1
|
Corbeil O, Anderson É, Béchard L, Desmeules C, Huot-Lavoie M, Bachand L, Brodeur S, Carmichael PH, Jacques C, Solmi M, Giroux I, Dorval M, Demers MF, Roy MA. Problem gambling in psychotic disorders: A systematic review and meta-analysis of prevalence. Acta Psychiatr Scand 2024. [PMID: 38566334 DOI: 10.1111/acps.13686] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Problem gambling (PBG) is more common in people with mental health disorders, including substance use, bipolar, and personality disorders, than in the general population. Although individuals with psychotic disorders might be expected to be more vulnerable to PBG, fewer studies have focused on this comorbidity. The aim of this review was to estimate the prevalence of PBG in people with psychotic disorders. METHODS Medline (Ovid), EMBASE, PsycINFO (Ovid), CINAHL, CENTRAL, Web of science, and ProQuest were searched on November 1, 2023, without language restrictions. Observational and experimental studies including individuals with psychotic disorders and reporting the prevalence of PBG were included. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal for systematic reviews of prevalence data. The pooled prevalence of PBG was calculated using a fixed effects generalized linear mixed model and presented through forest plots. RESULTS Of 1271 records screened, 12 studies (n = 3443) were included. The overall prevalence of PBG was 8.7% (95% CI = 7.8%-9.7%, I2 = 69%). A lower prevalence was found in studies with a low risk of bias (5.6%; 95% CI = 4.4%-7.0%) compared with studies with a moderate risk of bias (10.4%; 95% CI = 9.2%-11.7%). Different methods used to assess PBG also contributed to the heterogeneity found. CONCLUSION This meta-analysis found substantial heterogeneity, partly due to the risk of bias of the included studies and a lack of uniformity in PBG assessment. Although more research is needed to identify those at increased risk for PBG, its relatively high prevalence warrants routine screening for gambling in clinical practice.
Collapse
Affiliation(s)
- Olivier Corbeil
- Faculty of Pharmacy, Université Laval, Quebec, Quebec, Canada
- Quebec Mental Health University Institute, Quebec, Quebec, Canada
- CERVO Brain Research Centre, Quebec, Quebec, Canada
| | - Élizabeth Anderson
- CERVO Brain Research Centre, Quebec, Quebec, Canada
- School of Psychology, Université Laval, Quebec, Quebec, Canada
| | - Laurent Béchard
- Faculty of Pharmacy, Université Laval, Quebec, Quebec, Canada
- Quebec Mental Health University Institute, Quebec, Quebec, Canada
- CERVO Brain Research Centre, Quebec, Quebec, Canada
| | - Charles Desmeules
- CERVO Brain Research Centre, Quebec, Quebec, Canada
- Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
| | - Maxime Huot-Lavoie
- CERVO Brain Research Centre, Quebec, Quebec, Canada
- Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
| | | | - Sébastien Brodeur
- Quebec Mental Health University Institute, Quebec, Quebec, Canada
- CERVO Brain Research Centre, Quebec, Quebec, Canada
- Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Christian Jacques
- School of Psychology, Université Laval, Quebec, Quebec, Canada
- Centre Québécois d'Excellence pour la Prévention et le Traitement du Jeu, Quebec, Quebec, Canada
| | - Marco Solmi
- SCIENCES Lab, Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
- Regional Centre for the Treatment of Eating Disorders and On Track: The Champlain First Episode Psychosis Program, Department of Mental Health, The Ottawa Hospital, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program, University of Ottawa, Ottawa, Ontario, Canada
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Isabelle Giroux
- School of Psychology, Université Laval, Quebec, Quebec, Canada
- Centre Québécois d'Excellence pour la Prévention et le Traitement du Jeu, Quebec, Quebec, Canada
| | - Michel Dorval
- Faculty of Pharmacy, Université Laval, Quebec, Quebec, Canada
- CHU de Québec - Université Laval Research Centre, Quebec, Quebec, Canada
| | - Marie-France Demers
- Faculty of Pharmacy, Université Laval, Quebec, Quebec, Canada
- Quebec Mental Health University Institute, Quebec, Quebec, Canada
- CERVO Brain Research Centre, Quebec, Quebec, Canada
| | - Marc-André Roy
- Quebec Mental Health University Institute, Quebec, Quebec, Canada
- CERVO Brain Research Centre, Quebec, Quebec, Canada
- Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
| |
Collapse
|
2
|
Lessard-Roy A, Marchand R, Lemieux P, Masse M, Lacerte A, Carmichael PH, Laurin D. Immune checkpoint inhibitors and risk of immune-mediated adverse events: a cohort study comparing extended versus standard interval administration. Clin Exp Med 2024; 24:40. [PMID: 38386053 PMCID: PMC10884063 DOI: 10.1007/s10238-024-01301-7] [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: 07/20/2023] [Accepted: 01/19/2024] [Indexed: 02/23/2024]
Abstract
The COVID-19 pandemic precipitated the implementation of extended interval immune checkpoint inhibitors (ICIs) in an effort to limit hospital visits, but few studies have examined their safety. This study aimed to compare in oncology outpatients, immune-mediated adverse events (IMAEs) in terms of total number, incidence, severity, and time to occurrence, based on exposure to standard or extended interval ICIs. A retrospective cohort study was conducted in patients who received at least one dose of an ICI between 2015 and 2021. Data were collected from patient records and pharmacy software. Adjusted logistic, Poisson, and Cox regression models were estimated. A total of 310 patients with a mean age of 67.1 years were included, 130 of whom had the extended interval. No statistically significant differences were observed between the groups. With the standard and extended intervals, the mean total number of IMAE per participant was 1.02 and 1.18, respectively; the incidence of an IMAE was 62% and 64%. Of the 147 IMAE episodes in the standard interval group, 14 (9.5%) were grade 3 or higher, while there were 15 (12.4%) among the 121 IMAE episodes in the extended interval group. Compared with standard interval, the use of extended interval did not increase the risk of having a first IMAE (adjusted hazard ratio 0.92 (95% CI 0.67-1.26)). This study suggests that the administration of an ICI according to extended interval is as safe as the administration according to standard interval in oncology outpatients.
Collapse
Affiliation(s)
- Amélia Lessard-Roy
- Faculté de Pharmacie, Université Laval, Québec, QC, Canada
- Département de Pharmacie, Hôpital Sainte-Croix, Centre Intégré Universitaire de Santé et de Services Sociaux de la Mauricie-et-du-Centre-du-Québec, Drummondville, Canada
| | - Roxanne Marchand
- Faculté de Pharmacie, Université Laval, Québec, QC, Canada
- Département de Pharmacie, Centre Hospitalier Affilié Universitaire Régional de Trois-Rivières, Centre Intégré Universitaire de Santé et de Services Sociaux de la Mauricie-et-du-Centre-du-Québec, 1991 Boul. du Carmel, Trois-Rivières, QC, G8Z 3R9, Canada
| | - Pierre Lemieux
- Faculté de Pharmacie, Université Laval, Québec, QC, Canada.
- Département de Pharmacie, Centre Hospitalier Affilié Universitaire Régional de Trois-Rivières, Centre Intégré Universitaire de Santé et de Services Sociaux de la Mauricie-et-du-Centre-du-Québec, 1991 Boul. du Carmel, Trois-Rivières, QC, G8Z 3R9, Canada.
| | - Mélanie Masse
- Faculté de Pharmacie, Université Laval, Québec, QC, Canada
- Département de Pharmacie, Centre Hospitalier Affilié Universitaire Régional de Trois-Rivières, Centre Intégré Universitaire de Santé et de Services Sociaux de la Mauricie-et-du-Centre-du-Québec, 1991 Boul. du Carmel, Trois-Rivières, QC, G8Z 3R9, Canada
| | | | - Pierre-Hugues Carmichael
- Faculté de Pharmacie, Université Laval, Québec, QC, Canada
- Centre d'excellence sur le Vieillissement de Québec, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale Nationale, Québec, Canada
| | - Danielle Laurin
- Faculté de Pharmacie, Université Laval, Québec, QC, Canada
- Centre d'excellence sur le Vieillissement de Québec, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale Nationale, Québec, Canada
| |
Collapse
|
3
|
O’Keefe JH, Tintle NL, Harris WS, O’Keefe EL, Sala-Vila A, Attia J, Garg GM, Hure A, Bork CS, Schmidt EB, Venø SK, Chien KL, Chen YY(A, Egert S, Feldreich TR, Ärnlöv J, Lind L, Forouhi NG, Geleijnse JM, Pertiwi K, Imamura F, de Mello Laaksonen V, Uusitupa WM, Tuomilehto J, Laakso M, Lankinen MA, Laurin D, Carmichael PH, Lindsay J, Leander K, Laguzzi F, Swenson BR, Longstreth WT, Manson JE, Mora S, Cook NR, Marklund M, van Lent DM, Murphy R, Gudnason V, Ninomiya T, Hirakawa Y, Qian F, Sun Q, Hu F, Ardisson Korat AV, Risérus U, Lázaro I, Samieri C, Le Goff M, Helmer C, Steur M, Voortman T, Ikram MK, Tanaka T, Das JK, Ferrucci L, Bandinelli S, Tsai M, Guan W, Garg P, Verschuren WMM, Boer JMA, Biokstra A, Virtanen J, Wagner M, Westra J, Albuisson L, Yamagishi K, Siscovick DS, Lemaitre RN, Mozaffarian D. Omega-3 Blood Levels and Stroke Risk: A Pooled and Harmonized Analysis of 183 291 Participants From 29 Prospective Studies. Stroke 2024; 55:50-58. [PMID: 38134264 PMCID: PMC10840378 DOI: 10.1161/strokeaha.123.044281] [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: 06/22/2023] [Accepted: 10/30/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND The effect of marine omega-3 PUFAs on risk of stroke remains unclear. METHODS We investigated the associations between circulating and tissue omega-3 PUFA levels and incident stroke (total, ischemic, and hemorrhagic) in 29 international prospective cohorts. Each site conducted a de novo individual-level analysis using a prespecified analytical protocol with defined exposures, covariates, analytical methods, and outcomes; the harmonized data from the studies were then centrally pooled. Multivariable-adjusted HRs and 95% CIs across omega-3 PUFA quintiles were computed for each stroke outcome. RESULTS Among 183 291 study participants, there were 10 561 total strokes, 8220 ischemic strokes, and 1142 hemorrhagic strokes recorded over a median of 14.3 years follow-up. For eicosapentaenoic acid, comparing quintile 5 (Q5, highest) with quintile 1 (Q1, lowest), total stroke incidence was 17% lower (HR, 0.83 [CI, 0.76-0.91]; P<0.0001), and ischemic stroke was 18% lower (HR, 0.82 [CI, 0.74-0.91]; P<0.0001). For docosahexaenoic acid, comparing Q5 with Q1, there was a 12% lower incidence of total stroke (HR, 0.88 [CI, 0.81-0.96]; P=0.0001) and a 14% lower incidence of ischemic stroke (HR, 0.86 [CI, 0.78-0.95]; P=0.0001). Neither eicosapentaenoic acid nor docosahexaenoic acid was associated with a risk for hemorrhagic stroke. These associations were not modified by either baseline history of AF or prevalent CVD. CONCLUSIONS Higher omega-3 PUFA levels are associated with lower risks of total and ischemic stroke but have no association with hemorrhagic stroke.
