
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