Collapse
Affiliation(s)
- James H O’Keefe
- Saint Luke’s Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO
| | | | - William S Harris
- Fatty Acid Research Institute, Sioux Falls, SD
- University of South Dakota, Sioux Falls, SD
| | - Evan L O’Keefe
- Saint Luke’s Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO
| | - Aleix Sala-Vila
- Fatty Acid Research Institute, Sioux Falls, SD
- Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - John Attia
- The University of Newcastle, School of Biomedical Sciences and Pharmacy, Callaghan, Australia
| | - G Manohar Garg
- The University of Newcastle, School of Biomedical Sciences and Pharmacy, Callaghan, Australia
| | - Alexis Hure
- The University of Newcastle, School of Biomedical Sciences and Pharmacy, Callaghan, Australia
| | | | - Erik Berg Schmidt
- Aalborg University Hospital, Department of Clinical Medicine, Aalborg, Denmark
| | - Stine Krogh Venø
- Aalborg University Hospital, Department of Clinical Biochemistry, Aalborg, Denmark
| | - Kuo-Liong Chien
- National Taiwan University, Institute of Epidemiology and Preventive Medicine, Taipei Taiwan
| | - Yun-Yu (Amelia) Chen
- Taichung Veterans General Hospital, Department of Medical Research, Taichung, Taiwan
| | - Sarah Egert
- University of Bonn, Institute of Nutrition and Food Sciences and Nutritional Physiology, Bonn, Germany
| | | | - Johan Ärnlöv
- Karolinska Institutet, Division of Family Medicine and Primary Care, Department of Neurobiology Care Sciences & Society, Solna, Sweden
| | - Lars Lind
- Uppsala University, Department of Medical Sciences Cardiovascular Epidemiology, Uppsala, Sweden
| | - Nita G Forouhi
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Johanna M Geleijnse
- Wageningen University & Research, Division of Human Nutrition and Health, Wageningen, Netherlands
| | - Kamalita Pertiwi
- Wageningen University & Research, Division of Human Nutrition and Health, Wageningen, Netherlands
| | - Fumiaki Imamura
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Vanessa de Mello Laaksonen
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - W Matti Uusitupa
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jaakko Tuomilehto
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Markku Laakso
- University of Eastern Finland, School of Medicine, Department of Internal Medicine, Kuopio, Finland
| | - Maria Anneli Lankinen
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Danielle Laurin
- CHU de Québec-Université Laval and VITAM Research Centers, Centre d’Excellence sur le Vieillissement de Québec, Québec, Canada
| | - Pierre-Hugues Carmichael
- CHU de Québec-Université Laval and VITAM Research Centers, Centre d’Excellence sur le Vieillissement de Québec, Québec, Canada
| | - Joan Lindsay
- University of Ottawa, School of Epidemiology and Public Health, Ottawa, Canada
| | - Karin Leander
- Karolinska Institutet, Institute of Environmental Medicine, Unit of Cardiovascular and Nutritional Epidemiology, Stockholm, Sweden
| | - Federica Laguzzi
- Karolinska Institutet, Institute of Environmental Medicine, Unit of Cardiovascular and Nutritional Epidemiology, Stockholm, Sweden
| | - Brenton R Swenson
- University of Washington, Cardiovascular Health Research Unit, Seattle, WA
| | - William T Longstreth
- University of Washington, Departments of Neurology and Epidemiology, Seattle, WA
| | - JoAnn E Manson
- Harvard Medical School, Department of Medicine, Brigham & Women’s Hospital, Boston, MA
| | - Samia Mora
- Harvard Medical School, Department of Medicine, Brigham & Women’s Hospital, Boston, MA
| | - Nancy R Cook
- Harvard Medical School, Department of Medicine, Brigham & Women’s Hospital, Boston, MA
| | - Matti Marklund
- The George Institute for Global Health, University of New South Wales, Newtown, NSW Australia; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland: and Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Debora Melo van Lent
- University of Texas, Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, San Antonio, TX
| | - Rachel Murphy
- University of British Columbia, Cancer Control Research, British Columbia Cancer, School of Population and Public Health, Vancouver, Canada
| | | | - Toshihara Ninomiya
- Kyushu University, Department of Epidemiology and Public Health and Center for Cohort Studies, Fukouka, Japan
| | - Yoichiro Hirakawa
- Kyushu University, Department of Epidemiology and Public Health and Center for Cohort Studies, Fukouka, Japan
| | - Frank Qian
- Harvard Medical School, T.H. Chan School of Public Health and Beth Deaconess Medical Center, Boston, MA
| | - Qi Sun
- Harvard Medical School, T.H. Chan School of Public Health and Channing Division of Network Medicine Brigham and Women’s Hospital, Boston, MA
| | - Frank Hu
- Harvard Medical School, T.H. Chan School of Public Health and Channing Division of Network Medicine Brigham and Women’s Hospital, Boston, MA
| | | | - Ulf Risérus
- Uppsala University, Department of Public Health and Caring Sciences Clinical Nutrition and Metabolism Unit, Uppsala, Sweden
| | - Iolanda Lázaro
- Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Cecilia Samieri
- University of Bordeaux, Bordeaux Population Health Research Centre, Bordeaux, France
| | - Mélanie Le Goff
- University of Bordeaux, Bordeaux Population Health Research Centre, Bordeaux, France
| | - Catherine Helmer
- University of Bordeaux, Bordeaux Population Health Research Centre, Bordeaux, France
| | - Marinka Steur
- University Medical Center Rotterdam, Department of Epidemiology, Rotterdam, The Netherlands
| | - Trudy Voortman
- University Medical Center Rotterdam, Department of Epidemiology, Rotterdam, The Netherlands
| | - M Kamran Ikram
- University Medical Center Rotterdam, Department of Epidemiology, Rotterdam, The Netherlands
| | - Toshiko Tanaka
- National Institute of Health, National Institute on Aging, Longitudinal Studies Section, Baltimore, MD
| | | | - Luigi Ferrucci
- National Institute of Health, National Institute on Aging, Longitudinal Studies Section, Baltimore, MD
| | | | - Michael Tsai
- University of Minnesota, Department of Laboratory Medicine and Pathology, Minneapolis, MN
| | - Weihua Guan
- University of Minnesota, Division of Biostatistics, Minneapolis, MN
| | - Parveen Garg
- University of Southern California, Department of Medicine, Cardiology, Los Angeles, CA
| | - WM Monique Verschuren
- National Institute for Public Health and the Environment Bilthoven, The Netherlands, Julius Center for Health Sciences and Primary Care and Centre for Nutrition, Prevention and Health Services, Utrecht, The Netherlands
| | - Jolanda MA Boer
- National Institute for Public Health and the Environment Bilthoven, The Netherlands
| | - Anneke Biokstra
- National Institute for Public Health and the Environment Bilthoven, The Netherlands
| | - Jyrki Virtanen
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Michael Wagner
- University Hospital, Depts of Neurodegenerative Diseases and Geriatric Psychiatry and German Center for Neurodegenerative Diseases, Bonn, Germany
| | | | | | - Kazumasa Yamagishi
- University of Tsukubu, Department of Public Health Medicine, Tsukuba, Japan
| | - David S Siscovick
- New York Academy of Medicine, Department of Epidemiology, New York, New York
| | | | | |
Collapse
|
4
|
Gagnon S, Nadeau A, Tanguay K, Archambault PM, Brousseau AA, Carmichael PH, Emond M, Deshaies JF, Benhamed A, Blanchard PG, Mowbray FI, Mercier E. Prevalence and predictors of elder abuse among older adults attending emergency departments: a prospective cohort study. CAN J EMERG MED 2023; 25:953-958. [PMID: 37853307 DOI: 10.1007/s43678-023-00600-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 09/25/2023] [Indexed: 10/20/2023]
Abstract
INTRODUCTION Elder abuse is associated with impaired physical and psychological health. It is, however, rarely identified in emergency departments (EDs). The objective was to determine the prevalence and the predictors of elder abuse among older adults visiting EDs. METHODS This prospective cohort study was conducted in eight Canadian EDs between May and August 2021. Patients were eligible if they were ≥ 65 years old, oriented to time, and with a Canadian Triage and Acuity Scale score 3, 4 or 5. In a private setting, participants were questioned directly about abuse as part of a larger questionnaire exploring ten non-medical problems. We used multivariable logistic regression to identify predictors of elder abuse. RESULTS A total of 1061 participants were recruited (mean age: 77.1 (SD 7.6) years, female sex: 55.7%, lived alone: 42.5%). Patients mostly attended EDs for pain (19.6%), neurologic (11.3%) or cardiovascular (8.4%) symptoms. The most frequent pre-existing comorbidities were hypertension (67.2%), mental health conditions (33.3%) and cardiac insufficiency (29.6%). Mobility issues outside (41.0%) or inside their home (30.7%) and loneliness (29.4%) were also frequent. Fifty-four (5.1%) participants reported elder abuse, of which 34.3% were aware of available community-based resources. Identified predictors of elder abuse were female sex (OR 2.8 [95%CI 1.4; 5.6]), financial difficulties (OR 3.6 [95%CI 1.8; 7.3]), food insecurity (OR 2.7 [95%CI 1.2; 5.6]), need for a caregiver (OR 2.7 [95%CI 1.5; 5.0]) and at least one pre-existing mental health condition (OR 2.6 [95%CI 1.4; 4.9]). CONCLUSION When questioned directly, 5.1% of older adults attending EDs reported experiencing abuse. Female sex, functional impairment, social vulnerability, and mental health comorbidities are associated with elder abuse. Given its importance and relatively high prevalence, ED professionals should have a low threshold to ask directly about elder abuse.
Collapse
Affiliation(s)
- Samuel Gagnon
- Centre de recherche du CHU de Québec-Université Laval, Axe santé des populations et pratiques optimales en santé, Quebec, QC, Canada
| | - Alexandra Nadeau
- Centre de recherche du CHU de Québec-Université Laval, Axe santé des populations et pratiques optimales en santé, Quebec, QC, Canada
- VITAM-Centre de recherche en santé durable, Quebec, QC, Canada
| | - Katherine Tanguay
- Département de médecine de famille et de médecine d'urgence, Faculté de médecine, Université Laval, Quebec, QC, Canada
| | - Patrick M Archambault
- VITAM-Centre de recherche en santé durable, Quebec, QC, Canada
- Département de médecine de famille et de médecine d'urgence, Faculté de médecine, Université Laval, Quebec, QC, Canada
- Centre de recherche intégrée pour un système de santé apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière Appalaches, Lévis, QC, Canada
| | - Audrey-Anne Brousseau
- Département de médecine de famille et de médecine d'urgence, Faculté de médecine et sciences de la santé, Université de Sherbrooke, Sherbooke, QC, Canada
| | | | - Marcel Emond
- Centre de recherche du CHU de Québec-Université Laval, Axe santé des populations et pratiques optimales en santé, Quebec, QC, Canada
- VITAM-Centre de recherche en santé durable, Quebec, QC, Canada
- Département de médecine de famille et de médecine d'urgence, Faculté de médecine, Université Laval, Quebec, QC, Canada
| | - Jean-Francois Deshaies
- Centre de recherche intégrée pour un système de santé apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière Appalaches, Lévis, QC, Canada
| | - Axel Benhamed
- Centre de recherche du CHU de Québec-Université Laval, Axe santé des populations et pratiques optimales en santé, Quebec, QC, Canada
- Service SAMU-Urgences, Centre Hospitalier Universitaire Édouard Herriot, Hopitaux Civils de Lyon, Lyon, France
| | - Pierre-Gilles Blanchard
- Centre de recherche du CHU de Québec-Université Laval, Axe santé des populations et pratiques optimales en santé, Quebec, QC, Canada
- VITAM-Centre de recherche en santé durable, Quebec, QC, Canada
- Département de médecine de famille et de médecine d'urgence, Faculté de médecine, Université Laval, Quebec, QC, Canada
| | - Fabrice I Mowbray
- College of Nursing, Michigan State University, East Lansing, MI, USA
| | - Eric Mercier
- Centre de recherche du CHU de Québec-Université Laval, Axe santé des populations et pratiques optimales en santé, Quebec, QC, Canada.
- VITAM-Centre de recherche en santé durable, Quebec, QC, Canada.
- Département de médecine de famille et de médecine d'urgence, Faculté de médecine, Université Laval, Quebec, QC, Canada.
| |
Collapse
|
5
|
Koblinsky ND, Carmichael PH, Belleville S, Fiocco AJ, Gaudreau P, Greenwood CE, Kergoat MJ, Morais JA, Presse N, Laurin D, Ferland G. Associations between circulating cardiovascular disease risk factors and cognitive performance in cognitively healthy older adults from the NuAge study. Front Aging Neurosci 2023; 15:1274794. [PMID: 38020779 PMCID: PMC10668121 DOI: 10.3389/fnagi.2023.1274794] [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: 08/08/2023] [Accepted: 09/26/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Cardiovascular disease risk factors (CVRFs) contribute to the development of cognitive impairment and dementia. Methods This study examined the associations between circulating CVRF biomarkers and cognition in 386 cognitively healthy older adults (mean age = 78 ± 4 years, 53% females) selected from the Quebec Longitudinal Study on Nutrition and Successful Aging (NuAge). Memory, executive function, and processing speed were assessed at baseline and 2-year follow-up. CVRF biomarkers included total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C), triglycerides, glucose, insulin, high sensitivity C-reactive protein (hs-CRP), homocysteine, protein carbonyls, and cortisol. Linear mixed models were used to determine associations between individual CVRF biomarkers and cognition at both time points. Results HDL-C was most consistently associated with cognition with higher values related to better performance across several domains. Overall, stronger and more consistent relationships between CVRF biomarkers and cognition were observed in females relative to males. Discussion Findings suggest that increases in the majority of circulating CVRFs are not associated with worse cognition in cognitively healthy older adults.
Collapse
Affiliation(s)
- Noah D. Koblinsky
- Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada
| | - Pierre-Hugues Carmichael
- Center d’excellence sur le Vieillissement de Québec, Center de Recherche du Center Hospitalier Universitaire (CHU) de Québec-Université Laval and VITAM-Center de Recherche en Santé Durable, Center Intégré Universitaire de Santé et de Services Sociaux (CIUSSS) de la Capitale Nationale, Québec, QC, Canada
| | - Sylvie Belleville
- Center de Recherche de l’Institut Universitaire de Gériatrie de Montréal, CIUSSS du Center-Sud-de-l’Île-de-Montréal, Montreal, QC, Canada
| | - Alexandra J. Fiocco
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
| | - Pierrette Gaudreau
- Center de Recherche du Center Hospitalier de l’Université de Montréal and Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
| | - Carol E. Greenwood
- Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - José A. Morais
- Division of Geriatrics, McGill University, Montreal, QC, Canada
| | - Nancy Presse
- Center de Recherche du Center Hospitalier de l’Université de Montréal and Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
- Faculté de Médecine et des Sciences de la Santé de l’Université de Sherbrooke, Sherbrooke, QC, Canada
- Center de Recherche sur le Vieillissement du CIUSSS de l’Estrie-Center Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, QC, Canada
| | - Danielle Laurin
- Center d’excellence sur le Vieillissement de Québec, Center de Recherche du Center Hospitalier Universitaire (CHU) de Québec-Université Laval and VITAM-Center de Recherche en Santé Durable, Center Intégré Universitaire de Santé et de Services Sociaux (CIUSSS) de la Capitale Nationale, Québec, QC, Canada
- Faculté de Pharmacie, Institut sur le Vieillissement et la Participation Sociale des Aînés and Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Montreal, ON, Canada
| | - Guylaine Ferland
- Montreal Heart Institute Research Center, and Département de Nutrition, Université de Montréal, Montreal, QC, Canada
| |
Collapse
|
6
|
Kröger E, Wilchesky M, Morin M, Carmichael PH, Marcotte M, Misson L, Plante J, Voyer P, Durand P. The OptimaMed intervention to reduce medication burden in nursing home residents with severe dementia: results from a pragmatic, controlled study. BMC Geriatr 2023; 23:520. [PMID: 37641020 PMCID: PMC10464023 DOI: 10.1186/s12877-023-04222-4] [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: 10/05/2022] [Accepted: 08/07/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Nursing home (NH) residents with severe dementia use many medications, sometimes inappropriately within a comfort care approach. Medications should be regularly reviewed and eventually deprescribed. This pragmatic, controlled trial assessed the effect of an interprofessional knowledge exchange (KE) intervention to decrease medication load and the use of medications of questionable benefit among these residents. METHODS A 6-month intervention was performed in 4 NHs in the Quebec City area, while 3 NHs, with comparable admissions criteria, served as controls. Published lists of "mostly", "sometimes" or "exceptionally" appropriate medications, tailored for NH residents with severe dementia, were used. The intervention included 1) information for participants' families about medication use in severe dementia; 2) a 90-min KE session for NH nurses, pharmacists, and physicians; 3) medication reviews by NH pharmacists using the lists; 4) discussions on recommended changes with nurses and physicians. Participants' levels of agitation and pain were evaluated using validated scales at baseline and the end of follow-up. RESULTS Seven (7) NHs and 123 participants were included for study. The mean number of regular medications per participant decreased from 7.1 to 6.6 in the intervention, and from 7.7 to 5.9 in the control NHs (p-value for the difference in differences test: < 0.05). Levels of agitation decreased by 8.3% in the intervention, and by 1.4% in the control NHs (p = 0.026); pain levels decreased by 12.6% in the intervention and increased by 7% in the control NHs (p = 0.049). Proportions of participants receiving regular medications deemed only exceptionally appropriate decreased from 19 to 17% (p = 0.43) in the intervention and from 28 to 21% (p = 0.007) in the control NHs (p = 0.22). The mean numbers of regular daily antipsychotics per participant fell from 0.64 to 0.58 in the intervention and from 0.39 to 0.30 in the control NHs (p = 0.27). CONCLUSIONS This interprofessional intervention to reduce inappropriate medication use in NH residents with severe dementia decreased medication load in both intervention and control NHs, without important concomitant increase in agitation, but mixed effects on pain levels. Practice changes and heterogeneity within these 7 NHs, and a ceiling effect in medication optimization likely interfered with the intervention. TRIAL REGISTRATION The study is registered at ClinicalTrials.gov: # NCT05155748 (first registration 03-10-2017).
Collapse
Affiliation(s)
- Edeltraut Kröger
- Centre d'excellence sur le vieillissement de Québec, CIUSSSCN, Hôpital du Saint-Sacrement, 1050, Chemin Sainte-Foy, Québec (Québec), G1S 4L8, Canada.
- Université Laval, Faculté de pharmacie, Pavillon Ferdinand Vandry, 1050 Avenue de La Médecine, Québec, Québec, G1V 0A6, Canada.
- Institut sur le vieillissement et la participation sociale des aînés, Université Laval, Hôpital du Saint-Sacrement, bureau L2-42, 1050, Chemin Sainte-Foy, Québec (Québec), G1S 4L8, Canada.
| | - Machelle Wilchesky
- McGill University, Faculty of Medicine and Health Sciences, 3605, Chemin de La Montagne, Montreal (Québec), H3G 2M1, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Chem. de La Côte-Sainte-Catherine, Montréal, (Québec), H3T 1E2, Canada
| | - Michèle Morin
- Centre d'excellence sur le vieillissement de Québec, CIUSSSCN, Hôpital du Saint-Sacrement, 1050, Chemin Sainte-Foy, Québec (Québec), G1S 4L8, Canada
- Institut sur le vieillissement et la participation sociale des aînés, Université Laval, Hôpital du Saint-Sacrement, bureau L2-42, 1050, Chemin Sainte-Foy, Québec (Québec), G1S 4L8, Canada
- Donald Berman Maimonides Centre for Research in Aging, 5795 Av. Caldwell, Côte Saint-Luc, Montreal (Québec), H4W 1W3, Canada
| | - Pierre-Hugues Carmichael
- Centre d'excellence sur le vieillissement de Québec, CIUSSSCN, Hôpital du Saint-Sacrement, 1050, Chemin Sainte-Foy, Québec (Québec), G1S 4L8, Canada
| | - Martine Marcotte
- Centre d'excellence sur le vieillissement de Québec, CIUSSSCN, Hôpital du Saint-Sacrement, 1050, Chemin Sainte-Foy, Québec (Québec), G1S 4L8, Canada
| | - Lucie Misson
- Centre d'excellence sur le vieillissement de Québec, CIUSSSCN, Hôpital du Saint-Sacrement, 1050, Chemin Sainte-Foy, Québec (Québec), G1S 4L8, Canada
| | - Jonathan Plante
- Centre d'excellence sur le vieillissement de Québec, CIUSSSCN, Hôpital du Saint-Sacrement, 1050, Chemin Sainte-Foy, Québec (Québec), G1S 4L8, Canada
- Université Laval, Faculté de pharmacie, Pavillon Ferdinand Vandry, 1050 Avenue de La Médecine, Québec, Québec, G1V 0A6, Canada
| | - Philippe Voyer
- Centre d'excellence sur le vieillissement de Québec, CIUSSSCN, Hôpital du Saint-Sacrement, 1050, Chemin Sainte-Foy, Québec (Québec), G1S 4L8, Canada
- Université Laval, Faculté de pharmacie, Pavillon Ferdinand Vandry, 1050 Avenue de La Médecine, Québec, Québec, G1V 0A6, Canada
- Université Laval, Faculté de médecine, Pavillon Ferdinand Vandry, 1050 Avenue de La Médecine, Québec (Québec), G1V 0A6, Canada
| | - Pierre Durand
- Centre d'excellence sur le vieillissement de Québec, CIUSSSCN, Hôpital du Saint-Sacrement, 1050, Chemin Sainte-Foy, Québec (Québec), G1S 4L8, Canada
- Université Laval, Faculté de pharmacie, Pavillon Ferdinand Vandry, 1050 Avenue de La Médecine, Québec, Québec, G1V 0A6, Canada
- Donald Berman Maimonides Centre for Research in Aging, 5795 Av. Caldwell, Côte Saint-Luc, Montreal (Québec), H4W 1W3, Canada
- Université Laval, Faculté des sciences infirmières, Pavillon Ferdinand Vandry, 1050 Avenue de La Médecine, Québec (Québec), G1V 0A6, Canada
| |
Collapse
|
7
|
Duchaine CS, Brisson C, Diorio C, Talbot D, Maunsell E, Carmichael PH, Giguère Y, Gilbert-Ouimet M, Trudel X, Ndjaboué R, Vézina M, Milot A, Mâsse B, Dionne CE, Laurin D. Work-Related Psychosocial Factors and Global Cognitive Function: Are Telomere Length and Low-Grade Inflammation Potential Mediators of This Association? Int J Environ Res Public Health 2023; 20:4929. [PMID: 36981836 PMCID: PMC10049148 DOI: 10.3390/ijerph20064929] [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] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/05/2023] [Accepted: 03/08/2023] [Indexed: 06/18/2023]
Abstract
The identification of modifiable factors that could maintain cognitive function is a public health priority. It is thought that some work-related psychosocial factors help developing cognitive reserve through high intellectual complexity. However, they also have well-known adverse health effects and are considered to be chronic psychosocial stressors. Indeed, these stressors could increase low-grade inflammation and promote oxidative stress associated with accelerated telomere shortening. Both low-grade inflammation and shorter telomeres have been associated with a cognitive decline. This study aimed to evaluate the total, direct, and indirect effects of work-related psychosocial factors on global cognitive function overall and by sex, through telomere length and an inflammatory index. A random sample of 2219 participants followed over 17 years was included in this study, with blood samples and data with cognitive function drawn from a longitudinal study of 9188 white-collar workers (51% female). Work-related psychosocial factors were evaluated according to the Demand-Control-Support and the Effort-Reward Imbalance (ERI) models. Global cognitive function was evaluated with the validated Montreal Cognitive Assessment (MoCA). Telomere length and inflammatory biomarkers were measured using standardised protocols. The direct and indirect effects were estimated using a novel mediation analysis method developed for multiple correlated mediators. Associations were observed between passive work or low job control, and shorter telomeres among females, and between low social support at work, ERI or iso-strain, and a higher inflammatory index among males. An association was observed with higher cognitive performance for longer telomeres, but not for the inflammatory index. Passive work overall, and low reward were associated with lower cognitive performance in males; whereas, high psychological demand in both males and females and high job strain in females were associated with a higher cognitive performance. However, none of these associations were mediated by telomere length or the inflammatory index. This study suggests that some work-related psychosocial factors could be associated with shorter telomeres and low-grade inflammation, but these associations do not explain the relationship between work-related psychosocial factors and global cognitive function. A better understanding of the biological pathways, by which these factors affect cognitive function, could guide future preventive strategies to maintain cognitive function and promote healthy aging.
Collapse
Affiliation(s)
- Caroline S. Duchaine
- Centre d’excellence sur le vieillissement de Québec (CEVQ), CIUSSS-Capitale Nationale, Québec, QC G1S 4L8, Canada
- Faculty of Medicine, Université Laval, Québec, QC G1V 0A6, Canada
- Centre de Recherche du CHU de Québec—Université Laval, Québec, QC G1S 4L8, Canada
- VITAM, Centre de Recherche en santé Durable, Québec, QC G1S 4L8, Canada
- Institut sur le Vieillissement et la Participation Sociale des Aînés, Université Laval, Québec, QC G1S 4L8, Canada
| | - Chantal Brisson
- Centre d’excellence sur le vieillissement de Québec (CEVQ), CIUSSS-Capitale Nationale, Québec, QC G1S 4L8, Canada
- Faculty of Medicine, Université Laval, Québec, QC G1V 0A6, Canada
- Centre de Recherche du CHU de Québec—Université Laval, Québec, QC G1S 4L8, Canada
- VITAM, Centre de Recherche en santé Durable, Québec, QC G1S 4L8, Canada
| | - Caroline Diorio
- Faculty of Medicine, Université Laval, Québec, QC G1V 0A6, Canada
- Centre de Recherche du CHU de Québec—Université Laval, Québec, QC G1S 4L8, Canada
| | - Denis Talbot
- Faculty of Medicine, Université Laval, Québec, QC G1V 0A6, Canada
- Centre de Recherche du CHU de Québec—Université Laval, Québec, QC G1S 4L8, Canada
| | - Elizabeth Maunsell
- Faculty of Medicine, Université Laval, Québec, QC G1V 0A6, Canada
- Centre de Recherche du CHU de Québec—Université Laval, Québec, QC G1S 4L8, Canada
| | - Pierre-Hugues Carmichael
- Centre d’excellence sur le vieillissement de Québec (CEVQ), CIUSSS-Capitale Nationale, Québec, QC G1S 4L8, Canada
- Centre de Recherche du CHU de Québec—Université Laval, Québec, QC G1S 4L8, Canada
| | - Yves Giguère
- Faculty of Medicine, Université Laval, Québec, QC G1V 0A6, Canada
- Centre de Recherche du CHU de Québec—Université Laval, Québec, QC G1S 4L8, Canada
| | - Mahée Gilbert-Ouimet
- Centre de Recherche du CHU de Québec—Université Laval, Québec, QC G1S 4L8, Canada
- Canada Research Chair in Sex and Gender in Occupational Health, Université du Québec à Rimouski, Campus de Lévis, Lévis, QC G6V 0A6, Canada
| | - Xavier Trudel
- Centre d’excellence sur le vieillissement de Québec (CEVQ), CIUSSS-Capitale Nationale, Québec, QC G1S 4L8, Canada
- Faculty of Medicine, Université Laval, Québec, QC G1V 0A6, Canada
- Centre de Recherche du CHU de Québec—Université Laval, Québec, QC G1S 4L8, Canada
- VITAM, Centre de Recherche en santé Durable, Québec, QC G1S 4L8, Canada
| | - Ruth Ndjaboué
- School of Social Work, University of Sherbrooke, Sherbrooke, QC J1K 2R1, Canada
| | - Michel Vézina
- Institut National de Santé Publique du Québec (INSPQ), Québec, QC G1V 5B3, Canada
| | - Alain Milot
- Centre d’excellence sur le vieillissement de Québec (CEVQ), CIUSSS-Capitale Nationale, Québec, QC G1S 4L8, Canada
- Faculty of Medicine, Université Laval, Québec, QC G1V 0A6, Canada
| | - Benoît Mâsse
- École de Santé Publique de l’Université de Montréal, Montréal, QC H3N 1X9, Canada
| | - Clermont E. Dionne
- Centre d’excellence sur le vieillissement de Québec (CEVQ), CIUSSS-Capitale Nationale, Québec, QC G1S 4L8, Canada
- Faculty of Medicine, Université Laval, Québec, QC G1V 0A6, Canada
- Centre de Recherche du CHU de Québec—Université Laval, Québec, QC G1S 4L8, Canada
- VITAM, Centre de Recherche en santé Durable, Québec, QC G1S 4L8, Canada
- Institut sur le Vieillissement et la Participation Sociale des Aînés, Université Laval, Québec, QC G1S 4L8, Canada
| | - Danielle Laurin
- Centre d’excellence sur le vieillissement de Québec (CEVQ), CIUSSS-Capitale Nationale, Québec, QC G1S 4L8, Canada
- Centre de Recherche du CHU de Québec—Université Laval, Québec, QC G1S 4L8, Canada
- VITAM, Centre de Recherche en santé Durable, Québec, QC G1S 4L8, Canada
- Institut sur le Vieillissement et la Participation Sociale des Aînés, Université Laval, Québec, QC G1S 4L8, Canada
- Faculty of Pharmacy, Université Laval, Québec, QC G1V 0A6, Canada
| |
Collapse
|
8
|
Bernier PJ, Gourdeau C, Carmichael PH, Beauchemin JP, Voyer P, Hudon C, Laforce R. It's all about cognitive trajectory: Accuracy of the cognitive charts-MoCA in normal aging, MCI, and dementia. J Am Geriatr Soc 2023; 71:214-220. [PMID: 36102601 PMCID: PMC9870845 DOI: 10.1111/jgs.18029] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 07/27/2022] [Accepted: 08/09/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND The Montreal Cognitive Assessment (MoCA) is an established cognitive screening tool in older adults. It remains unclear, however, how to interpret its scores over time and distinguish age-associated cognitive decline (AACD) from early neurodegeneration. We aimed to create cognitive charts using the MoCA for longitudinal evaluation of AACD in clinical practice. METHODS We analyzed data from the National Alzheimer's Coordinating Center (9684 participants aged 60 years or older) who completed the MoCA at baseline. We developed a linear regression model for the MoCA score as a function of age and education. Based on this model, we generated the Cognitive Charts-MoCA designed to optimize accuracy for distinguishing participants with MCI and dementia from healthy controls. We validated our model using two separate data sets. RESULTS For longitudinal evaluation of the Cognitive Charts-MoCA, sensitivity (SE) was 89%, 95% confidence interval (CI): [86%, 92%] and specificity (SP) 79%, 95% CI: [77%, 81%], hence showing better performance than fixed cutoffs of MoCA (SE 82%, 95% CI: [79%, 85%], SP 68%, 95% CI: [67%, 70%]). For current cognitive status or baseline measurement, the Cognitive Charts-MoCA had a SE of 81%, 95% CI: [79%, 82%], SP of 84%, 95% CI: [83%, 85%] in distinguishing healthy controls from mild cognitive impairment or dementia. Results in two additional validation samples were comparable. CONCLUSIONS The Cognitive Charts-MoCA showed high validity and diagnostic accuracy for determining whether older individuals show abnormal performance on serial MoCAs. This innovative model allows longitudinal cognitive evaluation and enables prompt initiation of investigation and treatment when appropriate.
Collapse
Affiliation(s)
- Patrick J. Bernier
- Services Gériatriques Spécialisés, CIUSSS de la Capitale-Nationale, QC, Canada
| | | | | | | | - Philippe Voyer
- Centre d’Excellence sur le Vieillissement de Québec, QC, Canada;,Faculté des sciences infirmières, Université Laval, QC, Canada
| | - Carol Hudon
- École de psychologie, Université Laval, QC, Canada;,CERVO Brain Research Centre, QC, Canada
| | - Robert Laforce
- Clinique Interdisciplinaire de Mémoire du CHU de Québec, QC, Canada
| |
Collapse
|
9
|
Duchaine CS, Fiocco AJ, Carmichael PH, Cunnane SC, Plourde M, Lampuré A, Allès B, Belleville S, Gaudreau P, Presse N, Ferland G, Laurin D. Serum ω-3 Fatty Acids and Cognitive Domains in Community-Dwelling Older Adults from the NuAge Study: Exploring the Associations with Other Fatty Acids and Sex. J Nutr 2022; 152:2117-2124. [PMID: 35575619 PMCID: PMC9445853 DOI: 10.1093/jn/nxac110] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/06/2022] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Omega-3 (n-3) PUFAs are suggested to play a role in the prevention of cognitive decline. The evidence may be inconsistent due to methodologic issues, including interrelations with other long-chain (14 or more carbons) fatty acids (LCFAs) and use of sex as a confounding factor rather than an effect modifier. OBJECTIVES This study evaluated the association between serum n-3 PUFAs and performance across 4 cognitive domains, overall and by sex, while controlling for other LCFAs. METHODS In total, 386 healthy older adults (aged 77.4 ± 3.8 y; 53% females) from the Quebec Longitudinal Study on Nutrition and Successful Aging underwent a cognitive evaluation and blood sampling. Verbal and nonverbal episodic memory, executive functioning, and processing speed were evaluated. Serum LCFA concentrations were measured by gas chromatography. LCFAs were grouped according to standard fatty acid classes and factor analysis using principal component analysis (FA-PCA). Multivariate linear regression models were performed, including unadjusted and adjusted models for other LCFAs. RESULTS Higher n-3 PUFA concentrations were associated with better nonverbal memory and processing speed in fully adjusted models not including other LCFAs (βs of 0.21 and 0.19, respectively). The magnitude of these associations varied when other LCFAs were entered in the model (βs of 0.27 and 0.32, respectively) or when FA-PCA factors were considered (βs of 0.27 and 0.21, respectively). Associations with verbal episodic memory were limited to higher concentrations of EPA, whereas there was no association between n-3 PUFAs and executive functioning. Higher n-3 PUFAs were associated with better verbal and nonverbal episodic memory in females and with better executive functioning and processing speed in males. CONCLUSIONS These results suggest that other LCFAs should be considered when evaluating the association between n-3 PUFAs and cognitive performance in healthy older adults. Sex differences across cognitive domains warrant further investigation.
Collapse
Affiliation(s)
- Caroline S Duchaine
- Centre de recherche du CHU de Québec-Université Laval, VITAM-Centre de recherche en santé durable, CIUSSS-Capitale Nationale and Institut sur le vieillissement et la participation sociale des aînés, Quebec, Canada,Centre d'excellence sur le vieillissement de Québec, Quebec, Canada
| | - Alexandra J Fiocco
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | | | - Stephen C Cunnane
- Centre de recherche sur le vieillissement du CIUSSS-de-l'Estrie-CHUS, Université de Sherbrooke, Quebec, Canada
| | - Mélanie Plourde
- Centre de recherche sur le vieillissement du CIUSSS-de-l'Estrie-CHUS, Université de Sherbrooke, Quebec, Canada
| | - Aurélie Lampuré
- Centre Hospitalier de l'Université de Montréal Research Center and Faculté de Médecine, Université de Montréal, Montreal, Quebec, Canada
| | - Benjamin Allès
- Équipe de recherche en épidémiologie nutritionnelle, UMR U1153 Inserm/U1125 INRAE/Cnam/Université Sorbonne Paris Nord, UFR SMBH, Paris, France
| | - Sylvie Belleville
- Centre de recherche de l'Institut Universitaire de gériatrie de Montréal, CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montreal, Quebec, Canada
| | - Pierrette Gaudreau
- Centre Hospitalier de l'Université de Montréal Research Center and Faculté de Médecine, Université de Montréal, Montreal, Quebec, Canada
| | - Nancy Presse
- Centre de recherche sur le vieillissement du CIUSSS-de-l'Estrie-CHUS, Université de Sherbrooke, Quebec, Canada,Centre de recherche de l'Institut Universitaire de gériatrie de Montréal, CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montreal, Quebec, Canada,Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Quebec, Canada
| | - Guylaine Ferland
- Montreal Heart Institute, Department of Nutrition, Université de Montréal, Montreal, Quebec, Canada
| | | |
Collapse
|
10
|
Dufour-Neyron H, Tanguay K, Nadeau A, Emond M, Harrisson J, Robert S, Capolla-Daneau N, Groulx M, Carmichael PH, Mercier E. Prehospital Use of the Esophageal Tracheal Combitube Supraglottic Airway Device: A Retrospective Cohort Study. J Emerg Med 2022; 62:324-331. [PMID: 35067394 DOI: 10.1016/j.jemermed.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 10/26/2021] [Accepted: 11/27/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND In the province of Quebec (Canada), paramedics use the esophageal tracheal Combitube (ETC) for prehospital airway management. OBJECTIVES Our main objective was to determine the proportion of patients with successful ventilation achieved after ETC use. Our secondary aim was to determine the number of ETC insertion attempts required to ventilate the patient. METHOD This is a retrospective cohort study. All patients who had ≥1 attempt to insert an ETC during prehospital care between January 1, 2017 and December 31, 2018 were included. Prehospital and in-hospital data were extracted. Successful ventilation was defined as thorax elevation, lung sounds on chest auscultation, or positive end-tidal capnography after ETC insertion. RESULTS A total of 580 emergency medical services interventions (99.3% cardiac arrests) were included. Most patients were men (62.5%) with a mean age 67.0 years (SD 17.6 years), and 35 (13.1%) of the 298 patients transported to emergency department survived to hospital discharge. Sufficient information to determine whether ventilation was successful or not was available for 515 interventions. Ventilation was achieved during 427 (82.7%) of these interventions. The number of ETC insertion attempts was available for 349 of the 427 successful ETC use. Overall, the first insertion resulted in successful ventilation during 294 interventions for an overall proportion of first-pass success ranging between 57.1% and 72.1%. CONCLUSION Proportions of successful ventilation and ETC first-pass success are lower than those reported in the literature with supraglottic airway devices. The reasons explaining these lower rates and their impact on patient-centered outcomes need to be studied.
Collapse
Affiliation(s)
| | | | | | - Marcel Emond
- Centre de recherche du CHU de Québec, Université Laval; VITAM - Centre de recherche en santé durable de l'Université Laval; Département de médecine d'urgence, Institut de Cardiologie et de Pneumologie de l'Université Laval; Direction des services préhospitaliers d'urgence, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale
| | - Jessica Harrisson
- Direction des services préhospitaliers d'urgence, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale
| | - Sébastien Robert
- Département de médecine d'urgence, Institut de Cardiologie et de Pneumologie de l'Université Laval
| | - Nicolas Capolla-Daneau
- Direction des services préhospitaliers d'urgence, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale
| | | | | | - Eric Mercier
- Centre de recherche du CHU de Québec, Université Laval; VITAM - Centre de recherche en santé durable de l'Université Laval; Département de médecine d'urgence, Institut de Cardiologie et de Pneumologie de l'Université Laval; Direction des services préhospitaliers d'urgence, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale
| |
Collapse
|
11
|
Tourigny JN, Boucher V, Paquet V, Fortier É, Malo C, Mercier É, Chauny JM, Clark G, Blanchard PG, Carmichael PH, Gariépy JL, D'Astous M, Émond M. External validation of the updated Brain Injury Guidelines for complicated mild traumatic brain injuries: a retrospective cohort study. J Neurosurg 2022; 137:1-7. [PMID: 35078154 DOI: 10.3171/2021.10.jns211794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/16/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Approximately 10% of patients with mild traumatic brain injury (mTBI) have intracranial bleeding (complicated mTBI) and 3.5% eventually require neurosurgical intervention, which is mostly available at centers with a higher level of trauma care designation and often requires interhospital transfer. In 2018, the Brain Injury Guidelines (BIG) were updated in the United States to guide emergency department care and patient disposition for complicated mild to moderate TBI. The aim of this study was to validate the sensitivity and specificity of the updated BIG (uBIG) for predicting the need for interhospital transfer in Canadian patients with complicated mTBI. METHODS This study took place at three level I trauma centers. Consecutive medical records of patients with complicated mTBI (Glasgow Coma Scale score 13-15) who were aged ≥ 16 years and presented between September 2016 and December 2017 were retrospectively reviewed. Patients with a penetrating trauma and those who had a documented cerebral tumor or aneurysm were excluded. The primary outcome was a combination of neurosurgical intervention and/or mTBI-related death. Sensitivity and specificity analyses were performed. RESULTS A total of 477 patients were included, of whom 8.4% received neurosurgical intervention and 3% died as a result of their mTBI. Forty patients (8%) were classified as uBIG-1, 168 (35%) as uBIG-2, and 269 (56%) as uBIG-3. No patients in uBIG-1 underwent neurosurgical intervention or died as a result of their injury. This translates into a sensitivity for predicting the need for a transfer of 100% (95% CI 93.2%-100%) and a specificity of 9.4% (95% CI 6.8%-12.6%). Using the uBIG could potentially reduce the number of transfers by 6% to 25%. CONCLUSIONS The patients in uBIG-1 could be safely managed at their initial center without the need for transfer to a center with a higher level of neurotrauma care. Although the uBIG could decrease the number of transfers, further refinement of the criteria could improve its specificity.
Collapse
Affiliation(s)
- Jean-Nicolas Tourigny
- 1Département de médecine familiale et de médecine d'urgence, Faculté de médecine, Université Laval, Québec, Québec, Canada
| | - Valérie Boucher
- 2Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
- 3VITAM-Centre de recherche en santé durable de l'Université Laval, Québec, Québec, Canada
- 6Centre d'excellence sur le vieillissement de Québec, Québec, Canada
| | - Véronique Paquet
- 1Département de médecine familiale et de médecine d'urgence, Faculté de médecine, Université Laval, Québec, Québec, Canada
| | - Émile Fortier
- 1Département de médecine familiale et de médecine d'urgence, Faculté de médecine, Université Laval, Québec, Québec, Canada
| | - Christian Malo
- 1Département de médecine familiale et de médecine d'urgence, Faculté de médecine, Université Laval, Québec, Québec, Canada
- 2Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Éric Mercier
- 1Département de médecine familiale et de médecine d'urgence, Faculté de médecine, Université Laval, Québec, Québec, Canada
- 3VITAM-Centre de recherche en santé durable de l'Université Laval, Québec, Québec, Canada
| | | | | | - Pierre-Gilles Blanchard
- 1Département de médecine familiale et de médecine d'urgence, Faculté de médecine, Université Laval, Québec, Québec, Canada
- 2Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
- 3VITAM-Centre de recherche en santé durable de l'Université Laval, Québec, Québec, Canada
| | | | - Jean-Luc Gariépy
- 2Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Myreille D'Astous
- 2Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Marcel Émond
- 1Département de médecine familiale et de médecine d'urgence, Faculté de médecine, Université Laval, Québec, Québec, Canada
- 2Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
- 3VITAM-Centre de recherche en santé durable de l'Université Laval, Québec, Québec, Canada
- 6Centre d'excellence sur le vieillissement de Québec, Québec, Canada
| |
Collapse
|
12
|
Duchaine C, Carmichael PH, Presse N, Fiocco A, Gaudreau P, Ferland G, Laurin D. Plasma Long Chain Fatty Acids and Cognitive Function in Older Adults: A Comparison of Statistical Analyses. Innov Aging 2021. [PMCID: PMC8679292 DOI: 10.1093/geroni/igab046.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Omega-3 fatty acids (FAs) have been suggested as modifiable protective factors for cognitive decline because of their neuroprotective properties. However, the evidence is still inconsistent regarding types of omega-3 FAs, and the probable interrelation with other circulating long chain FAs (LCFAs). This study aimed to evaluate associations between 14 plasma LCFAs and four cognitive domains using a principal component analysis (PCA) and to compare results with those obtained using standard methods. A group of 386 healthy older adults aged 77 ± 4 years (53% women), selected from the NutCog Study, a sub-study from the Québec cohort on Nutrition and Successful Aging (NuAge), underwent a cognitive evaluation and fasting blood sampling. Verbal and non-verbal episodic memory, executive functioning, and processing speed were evaluated using validated tests. LCFAs circulating concentrations were measured by high-performance liquid chromatography using published procedures. Linear regressions adjusted for age, sex, education, and BMI were used to evaluate cross-sectional associations between LCFAs, using PCA or a more standard grouping (omega-3, omega-6, monounsaturated, and saturated LCFAs), and cognitive performance. Higher scoring on the omega-3 PCA factor and higher concentrations of total omega-3 FAs were both associated with better episodic non-verbal memory and processing speed. Higher eicosapentaenoic acid (EPA omega-3) was also associated with these two cognitive domains and with episodic verbal memory. The associations with total omega-3 FAs taken separately were of smaller magnitude than those with PCA. These results suggest that omega-3 FAs should be considered in combination with other LCFAs when evaluating the association with cognitive function.
Collapse
Affiliation(s)
| | - Pierre-Hugues Carmichael
- Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, Quebec, Canada
| | - Nancy Presse
- Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | | | | | | | | |
Collapse
|
13
|
Tremblay Z, Mumbere D, Laurin D, Sirois C, Furrer D, Poisblaud L, Carmichael PH, Farrell B, Tourigny A, Giguere A, Vedel I, Morais J, Kröger E. Health Impacts and Characteristics of Deprescribing Interventions in Older Adults: Protocol for a Systematic Review and Meta-analysis. JMIR Res Protoc 2021; 10:e25200. [PMID: 34889771 PMCID: PMC8704115 DOI: 10.2196/25200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 08/05/2021] [Accepted: 09/03/2021] [Indexed: 12/05/2022] Open
Abstract
Background Deprescribing, a relatively recent concept, has been proposed as a promising solution to the growing issues of polypharmacy and use of medications of questionable benefit among older adults. However, little is known about the health outcomes of deprescribing interventions. Objective This paper presents the protocol of a study that aims to contribute to the knowledge on deprescribing by addressing two specific objectives: (1) describe the impact of deprescribing in adults ≥60 years on health outcomes or quality of life; and (2) determine the characteristics of effective interventions in deprescribing. Methods Primary studies targeting three concepts (older adults, deprescribing, and health or quality of life outcomes) will be included in the review. The search will be performed using key international databases (MEDLINE, EMBASE, CINAHL, Ageline, PsycInfo), and a special effort will be made to identify gray literature. Two reviewers will independently screen the articles, extract the information, and evaluate the quality of the selected studies. If methodologically feasible, meta-analyses will be performed for groups of intervention studies reporting on deprescribing interventions for similar medications, used for similar or identical indications, and reporting on similar outcomes (eg, benzodiazepines used against insomnia and studies reporting on quality of sleep or quality of life). Alternatively, the results will be presented in bottom-line statements (objective 1) and a matrix outlining effective interventions (objective 2). Results The knowledge synthesis may be limited by the availability of high-quality clinical trials on deprescribing and their outcomes in older adults. Additionally, analyses will likely be affected by studies on the deprescribing of different types of molecules within the same indication (eg, different pharmacological classes and medications to treat hypertension) and different measures of health and quality of life outcomes for the same indication. Nevertheless, we expect the review to identify which deprescribing interventions lead to improved health outcomes among seniors and which of their characteristics contribute to these outcomes. Conclusions This systematic review will contribute to a better understanding of the health outcomes of deprescribing interventions among seniors. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42015020866; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42015020866 International Registered Report Identifier (IRRID) PRR1-10.2196/25200
Collapse
Affiliation(s)
- Zoë Tremblay
- Faculté de pharmacie, Université Laval, Québec, QC, Canada
| | - David Mumbere
- Faculté de pharmacie, Université Laval, Québec, QC, Canada
| | | | | | - Daniela Furrer
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale Nationale, Québec, QC, Canada
| | - Lise Poisblaud
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale Nationale, Québec, QC, Canada
| | - Pierre-Hugues Carmichael
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale Nationale, Québec, QC, Canada
| | - Barbara Farrell
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - André Tourigny
- Faculté de médecine, Université Laval, Québec, QC, Canada
| | - Anik Giguere
- Faculté de médecine, Université Laval, Québec, QC, Canada
| | - Isabelle Vedel
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - José Morais
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Edeltraut Kröger
- Faculté de pharmacie, Université Laval, Québec, QC, Canada.,Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale Nationale, Québec, QC, Canada.,Faculty of Medicine, McGill University, Montreal, QC, Canada
| |
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
Wilchesky M, Ballard SA, Voyer P, McCusker J, Lungu O, Champoux N, Vu TTM, Cole MG, Monette J, Ciampi A, Belzile E, Carmichael PH, McConnell T. The PREvention Program for Alzheimer's RElated Delirium (PREPARED) cluster randomized trial: a study protocol. BMC Geriatr 2021; 21:645. [PMID: 34784897 PMCID: PMC8594158 DOI: 10.1186/s12877-021-02558-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/15/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Delirium is a significant cause of morbidity and mortality among older people admitted to both acute and long-term care facilities (LTCFs). Multicomponent interventions have been shown to reduce delirium incidence in the acute care setting (30-73%) by acting on modifiable risk factors. Little work, however, has focused on using this approach to reduce delirium incidence in LTCFs. METHODS The objective is to assess the effectiveness of the multicomponent PREPARED Trial intervention in reducing the following primary outcomes: incidence, severity, duration, and frequency of delirium episodes in cognitively impaired residents. This 4-year, parallel-design, cluster randomized study will involve nursing staff and residents in 45-50 LTCFs in Montreal, Canada. Participating public and private LTCFs (clusters) that provide 24-h nursing care will be assigned to either the PREPARED Trial intervention or the control (usual care) arm of the study using a covariate constrained randomization procedure. Approximately 400-600 LTC residents aged 65 and older with dementia and/or cognitive impairment will be enrolled in the study and followed for 18 weeks. Residents must be at risk of delirium, delirium-free at baseline and have resided at the facility for at least 2 weeks. Residents who are unable to communicate verbally, have a history of specific psychiatric conditions, or are receiving end-of-life care will be excluded. The PREPARED Trial intervention consists of four main components: a decision tree, an instruction manual, a training package, and a toolkit. Primary study outcomes will be assessed weekly. Functional autonomy and cognitive levels will be assessed at the beginning and end of follow-up, while information pertaining to modifiable delirium risk factors, medical consultations, and facility transfers will be collected retrospectively for the duration of the follow-up period. Primary outcomes will be reported at the level of intervention assignment. All researchers analyzing the data will be blinded to group allocation. DISCUSSION This large-scale intervention study will contribute significantly to the development of evidence-based clinical guidelines for delirium prevention in this frail elderly population, as it will be the first to evaluate the efficacy of a multicomponent delirium prevention program translated into LTC clinical practice on a large scale. TRIAL REGISTRATION NCT03718156 , ClinicalTrials.gov .
Collapse
Affiliation(s)
- Machelle Wilchesky
- Centre for Research in Aging, Donald Berman Maimonides Geriatric Centre, 5795 Ave Caldwell, Montreal, QC, H4W 1W3, Canada.
- Department of Family Medicine, McGill University, 5858 Côte-des-Neiges Road, Montreal, QC, H3S 1Z1, Canada.
- Division of Geriatric Medicine, McGill University, Jewish General Hospital, 3755 Cote St. Catherine Road, Room E-0012, Montreal, QC, H3T 1E2, Canada.
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, 3755 Cote St. Catherine Road, Montreal, QC, H3T 1E2, Canada.
| | - Stephanie A Ballard
- Centre for Research in Aging, Donald Berman Maimonides Geriatric Centre, 5795 Ave Caldwell, Montreal, QC, H4W 1W3, Canada
- Department of Family Medicine, McGill University, 5858 Côte-des-Neiges Road, Montreal, QC, H3S 1Z1, Canada
| | - Philippe Voyer
- Faculty of Nursing Sciences, Laval University, Pavillon Ferdinand-Vandry, 1050 avenue de la Médecine, local 3645, Québec, QC, G1V 0A6, Canada
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 1050 chemin Sainte-Foy, L2-30, Quebec City, QC, G1S 4L8, Canada
| | - Jane McCusker
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Ave W, Montreal, QC, H3A 1A2, Canada
- St. Mary's Research Centre, 3830 Avenue Lacombe, Hayes Pavilion, suite 4720, Montreal, QC, H3T 1M5, Canada
| | - Ovidiu Lungu
- Centre for Research in Aging, Donald Berman Maimonides Geriatric Centre, 5795 Ave Caldwell, Montreal, QC, H4W 1W3, Canada
- Functional Neuroimaging Unit, Centre de recherche de l'Institut universitaire de gériatrie de Montréal, 4565 Queen Mary Rd, Montreal, QC, H3W 1W5, Canada
- Department of Psychiatry, Université de Montréal, Pavillon Roger-Gaudry, Faculté de Medicine, C.P. 6128, succursale Centre-ville, Montreal, QC, H3C 3J7, Canada
| | - Nathalie Champoux
- Faculty of Medicine, Université de Montréal, 2900 Boulevard Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada
| | - T T Minh Vu
- Centre de recherche du CHUM, 91000, rue Saint-Denis, Montréal, QC, H2X 0A9, Canada
| | - Martin G Cole
- Department of Psychiatry, McGill University, Ludmer Research & Training Building, 1033 Pine Avenue West, Montreal, QC, H3A 1A, Canada
| | - Johanne Monette
- Division of Geriatric Medicine, McGill University, Jewish General Hospital, 3755 Cote St. Catherine Road, Room E-0012, Montreal, QC, H3T 1E2, Canada
| | - Antonio Ciampi
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Ave W, Montreal, QC, H3A 1A2, Canada
- St. Mary's Research Centre, 3830 Avenue Lacombe, Hayes Pavilion, suite 4720, Montreal, QC, H3T 1M5, Canada
| | - Eric Belzile
- St. Mary's Research Centre, 3830 Avenue Lacombe, Hayes Pavilion, suite 4720, Montreal, QC, H3T 1M5, Canada
| | - Pierre-Hugues Carmichael
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 1050 chemin Sainte-Foy, L2-30, Quebec City, QC, G1S 4L8, Canada
| | - Ted McConnell
- Division of General Internal Medicine, McGill University, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada
| |
Collapse
|
16
|
Plante-Lepage R, Voyer P, Carmichael PH, Kröger E. A nursing mentoring programme on non-pharmacological interventions against BPSD: Effectiveness and use of antipsychotics-A retrospective, before-after study. Nurs Open 2021; 9:181-188. [PMID: 34612586 PMCID: PMC8685876 DOI: 10.1002/nop2.1042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/19/2021] [Accepted: 08/04/2021] [Indexed: 11/18/2022] Open
Abstract
Behavioural and psychological symptoms of dementia (BPSD) are common and have significant implications for patients and caregivers. Non‐pharmacological interventions (NPI) have shown to be effective in the management of BPSD. However, the use of antipsychotics to treat BPSD remains ubiquitous. This retrospective, before–after study aimed to examine whether a nurse mentoring programme promoting NPI for BPSD management had a significant association with the use of antipsychotics in older adults with major neurocognitive disorders residing in different settings. Results obtained from the medical files of 134 older adults having benefitted from the mentoring programme demonstrate that this intervention significantly reduced BPSD. The effect on antipsychotics use was modest: a 10% reduction in the use of antipsychotics has been observed among patients for which the NPI were effective. However, the use of antipsychotics remained widespread despite the nursing recommendations of the mentoring team of the Center of Excellence on Aging in Quebec (CEVQ).
Collapse
Affiliation(s)
| | - Philippe Voyer
- Faculté des Sciences Infirmières, Université Laval, Laval, QC, Canada.,Centre d'Excellence sur le Vieillissement de Québec, Québec, QC, Canada.,Faculté des Sciences Infirmières, Université Laval, Québec, QC, Canada
| | - Pierre-Hugues Carmichael
- Centre d'Excellence sur le Vieillissement de Québec, Québec, QC, Canada.,Faculté des Sciences Infirmières, Université Laval, Québec, QC, Canada
| | - Edeltraut Kröger
- Centre d'Excellence sur le Vieillissement de Québec, Québec, QC, Canada.,Faculté des Sciences Infirmières, Université Laval, Québec, QC, Canada.,Faculté de Pharmacie, Université Laval, Québec, QC, Canada
| |
Collapse
|
17
|
Lamarre M, Marcotte M, Laurin D, Furrer D, Vedel I, Tourigny A, Giguère A, Carmichael PH, Martines R, Morais J, Kröger E. Discontinuation of bisphosphonates in seniors: a systematic review on health outcomes. Arch Osteoporos 2021; 16:133. [PMID: 34524561 DOI: 10.1007/s11657-021-01000-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 09/05/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE Bisphosphonates are used to treat osteoporosis. Despite their benefits on bone mineral density (BMD) and fractures, they have shown adverse effects, sometimes severe, during chronic use. Taken for several years, they achieve long-term bone retention, making deprescribing feasible. This review aimed to synthesize evidence on the success and health outcomes of deprescribing of bisphosphonates in seniors, aged over 60 years. METHODS The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, including articles in English, French, or German published before July 2020. Eligible studies included seniors having discontinued bisphosphonates and reported on health outcomes; some allowed meta-analyses on fracture risk. RESULTS The review included 9 RCTs and 9 cohort studies of moderate quality. Bisphosphonates were discontinued after 2 to 7 years of use, and BMD or fractures were assessed during follow-up of 0.5 to 5 years. A significant reduction in BMD after discontinuation was observed in 9 of 10 studies. Results on fracture risk after discontinuation are mitigated: 6 RCT extensions showed no increase in the risk of any osteoporotic fractures after discontinuation. Meta-analyses including 4 RCTs showed an increased odds ratio of vertebral fractures of 2.04 (95% CI, 1.39-2.99) among discontinuers. Results from 2 large cohort studies showed no increased risks of any osteoporotic or vertebral fractures, while 2 studies found increased fracture risks. CONCLUSION Bisphosphonates have successfully been discontinued low overall fracture risk after at least 3 years of use, but a risk for decreased BMD and increased vertebral fractures remained.
Collapse
Affiliation(s)
- Marianne Lamarre
- Faculté de médecine, Université Laval, Quebec City, Quebec, Canada
| | - Martine Marcotte
- Centre d'excellence sur le vieillissement de Québec, CIUSSS Capitale Nationale, Quebec City, Quebec, Canada
| | - Danielle Laurin
- Centre d'excellence sur le vieillissement de Québec, CIUSSS Capitale Nationale, Quebec City, Quebec, Canada.,Faculté de pharmacie, Université Laval, Quebec City, Quebec, Canada.,Institut sur le vieillissement et la participation sociale des aînés de l, Université Laval, Quebec City, Quebec, Canada.,Centre de recherche du CHU de Québec, Université Laval, Quebec City, Quebec, Canada.,VITAM Centre de recherche sur la santé durable, Quebec City, Quebec, Canada
| | - Daniela Furrer
- Centre d'excellence sur le vieillissement de Québec, CIUSSS Capitale Nationale, Quebec City, Quebec, Canada
| | - Isabelle Vedel
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - André Tourigny
- Faculté de médecine, Université Laval, Quebec City, Quebec, Canada.,Centre d'excellence sur le vieillissement de Québec, CIUSSS Capitale Nationale, Quebec City, Quebec, Canada.,Institut sur le vieillissement et la participation sociale des aînés de l, Université Laval, Quebec City, Quebec, Canada.,Centre de recherche du CHU de Québec, Université Laval, Quebec City, Quebec, Canada.,VITAM Centre de recherche sur la santé durable, Quebec City, Quebec, Canada
| | - Anik Giguère
- Faculté de médecine, Université Laval, Quebec City, Quebec, Canada.,Centre d'excellence sur le vieillissement de Québec, CIUSSS Capitale Nationale, Quebec City, Quebec, Canada.,Centre de recherche du CHU de Québec, Université Laval, Quebec City, Quebec, Canada.,VITAM Centre de recherche sur la santé durable, Quebec City, Quebec, Canada
| | - Pierre-Hugues Carmichael
- Centre d'excellence sur le vieillissement de Québec, CIUSSS Capitale Nationale, Quebec City, Quebec, Canada.,VITAM Centre de recherche sur la santé durable, Quebec City, Quebec, Canada
| | - Rosa Martines
- Centre d'excellence sur le vieillissement de Québec, CIUSSS Capitale Nationale, Quebec City, Quebec, Canada
| | - José Morais
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Edeltraut Kröger
- Centre d'excellence sur le vieillissement de Québec, CIUSSS Capitale Nationale, Quebec City, Quebec, Canada. .,Faculté de pharmacie, Université Laval, Quebec City, Quebec, Canada. .,Centre de recherche du CHU de Québec, Université Laval, Quebec City, Quebec, Canada. .,VITAM Centre de recherche sur la santé durable, Quebec City, Quebec, Canada. .,Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
| |
Collapse
|
18
|
Tourigny JN, Paquet V, Fortier É, Malo C, Mercier É, Chauny JM, Clark G, Blanchard PG, Boucher V, Carmichael PH, Gariépy JL, Émond M. Predictors of neurosurgical intervention in complicated mild traumatic brain injury patients: a retrospective cohort study. Brain Inj 2021; 35:1267-1274. [PMID: 34488497 DOI: 10.1080/02699052.2021.1972147] [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: 10/20/2022]
Abstract
OBJECTIVES To determine the predicting demographic, clinical and radiological factors for neurosurgical intervention in complicated mild traumatic brain injury (mTBI) patients. METHODS Design: retrospective multicenter cohort study. Participants: patients aged ≥16 presenting to all level-I trauma centers in Quebec between 09/2016 and 12/2017 with mTBI(GCS 13-15) and complication on initial head CT (intracranial hemorrhage/skull fracture). Procedure: Consecutive medical records were reviewed and separated into two groups: no neurosurgical intervention and neurosurgical intervention (NSI). Main outcome: neurosurgical intervention. Analysis: multiple logistic regression model. RESULTS Four hundred and seventy-eight patients were included and 40 underwent NSI. One patient had radiological deterioration but no clinical deterioration prior to surgery. Subdural hemorrhage ≥4 mm width (OR:3.755 [95% CI:1.290-10.928]) and midline shift (OR:7.507 [95% CI: 3.317-16.989]) increased the risk of NSI. Subarachnoid hemorrhage was associated with a lower risk of NSI (OR:0.312 [95% CI: 0.136-0.713]). All other intracranial hemorrhages were not associated with NSI. CONCLUSION Radiological deterioration was not associated with the incidence of NSI. Subdural hemorrhage and midline shift should be predicting factors for neurosurgery. Some patients with isolated findings such as subarachnoid hemorrhage could be safely managed in their original center without being transferred to a level-I trauma center.
Collapse
Affiliation(s)
- Jean-Nicolas Tourigny
- Département de Médicine Familiale et de Médicine d'urgence, Faculté de Médecine, Université Laval, Québec, Canada
| | - Véronique Paquet
- Département de Médicine Familiale et de Médicine d'urgence, Faculté de Médecine, Université Laval, Québec, Canada
| | - Émile Fortier
- Département de Médicine Familiale et de Médicine d'urgence, Faculté de Médecine, Université Laval, Québec, Canada
| | - Christian Malo
- Département de Médicine Familiale et de Médicine d'urgence, Faculté de Médecine, Université Laval, Québec, Canada.,Chu de Québec - Université Laval, Québec, Canada
| | - Éric Mercier
- Département de Médicine Familiale et de Médicine d'urgence, Faculté de Médecine, Université Laval, Québec, Canada.,Chu de Québec - Université Laval, Québec, Canada.,Vitam - Centre de Recherche en Santé Durable, Québec, Canada
| | | | | | - Pierre-Gilles Blanchard
- Département de Médicine Familiale et de Médicine d'urgence, Faculté de Médecine, Université Laval, Québec, Canada.,Chu de Québec - Université Laval, Québec, Canada.,Vitam - Centre de Recherche en Santé Durable, Québec, Canada
| | - Valérie Boucher
- Chu de Québec - Université Laval, Québec, Canada.,Vitam - Centre de Recherche en Santé Durable, Québec, Canada.,Centre d'excellence Sur le Vieillissement de Québec, Québec, Canada
| | | | | | - Marcel Émond
- Département de Médicine Familiale et de Médicine d'urgence, Faculté de Médecine, Université Laval, Québec, Canada.,Chu de Québec - Université Laval, Québec, Canada.,Vitam - Centre de Recherche en Santé Durable, Québec, Canada.,Centre d'excellence Sur le Vieillissement de Québec, Québec, Canada
| |
Collapse
|
19
|
Baril L, Nguyen E, Dufresne-Santerre L, Émond V, Émond M, Berthelot S, Gagnon AP, Nadeau A, Carmichael PH, Mercier E. Pain induced by investigations and procedures commonly administered to older adults in the emergency department: a prospective cohort study. Emerg Med J 2021; 38:825-829. [PMID: 34344731 DOI: 10.1136/emermed-2020-210535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 07/16/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND This study aimed to assess the level of pain induced by common interventions performed in older adults consulting to the ED. METHODS We conducted a prospective multicentre observational cohort study in two academic EDs (Quebec City, Canada) between June 2018 and December 2019. A convenience sample of well-oriented and haemodynamically stable older adults (≥65 years old) who underwent at least two interventions during their ED stay was recruited. The level of pain was assessed using an 11-point Numerous Rating Scale (NRS) and is presented using median and IQR or categorised as no pain (0), mild (1-3), moderate (4-6) or severe pain (7-10). RESULTS A total of 318 patients were included. The mean age was 77.8±8.0 years old and 54.4% were female . The number of pain assessments per intervention ranged between 22 (urinary catheterisation) and 240 (intravenous catheter). All imaging investigations (X-rays, CT and bedside ultrasound) were associated with a median level of pain of 0. The median level of pain for other interventions was as follows: blood samplings (n=231, NRS 1 (IQR 0-3)), intravenous catheters (n=240, NRS 2 (IQR 0-4)), urinary catheterisations (n=22, NRS 4.5 (IQR 2-6)), cervical collars (n=50, NRS 5 (IQR 0-8)) and immobilisation mattresses (n=34, NRS 5 (IQR 0-8)). Urinary catheterisations (63.8%), cervical collars (56.0%) and immobilisation mattresses (52.9%) frequently induced moderate or severe pain. CONCLUSIONS Most interventions administered to older adults in the ED are associated with no or low pain intensity. However, urinary catheterisation and spinal motion restriction devices are frequently associated with moderate or severe pain.
Collapse
Affiliation(s)
- Laurence Baril
- Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Elisabeth Nguyen
- Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
| | | | - Virginie Émond
- Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Marcel Émond
- Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada.,Emergency Department, CHU de Québec - Université Laval, Quebec City, Quebec, Canada
| | - Simon Berthelot
- Emergency Department, CHU de Québec - Université Laval, Quebec City, Quebec, Canada.,Axe Santé des Populations et Pratiques Optimales en Santé, Unité de recherche en Traumatologie - Urgences - Soins Intensifs, Centre de recherche du CHU de Québec - Université Laval, Quebec City, Quebec, Canada
| | - Ann-Pier Gagnon
- Axe Santé des Populations et Pratiques Optimales en Santé, Unité de recherche en Traumatologie - Urgences - Soins Intensifs, Centre de recherche du CHU de Québec - Université Laval, Quebec City, Quebec, Canada
| | - Alexandra Nadeau
- Axe Santé des Populations et Pratiques Optimales en Santé, Unité de recherche en Traumatologie - Urgences - Soins Intensifs, Centre de recherche du CHU de Québec - Université Laval, Quebec City, Quebec, Canada.,VITAM - Centre de recherche en santé durable de l'Université Laval, Quebec City, Quebec, Canada
| | | | - Eric Mercier
- Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada .,VITAM - Centre de recherche en santé durable de l'Université Laval, Quebec City, Quebec, Canada
| |
Collapse
|
20
|
Ho JK, Moriarty F, Manly JJ, Larson EB, Evans DA, Rajan KB, Hudak EM, Hassan L, Liu E, Sato N, Hasebe N, Laurin D, Carmichael PH, Nation DA. Blood-Brain Barrier Crossing Renin-Angiotensin Drugs and Cognition in the Elderly: A Meta-Analysis. Hypertension 2021; 78:629-643. [PMID: 34148364 DOI: 10.1161/hypertensionaha.121.17049] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [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: 11/16/2022]
Abstract
[Figure: see text].
Collapse
Affiliation(s)
- Jean K Ho
- Institute for Memory Impairments and Neurological Disorders (J.K.H., D.A.N.), University of California, Irvine
| | - Frank Moriarty
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin (F.M.).,The Irish Longitudinal Study on Ageing, Trinity College Dublin, Ireland (F.M.)
| | - Jennifer J Manly
- Department of Neurology, Gertrude H. Sergievsky Center, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York (J.J.M.)
| | - Eric B Larson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA (E.B.L.)
| | - Denis A Evans
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL (D.A.E., K.B.R.)
| | - Kumar B Rajan
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL (D.A.E., K.B.R.)
| | - Elizabeth M Hudak
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa (E.M.H.)
| | - Lamiaa Hassan
- Institute of Medical Epidemiology, Biometrics and Informatics, Interdisciplinary Center for Health Sciences, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Saxony-Anhalt, Germany (L.H.)
| | - Enwu Liu
- Mary MacKillop Institute for Health Research, Australian Catholic University (E.L.)
| | - Nobuyuki Sato
- Department of Cardiovascular Medicine, Asahikawa Medical University, Japan (N.S., N.H.)
| | - Naoyuki Hasebe
- Department of Cardiovascular Medicine, Asahikawa Medical University, Japan (N.S., N.H.)
| | - Danielle Laurin
- Centre d'excellence sur le vieillissement de Québec, Centre de recherche du CHU de Québec and VITAM-Centre de recherche en santé durable, Canada (D.L., P-H.C.)
| | - Pierre-Hugues Carmichael
- Centre d'excellence sur le vieillissement de Québec, Centre de recherche du CHU de Québec and VITAM-Centre de recherche en santé durable, Canada (D.L., P-H.C.)
| | - Daniel A Nation
- Institute for Memory Impairments and Neurological Disorders (J.K.H., D.A.N.), University of California, Irvine.,Department of Psychological Science (D.A.N.), University of California, Irvine
| |
Collapse
|
21
|
Landreville P, Gosselin P, Grenier S, Carmichael PH. Self-help guided by trained lay providers for generalized anxiety disorder in older adults: study protocol for a randomized controlled trial. BMC Geriatr 2021; 21:324. [PMID: 34022795 PMCID: PMC8140311 DOI: 10.1186/s12877-021-02221-x] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/15/2021] [Indexed: 12/03/2022] Open
Abstract
Background Only a small proportion of older patients with generalized anxiety disorder (GAD) seek professional help. Difficulties in accessing treatment may contribute to this problem. Guided self-help based on the principles of cognitive-behavioral therapy (GSH-CBT) is one way of promoting access to psychological treatment. Moreover, because the therapist’s role in GSH-CBT is limited to supporting the patient, this role could be assumed by trained and supervised lay providers (LPs) instead of licensed providers. The main goal of this study is to evaluate the efficacy of GSH-CBT guided by LPs for primary threshold or subthreshold GAD in older adults. Methods We will conduct a multisite randomized controlled trial comparing an experimental group receiving GSH-CBT guided by LPs (n = 45) to a wait-list control group (n = 45). Treatment will last 15 weeks and will be based on a participant’s manual. Weekly telephone sessions with LPs (30 min maximum) will be limited to providing support. Data will be obtained through clinician evaluations and self-assessment questionnaires. Primary outcomes will be the tendency to worry and severity of GAD symptoms. Secondary outcomes will be anxiety symptoms, sleep difficulties, functional deficit, diagnosis of GAD, and cognitive difficulties. For the experimental group, measurements will take place at pre- and post-treatment and at 6 and 12 months post-treatment. For the control group, three evaluations are planned: two pre-treatment evaluations (before and after the waiting period) and after receiving treatment (post-treatment). The efficacy of GSH-CBT will be established by comparing the change in the two groups on the primary outcomes. Discussion This project will provide evidence on the efficacy of a novel approach to treat GAD in older adults. If effective, it could be implemented on a larger scale and provide many older adults with much needed mental health treatment through an expanded workforce. Trial registration The trial was registered at ClinicalTrials.gov, number NCT03768544, on December 7, 2018.
Collapse
Affiliation(s)
- Philippe Landreville
- School of Psychology, Université Laval, 2325 rue des Bibliothèques, Quebec City, Quebec, G1V 0A6, Canada. .,Centre d'Excellence sur le Vieillissement de Québec, Quebec City, Canada. .,VITAM - Centre de Recherche en Santé Durable, Quebec City, Canada. .,Centre de Recherche du Centre Hospitalier Universitaire de Québec-Université Laval, Quebec City, Canada.
| | - Patrick Gosselin
- Department of Psychology, Université de Sherbrooke, Sherbrooke, Canada.,Institut Universitaire de Première Ligne en Santé et Services Sociaux (IUPLSSS), Sherbrooke, Canada
| | - Sébastien Grenier
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada.,Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), Montreal, Canada
| | | |
Collapse
|
22
|
Corbeil O, Corbeil S, Dorval M, Carmichael PH, Giroux I, Jacques C, Demers MF, Roy MA. Problem Gambling Associated with Aripiprazole: A Nested Case-Control Study in a First-Episode Psychosis Program. CNS Drugs 2021; 35:461-468. [PMID: 33713298 DOI: 10.1007/s40263-021-00801-4] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Aripiprazole has been linked to cases of problem gambling (PBG), but evidence supporting this association remains preliminary. Additionally, data specific to PBG in individuals with first-episode psychosis (FEP) receiving aripiprazole are limited to a few case reports, even though aripiprazole is widely used among this population that might be especially vulnerable to PBG. METHODS To examine this association, a nested case-control study was conducted in a cohort of 219 patients followed at a FEP program located in the Quebec City, Quebec, Canada, metropolitan area. Fourteen cases meeting the PBG criteria according to the Problem Gambling Severity Index were identified and matched for gender and index date to 56 control subjects. RESULTS In the univariable conditional logistic regression analysis, the use of aripiprazole was associated with an increased risk of PBG (odds ratio [OR] 15.2; 95% confidence interval [CI] 2.1-670.5). Cases were more likely to have a prior gambling history (either recreational or problematic) than controls at admittance in the program; they were also more frequently in a relationship and employed. After adjustment for age, relationship status, employment and Cluster B personality disorders, the use of aripiprazole remained associated with an increased risk of PBG (OR 8.6 [95% CI 1.5-227.2]). CONCLUSIONS Findings from this study suggest that FEP patients with a gambling history, problematic or not, may be at increased risk of developing PBG when receiving aripiprazole. They also highlight the importance of systematically screening for PBG all individuals with psychotic disorders, as this comorbidity hinders recovery. While the results also add credence to a causal association between aripiprazole and PBG, further prospective studies are needed to address some of the limitations of this present study.
Collapse
Affiliation(s)
- Olivier Corbeil
- Faculté de pharmacie, Université Laval, 1050, avenue de la Médecine, Québec, QC, G1V 0A6, Canada. .,Clinique Notre-Dame des Victoires, Institut universitaire en santé mentale de Québec, 2601, chemin de la Canardière, Québec, QC, G1J 2G3, Canada.
| | - Stéphanie Corbeil
- Faculté de pharmacie, Université Laval, 1050, avenue de la Médecine, Québec, QC, G1V 0A6, Canada.,Centre hospitalier universitaire de Sherbrooke, 375, rue Argyll, Sherbrooke, QC, J1J 3H5, Canada
| | - Michel Dorval
- Faculté de pharmacie, Université Laval, 1050, avenue de la Médecine, Québec, QC, G1V 0A6, Canada.,Centre de recherche du CHU de Québec-Université Laval, 1050, chemin Ste-Foy, Québec, QC, G1S 4L8, Canada.,Centre de recherche du CISSS Chaudière-Appalaches, 143, rue Wolfe, Lévis, QC, G6V 3Z1, Canada
| | - Pierre-Hugues Carmichael
- Centre d'excellence sur le vieillissement de Québec, 1050, chemin Sainte-Foy, Québec, QC, G1S 4L8, Canada
| | - Isabelle Giroux
- École de psychologie, Université Laval, 2325, rue des Bibliothèques, Québec, QC, G1V 0A6, Canada.,Centre québécois d'excellence pour la prévention et le traitement du jeu, 2325, rue des Bibliothèques, Québec, QC, G1V 0A6, Canada
| | - Christian Jacques
- École de psychologie, Université Laval, 2325, rue des Bibliothèques, Québec, QC, G1V 0A6, Canada.,Centre québécois d'excellence pour la prévention et le traitement du jeu, 2325, rue des Bibliothèques, Québec, QC, G1V 0A6, Canada
| | - Marie-France Demers
- Faculté de pharmacie, Université Laval, 1050, avenue de la Médecine, Québec, QC, G1V 0A6, Canada.,Clinique Notre-Dame des Victoires, Institut universitaire en santé mentale de Québec, 2601, chemin de la Canardière, Québec, QC, G1J 2G3, Canada.,Centre de recherche CERVO, 2601, chemin de la Canardière, Québec, QC, G1J 2G3, Canada
| | - Marc-André Roy
- Clinique Notre-Dame des Victoires, Institut universitaire en santé mentale de Québec, 2601, chemin de la Canardière, Québec, QC, G1J 2G3, Canada.,Centre de recherche CERVO, 2601, chemin de la Canardière, Québec, QC, G1J 2G3, Canada.,Département de psychiatrie et neurosciences, Faculté de médecine, Université Laval, 1050, avenue de la Médecine, Québec, QC, G1V 0A6, Canada
| |
Collapse
|
23
|
Parrott MD, Carmichael PH, Laurin D, Greenwood CE, Anderson ND, Ferland G, Gaudreau P, Belleville S, Morais JA, Kergoat MJ, Fiocco AJ. The Association Between Dietary Pattern Adherence, Cognitive Stimulating Lifestyle, and Cognitive Function Among Older Adults From the Quebec Longitudinal Study on Nutrition and Successful Aging. J Gerontol B Psychol Sci Soc Sci 2021; 76:444-450. [PMID: 33063101 DOI: 10.1093/geronb/gbaa178] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES This study examined the effect of dietary patterns and engagement in cognitive stimulating lifestyle (CSL) behaviors on the trajectory of global cognition, executive function (EF), and verbal episodic memory (VEM). METHODS Western and prudent dietary patterns were empirically derived using food frequency questionnaire responses from 350 community-dwelling older adults (mean age: 73.7 years) participating in the Quebec Longitudinal Study on Nutrition and Successful Aging. CSL was represented by a binary composite indicator based on education, occupational complexity, and social engagement. Global cognition, EF, and VEM were assessed prospectively. RESULTS Primary effect models revealed an association between higher Western dietary pattern score and a greater rate of decline in global cognition and EF. Higher Western dietary pattern adherence was also associated with poorer baseline VEM. Primary effect models also revealed that CSL was independently associated with baseline global cognition and EF. Effect modification models suggested an interactive effect between Western dietary pattern and CLS on global cognition only. No associations were found for prudent dietary pattern score. DISCUSSION Contributing to existing research supporting the negative impact of consuming an unhealthy diet on cognitive function, the current study suggests increased vulnerability among older adults who do not engage in a CSL. These findings can inform the development of lifestyle intervention programs that target brain health in later adulthood.
Collapse
Affiliation(s)
| | - Pierre-Hugues Carmichael
- Centre d'excellence sur le vieillissement de Québec, Centre de recherche du CHU de Québec, Canada.,Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Canada
| | - Danielle Laurin
- Centre d'excellence sur le vieillissement de Québec, Centre de recherche du CHU de Québec, Canada.,Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Canada
| | - Carol E Greenwood
- Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada.,Department of Nutritional Sciences, University of Toronto, Ontario, Canada
| | - Nicole D Anderson
- Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada.,Departments of Psychiatry and Psychology, University of Toronto, Ontario, Canada
| | - Guylaine Ferland
- Département de nutrition, Université de Montréal, Quebec, Canada.,Research Center, Montreal Heart Institute, Quebec, Canada
| | - Pierrette Gaudreau
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Quebec, Canada.,Département de médecine, Université de Montréal, Quebec, Canada
| | - Sylvie Belleville
- Centre de recherche, Institut universitaire de gériatrie de Montréal, CIUSSS du Centre-sud-de-l'Île-de-Montréal, Quebec, Canada
| | - José A Morais
- School of Dietetics and Human Nutrition, McGill University, Montréal, Quebec, Canada.,Division of Geriatric Medicine, McGill University, Montréal, Quebec, Canada
| | - Marie-Jeanne Kergoat
- Département de médecine, Université de Montréal, Quebec, Canada.,Centre de recherche, Institut universitaire de gériatrie de Montréal, CIUSSS du Centre-sud-de-l'Île-de-Montréal, Quebec, Canada
| | | |
Collapse
|
24
|
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.
Collapse
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
| |
Collapse
|
25
|
Giguère A, Zomahoun HTV, Carmichael PH, Uwizeye CB, Légaré F, Grimshaw JM, Gagnon MP, Auguste DU, Massougbodji J. Printed educational materials: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev 2020; 8:CD004398. [PMID: 32748975 PMCID: PMC8475791 DOI: 10.1002/14651858.cd004398.pub4] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Printed educational materials are widely used dissemination strategies to improve the quality of healthcare professionals' practice and patient health outcomes. Traditionally they are presented in paper formats such as monographs, publication in peer-reviewed journals and clinical guidelines. This is the fourth update of the review. OBJECTIVES To assess the effect of printed educational materials (PEMs) on the practice of healthcare professionals and patient health outcomes. To explore the influence of some of the characteristics of the printed educational materials (e.g. source, content, format) on their effect on healthcare professionals' practice and patient health outcomes. SEARCH METHODS We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), HealthStar, CINAHL, ERIC, CAB Abstracts, Global Health, and EPOC Register from their inception to 6 February 2019. We checked the reference lists of all included studies and relevant systematic reviews. SELECTION CRITERIA We included randomised trials (RTs), controlled before-after studies (CBAs) and interrupted time series studies (ITSs) that evaluated the impact of PEMs on healthcare professionals' practice or patient health outcomes. We included three types of comparisons: (1) PEM versus no intervention, (2) PEM versus single intervention, (3) multifaceted intervention where PEM is included versus multifaceted intervention without PEM. Any objective measure of professional practice (e.g. prescriptions for a particular drug), or patient health outcomes (e.g. blood pressure) were included. DATA COLLECTION AND ANALYSIS Two reviewers undertook data extraction independently. Disagreements were resolved by discussion. For analyses, we grouped the included studies according to study design, type of outcome and type of comparison. For controlled trials, we reported the median effect size for each outcome within each study, the median effect size across outcomes for each study and the median of these effect sizes across studies. Where data were available, we re-analysed the ITS studies by converting all data to a monthly basis and estimating the effect size from the change in the slope of the regression line between before and after implementation of the PEM. We reported median changes in slope for each outcome, for each study, and then across studies. We standardised all changes in slopes by their standard error, allowing comparisons and combination of different outcomes. We categorised each PEM according to potential effects modifiers related to the source of the PEMs, the channel used for their delivery, their content, and their format. We assessed the risks of bias of all the included studies. MAIN RESULTS We included 84 studies: 32 RTs, two CBAs and 50 ITS studies. Of the 32 RTs, 19 were cluster RTs that used various units of randomisation, such as practices, health centres, towns, or areas. The majority of the included studies (82/84) compared the effectiveness of PEMs to no intervention. Based on the RTs that provided moderate-certainty evidence, we found that PEMs distributed to healthcare professionals probably improve their practice, as measured with dichotomous variables, compared to no intervention (median absolute risk difference (ARD): 0.04; interquartile range (IQR): 0.01 to 0.09; 3,963 healthcare professionals randomised within 3073 units). We could not confirm this finding using the evidence gathered from continuous variables (standardised mean difference (SMD): 0.11; IQR: -0.16 to 0.52; 1631 healthcare professionals randomised within 1373 units ), from the ITS studies (standardised median change in slope = 0.69; 35 studies), or from the CBA study because the certainty of this evidence was very low. We also found, based on RTs that provided moderate-certainty evidence, that PEMs distributed to healthcare professionals probably make little or no difference to patient health as measured using dichotomous variables, compared to no intervention (ARD: 0.02; IQR: -0.005 to 0.09; 935,015 patients randomised within 959 units). The evidence gathered from continuous variables (SMD: 0.05; IQR: -0.12 to 0.09; 6,737 patients randomised within 594 units) or from ITS study results (standardised median change in slope = 1.12; 8 studies) do not strengthen these findings because the certainty of this evidence was very low. Two studies (a randomised trial and a CBA) compared a paper-based version to a computerised version of the same PEM. From the RT that provided evidence of low certainty, we found that PEM in computerised versions may make little or no difference to professionals' practice compared to PEM in printed versions (ARD: -0.02; IQR: -0.03 to 0.00; 139 healthcare professionals randomised individually). This finding was not strengthened by the CBA study that provided very low certainty evidence (SMD: 0.44; 32 healthcare professionals). The data gathered did not allow us to conclude which PEM characteristics influenced their effectiveness. The methodological quality of the included studies was variable. Half of the included RTs were at risk of selection bias. Most of the ITS studies were conducted retrospectively, without prespecifying the expected effect of the intervention, or acknowledging the presence of a secular trend. AUTHORS' CONCLUSIONS The results of this review suggest that, when used alone and compared to no intervention, PEMs may slightly improve healthcare professionals' practice outcomes and patient health outcomes. The effectiveness of PEMs compared to other interventions, or of PEMs as part of a multifaceted intervention, is uncertain.
Collapse
Affiliation(s)
- Anik Giguère
- Department of Family Medicine and Emergency Medicine, Laval University, Québec, Canada
- VITAM Research center on Sustainable Health, Quebec, Canada
| | - Hervé Tchala Vignon Zomahoun
- Health and Social Services Systems, Knowledge Translation and Implementation Component of the SPOR-SUPPORT Unit of Québec, Centre de recherche sur les soins et les services de première ligne - Université Laval, Quebec, Canada
| | | | - Claude Bernard Uwizeye
- Laval University Research Center on Primary Health Care and Services (CERSSPL-UL), Québec, Canada
| | - France Légaré
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL), Université Laval, Quebec, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Marie-Pierre Gagnon
- Population Health and Optimal Health Practices Research Unit, CHU de Québec - Université Laval Research Centre, Québec City, Canada
| | - David U Auguste
- Département de médecine familiale et de médecine d'urgence, Université Laval, Québec, Canada
| | - José Massougbodji
- Health and Social Services Systems, Knowledge Translation and Implementation Component of the SPOR-SUPPORT Unit of Québec, Quebec SPOR-SUPPORT Unit, Québec, Canada
| |
Collapse
|
26
|
Duchaine CS, Talbot D, Nafti M, Giguère Y, Dodin S, Tourigny A, Carmichael PH, Laurin D. Vitamin D status, cognitive decline and incident dementia: the Canadian Study of Health and Aging. Can J Public Health 2020; 111:312-321. [PMID: 32016921 DOI: 10.17269/s41997-019-00290-5] [Citation(s) in RCA: 14] [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] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 12/19/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Vitamin D could prevent cognitive decline because of its neuroprotective, anti-inflammatory and antioxidant properties. This study aimed to evaluate the associations of plasma 25-hydroxyvitamin D (25(OH)D) concentrations with global cognitive function and incident dementia, including Alzheimer's disease (AD). METHODS The Canadian Study of Health and Aging is a 10-year cohort study of a representative sample of individuals aged 65 years or older. A total of 661 subjects initially without dementia with frozen blood samples and follow-up data were included. Global cognitive function was measured using the validated Modified Mini-Mental State (3MS) examination. A consensus diagnosis of all-cause dementia and AD was made between the physician and the neuropsychologist according to published criteria. Cognitive decline for a 5-year increase in age at specific 25(OH)D concentrations was obtained using linear mixed models with repeated measures. Hazard ratios of incident dementia and AD were obtained using semi-parametric proportional hazards models with age as time scale. RESULTS Over a mean follow-up of 5.4 years, 141 subjects developed dementia of which 100 were AD. Overall, no significant association was found between 25(OH)D and cognitive decline, dementia or AD. Higher 25(OH)D concentrations were associated with an increased risk of dementia and AD in women, but not in men. CONCLUSION This study does not support a protective effect of vitamin D status on cognitive function. Further research is needed to clarify the relation by sex.
Collapse
Affiliation(s)
- Caroline S Duchaine
- Centre d'excellence sur le vieillissement de Québec, 1050 Chemin Sainte-Foy, Local L2-32, Quebec, QC, G1S 4L8, Canada.,CHU de Québec-Université Laval Research Centre, Quebec, QC, Canada.,Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec, QC, Canada.,Institut sur le vieillissement et la participation sociale des aînés de l'Université Laval, Quebec, Canada.,Centre de recherche sur les soins et les services de première ligne de l'Université Laval, CIUSSS-CN, Quebec, QC, Canada
| | - Denis Talbot
- Centre d'excellence sur le vieillissement de Québec, 1050 Chemin Sainte-Foy, Local L2-32, Quebec, QC, G1S 4L8, Canada.,CHU de Québec-Université Laval Research Centre, Quebec, QC, Canada.,Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Mohamed Nafti
- Centre d'excellence sur le vieillissement de Québec, 1050 Chemin Sainte-Foy, Local L2-32, Quebec, QC, G1S 4L8, Canada.,Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Yves Giguère
- CHU de Québec-Université Laval Research Centre, Quebec, QC, Canada.,Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Sylvie Dodin
- CHU de Québec-Université Laval Research Centre, Quebec, QC, Canada.,Faculty of Medicine, Laval University, Quebec, QC, Canada.,Institut sur la nutrition et les aliments fonctionnels, Laval University, Quebec, Canada
| | - André Tourigny
- Centre d'excellence sur le vieillissement de Québec, 1050 Chemin Sainte-Foy, Local L2-32, Quebec, QC, G1S 4L8, Canada.,CHU de Québec-Université Laval Research Centre, Quebec, QC, Canada.,Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec, QC, Canada.,Institut sur le vieillissement et la participation sociale des aînés de l'Université Laval, Quebec, Canada.,Centre de recherche sur les soins et les services de première ligne de l'Université Laval, CIUSSS-CN, Quebec, QC, Canada
| | - Pierre-Hugues Carmichael
- Centre d'excellence sur le vieillissement de Québec, 1050 Chemin Sainte-Foy, Local L2-32, Quebec, QC, G1S 4L8, Canada.,CHU de Québec-Université Laval Research Centre, Quebec, QC, Canada.,Centre de recherche sur les soins et les services de première ligne de l'Université Laval, CIUSSS-CN, Quebec, QC, Canada
| | - Danielle Laurin
- Centre d'excellence sur le vieillissement de Québec, 1050 Chemin Sainte-Foy, Local L2-32, Quebec, QC, G1S 4L8, Canada. .,CHU de Québec-Université Laval Research Centre, Quebec, QC, Canada. .,Institut sur le vieillissement et la participation sociale des aînés de l'Université Laval, Quebec, Canada. .,Centre de recherche sur les soins et les services de première ligne de l'Université Laval, CIUSSS-CN, Quebec, QC, Canada. .,Institut sur la nutrition et les aliments fonctionnels, Laval University, Quebec, Canada. .,Faculty of Pharmacy, Laval University, Quebec, QC, Canada.
| |
Collapse
|
27
|
Tremblay G, Carmichael PH, Maziade J, Grégoire M. Detection of Residents With Progress Issues Using a Keyword-Specific Algorithm. J Grad Med Educ 2019; 11:656-662. [PMID: 31871565 PMCID: PMC6919172 DOI: 10.4300/jgme-d-19-00386.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 09/16/2019] [Accepted: 09/17/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The literature suggests that specific keywords included in summative rotation assessments might be an early indicator of abnormal progress or failure. OBJECTIVE This study aims to determine the possible relationship between specific keywords on in-training evaluation reports (ITERs) and subsequent abnormal progress or failure. The goal is to create a functional algorithm to identify residents at risk of failure. METHODS A database of all ITERs from all residents training in accredited programs at Université Laval between 2001 and 2013 was created. An instructional designer reviewed all ITERs and proposed terms associated with reinforcing and underperformance feedback. An algorithm based on these keywords was constructed by recursive partitioning using classification and regression tree methods. The developed algorithm was tuned to achieve 100% sensitivity while maximizing specificity. RESULTS There were 41 618 ITERs for 3292 registered residents. Residents with failure to progress were detected for family medicine (6%, 67 of 1129) and 36 other specialties (4%, 78 of 2163), while the positive predictive values were 23.3% and 23.4%, respectively. The low positive predictive value may be a reflection of residents improving their performance after receiving feedback or a reluctance by supervisors to ascribe a "fail" or "in difficulty" score on the ITERs. CONCLUSIONS Classification and regression trees may be helpful to identify pertinent keywords and create an algorithm, which may be implemented in an electronic assessment system to detect future residents at risk of poor performance.
Collapse
|
28
|
Yadav K, Boucher V, Carmichael PH, Voyer P, Eagles D, Pelletier M, Gouin É, Daoust R, Vu TTM, Berthelot S, Émond M. Serial Ottawa 3DY assessments to detect delirium in older emergency department community dwellers. Age Ageing 2019; 49:130-134. [PMID: 31755527 DOI: 10.1093/ageing/afz144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/11/2019] [Accepted: 10/07/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND delirium is associated with increased morbidity and mortality among older emergency department (ED) patients. When using physician gestalt, delirium is missed in the majority of patients. The Ottawa 3DY (O3DY) has been validated to detect cognitive dysfunction among older ED patients. OBJECTIVES to determine the sensitivity and specificity of serial O3DY assessments to detect delirium in older ED patients. DESIGN a prospective observational multicenter cohort study. SETTING four Quebec EDs. PARTICIPANTS independent or semi-independent older patients (age ≥ 65 years) with an ED stay of at least 8 hours that required hospitalisation. MEASUREMENTS eligible patients were evaluated using serial O3DY assessments at least 6 hours apart. The primary outcome was delirium after at least 8 hours in the ED. The reference standard for delirium assessment was the confusion assessment method (CAM). The sensitivity and specificity of the serial O3DY to detect delirium were calculated. RESULTS we enrolled 301 patients (mean age 77 years, 49.5% male, 3.0% with a history of mild dementia). Thirty patients (10.0%) were CAM positive for delirium. Patients had a median of three O3DY assessments. Serial O3DY evaluations to detect delirium among patients with at least one abnormal O3DY had a sensitivity of 86.7% (95% confidence interval-CI 69.3-96.2%) and a specificity of 44.3% (95%; CI 38.3-50.4%). CONCLUSION serial O3DY testing demonstrates good sensitivity as a screening tool to detect delirium among older adult patients with prolonged ED lengths of stay. Emergency physicians should consider the use of the serial O3DY over clinician gestalt to improve delirium detection.
Collapse
Affiliation(s)
| | - Valérie Boucher
- Centre de recherche sur les soins et les services de première ligne de l’Université Laval, Québec, Canada
- Centre d'excellence sur le vieillissement de Québec, Québec, Canada
- Faculté de Médecine, Université Laval, Québec, Canada
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
| | | | - Philippe Voyer
- Centre de recherche sur les soins et les services de première ligne de l’Université Laval, Québec, Canada
- Centre d'excellence sur le vieillissement de Québec, Québec, Canada
- Faculté des sciences infirmières, Université Laval, Québec, Canada
| | - Debra Eagles
- Department of Emergency Medicine, University of Ottawa, Ottawa, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Mathieu Pelletier
- Centre Intégré de Santé et de Services Sociaux de Lanaudière, Joliette, Canada
| | - Émilie Gouin
- Centre Hospitalier Régional de Trois-Rivières, Trois-Rivières, Canada
- CIUSSS, Trois-Rivières, Canada
| | - Raoul Daoust
- Centre de recherche de l’Hôpital du Sacré-Cœur de Montréal, Montréal, Canada
- Faculté de Médicine, Université de Montréal, Montréal, Canada
- Département Médecine d’Urgence, Hôpital Sacré-Cœur de Montréal, Montreal, Canada
| | - Thien Tuong Minh Vu
- Faculté de Médicine, Université de Montréal, Montréal, Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montréal, Canada
| | - Simon Berthelot
- Faculté de Médecine, Université Laval, Québec, Canada
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Département de Médicine d’Urgence, CHU de Québec-Université Laval, Québec, Canada
| | - Marcel Émond
- Centre de recherche sur les soins et les services de première ligne de l’Université Laval, Québec, Canada
- Centre d'excellence sur le vieillissement de Québec, Québec, Canada
- Faculté de Médecine, Université Laval, Québec, Canada
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Département de Médicine d’Urgence, CHU de Québec-Université Laval, Québec, Canada
| |
Collapse
|
29
|
Boucher V, Lamontagne ME, Lee J, Carmichael PH, Déry J, Émond M. Acceptability of older patients' self-assessment in the Emergency Department (ACCEPTED)-a randomised cross-over pilot trial. Age Ageing 2019; 48:875-880. [PMID: 31297513 DOI: 10.1093/ageing/afz084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 03/08/2019] [Revised: 05/19/2019] [Accepted: 06/13/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND patient self-assessment using electronic tablet could improve the quality of assessment of older Emergency Department(ED) patients. However, the acceptability of this practice remains unknown. OBJECTIVE to compare the acceptability of self-assessment using a tablet in the ED to a standard assessment by a research assistant (RA), according to seniors and their caregivers. DESIGN randomised crossover pilot study. SETTING The Hôpital de l'Enfant-Jésus (CHU de Québec-Université Laval) (2018/05-2018/07). SUBJECTS (1) ED patients aged ≥65, (2) their caregiver, if present. METHODS participants' frailty, cognitive and functional status were assessed with the Clinical Frailty scale, Montreal Cognitive Assessment, and Older American Resources and Services scale and patients self-assessed using a tablet. Test administration order was randomised. The primary outcome, acceptability, was measured using the Treatment Acceptability and Preferences (TAP) scale. Descriptive analyses were performed for sociodemographic variables. TAP scores were adjusted using multivariate linear regression. Thematic content analysis was performed for qualitative data. RESULTS sixty-seven patients were included. Mean age was 75.5 ± 8.0 and 55.2% were women. Adjusted TAP scores for RA evaluation and patient self-assessment were 2.36 and 2.20, respectively (P = 0.08). Patients aged ≥85 showed a difference between the TAP scores (P < 0.05). Qualitative data indicates that this might be attributed to the use of technology. Data from nine caregivers showed a 2.42 mean TAP score for RA evaluation and 2.44 for self-assessment. CONCLUSIONS our results show that older patients believe self-assessment in the ED using an electronic tablet as acceptable as a standard evaluation by a research assistant. Patients aged ≥85 find this practice less acceptable.
Collapse
Affiliation(s)
- Valérie Boucher
- Centre de recherche sur les soins et les services de première ligne de l’Université Laval (CERSSPL-UL)
- Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Québec, Canada
- Faculté de médecine, Université Laval, Québec, Canada
- Centre d’excellence sur le vieillissement de Québec, Québec, Canada
| | - Marie-Eve Lamontagne
- Faculté de médecine, 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
| | - Jacques Lee
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Sunnybrook Health Sciences Center, Toronto, Canada
| | | | - Julien Déry
- Faculté de médecine, 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
| | - Marcel Émond
- Centre de recherche sur les soins et les services de première ligne de l’Université Laval (CERSSPL-UL)
- Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Québec, Canada
- Faculté de médecine, Université Laval, Québec, Canada
- Centre d’excellence sur le vieillissement de Québec, Québec, Canada
| |
Collapse
|
30
|
Nafti M, Sirois C, Kröger E, Carmichael PH, Laurin D. Is Benzodiazepine Use Associated With the Risk of Dementia and Cognitive Impairment–Not Dementia in Older Persons? The Canadian Study of Health and Aging. Ann Pharmacother 2019; 54:219-225. [DOI: 10.1177/1060028019882037] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: The use of benzodiazepines in relation to cognitive decline remains an area of controversy in aging populations. Objective: This study aims to evaluate the risk of cognitive impairment–not dementia (CIND), Alzheimer disease (AD), and all-cause dementia with benzodiazepine use. The effect modification by sex was also investigated. Methods: Data come from the Canadian Study of Health and Aging, a 10-year multicentric study involving 10 263 participants randomly selected, 65 years and older, living in the community and in institutions. Current exposure to benzodiazepines was assessed in a face-to-face interview or self-reported in a questionnaire. Cox proportional hazard regression models, using age as time scale, were conducted to estimate hazard ratios, with adjustment for sex, education, smoking, alcohol intake, depression, physical activity, nonsteroidal anti-inflammatory drug use, and vascular comorbidities. Results: Data sets included 5281 participants for dementia as the outcome, 5015 for AD, and 4187 for CIND. Compared with nonusers, current use of benzodiazepines was associated with an increased risk of CIND (hazard ratio = 1.36; 95% CI = 1.08-1.72) in the simplest model. Results remained similar in the fully adjusted model (hazard ratio = 1.32; 95% CI = 1.04-1.68). There was no association between benzodiazepine use and the risk of dementia or AD. All these effects were similar between men and women. Conclusion and Relevance: Benzodiazepine use in older people from the general population is related to subsequent occurrence of cognitive dysfunction but not implicated in the pathogenesis of dementia or AD. Caution should be exercised when prescribing benzodiazepines to preserve global cognitive function.
Collapse
Affiliation(s)
- Mohamed Nafti
- Centre d’excellence sur le vieillissement de Québec, Centre de recherche du CHU de Québec-Université Laval, Centre de recherche sur les soins et les services de première ligne de l’Université Laval and Institut sur le vieillissement et la participation sociale des aînés de l’Université Laval, Quebec City, QC, Canada
- Laval University, Quebec City, QC, Canada
| | - Caroline Sirois
- Centre d’excellence sur le vieillissement de Québec, Centre de recherche du CHU de Québec-Université Laval, Centre de recherche sur les soins et les services de première ligne de l’Université Laval and Institut sur le vieillissement et la participation sociale des aînés de l’Université Laval, Quebec City, QC, Canada
- Laval University, Quebec City, QC, Canada
| | - Edeltraut Kröger
- Centre d’excellence sur le vieillissement de Québec, Centre de recherche du CHU de Québec-Université Laval, Centre de recherche sur les soins et les services de première ligne de l’Université Laval and Institut sur le vieillissement et la participation sociale des aînés de l’Université Laval, Quebec City, QC, Canada
- Laval University, Quebec City, QC, Canada
| | - Pierre-Hugues Carmichael
- Centre d’excellence sur le vieillissement de Québec, Centre de recherche du CHU de Québec-Université Laval, Centre de recherche sur les soins et les services de première ligne de l’Université Laval and Institut sur le vieillissement et la participation sociale des aînés de l’Université Laval, Quebec City, QC, Canada
| | - Danielle Laurin
- Centre d’excellence sur le vieillissement de Québec, Centre de recherche du CHU de Québec-Université Laval, Centre de recherche sur les soins et les services de première ligne de l’Université Laval and Institut sur le vieillissement et la participation sociale des aînés de l’Université Laval, Quebec City, QC, Canada
- Laval University, Quebec City, QC, Canada
| |
Collapse
|
31
|
Boucher V, Lamontagne ME, Nadeau A, Carmichael PH, Yadav K, Voyer P, Pelletier M, Gouin É, Daoust R, Berthelot S, Morin M, Lemire S, Minh Vu TT, Lee J, Émond M. Unrecognized Incident Delirium in Older Emergency Department Patients. J Emerg Med 2019; 57:535-542. [DOI: 10.1016/j.jemermed.2019.05.024] [Citation(s) in RCA: 14] [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: 08/22/2018] [Revised: 04/30/2019] [Accepted: 05/06/2019] [Indexed: 10/26/2022]
|
32
|
Fournier N, Gariepy C, Prévost JF, Belhumeur V, Fortier É, Carmichael PH, Gariepy JL, Le Sage N, Émond M. Adapting the Canadian CT head rule age criteria for mild traumatic brain injury. Emerg Med J 2019; 36:617-619. [PMID: 31326953 DOI: 10.1136/emermed-2018-208153] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 07/04/2019] [Accepted: 07/07/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE With the ageing population, the prevalence of mild traumatic brain injury (mTBI) among older patients is increasing, and the age criteria of the Canadian CT head rule (CCHR) is challenged by many emergency physicians. We modified the age criteria of the CCHR to evaluate its predictive capacity. METHODS We conducted a retrospective cohort study at a level 1 trauma centre ED of all mTBI patients 65 years old and over with an mTBI between 2010 and 2014. Main outcome was a clinically important brain injury (CIBI) reported on CT. The clinical and radiological data collection was standardised. Univariate analyses were performed to measure the predictive capacities of different age cut-offs at 70, 75 and 80 years old. RESULTS 104 confirmed mTBI were included; CT scan identified 32 (30.8%) CIBI. Sensitivity and specificity (95% CI) of the CCHR were 100% (89.1 to 100) and 4.2% (0.9 to 11.7) for a modified criteria of 70 years old; 100% (89.1 to 100) and 13.9% (6.9 to 24.1) for 75 years old; and 90.6% (75.0 to 98.0) and 23.6% (14.4 to 35.1) for 80 years old. Furthermore, modifying the age criteria to 75 years old showed a reduction of CT up to 25% (n=10/41) among the individuals aged 65-74 without missing CIBI. CONCLUSION Adjusting the age criteria of the Canadian CT head rule to 75 years old could be safe while reducing radiation and ED resources. A future prospective study is suggested to confirm the proposed modification.
Collapse
Affiliation(s)
- Nicolas Fournier
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec - Université Laval, Quebec, Canada.,Département de médecine familiale et de médecine d'urgence, Université Laval, Quebec, Canada
| | - Charles Gariepy
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec - Université Laval, Quebec, Canada.,Département de médecine familiale et de médecine d'urgence, Université Laval, Quebec, Canada
| | - Jean-François Prévost
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec - Université Laval, Quebec, Canada.,Département de médecine familiale et de médecine d'urgence, Université Laval, Quebec, Canada
| | - Vincent Belhumeur
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec - Université Laval, Quebec, Canada.,Département de médecine familiale et de médecine d'urgence, Université Laval, Quebec, Canada
| | - Émile Fortier
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec - Université Laval, Quebec, Canada.,Département de médecine familiale et de médecine d'urgence, Université Laval, Quebec, Canada
| | - Pierre-Hugues Carmichael
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Canada
| | - Jean-Luc Gariepy
- Département de radiologie, CHU de Québec - Université Laval, Quebec, Canada
| | - Natalie Le Sage
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec - Université Laval, Quebec, Canada.,Département de médecine familiale et de médecine d'urgence, Université Laval, Quebec, Canada
| | - Marcel Émond
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec - Université Laval, Quebec, Canada.,Département de médecine familiale et de médecine d'urgence, Université Laval, Quebec, Canada.,Centre de Recherche sur les Soins et Services de Première Ligne de l'Université Laval, Québec, Canada
| |
Collapse
|
33
|
Bédard C, Boucher V, Voyer P, Yadav K, Eagles D, Nadeau A, Carmichael PH, Pelletier M, Gouin E, Berthelot S, Daoust R, Laguë A, Gagné AJ, Émond M. Validation of the O3DY French Version (O3DY-F) for the Screening of Cognitive Impairment in Community Seniors in the Emergency Department. J Emerg Med 2019; 57:59-65. [DOI: 10.1016/j.jemermed.2019.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 02/07/2019] [Accepted: 02/10/2019] [Indexed: 12/25/2022]
|
34
|
Medehouenou TCM, Ayotte P, Carmichael PH, Kröger E, Verreault R, Lindsay J, Dewailly É, Tyas SL, Bureau A, Laurin D. Exposure to polychlorinated biphenyls and organochlorine pesticides and risk of dementia, Alzheimer's disease and cognitive decline in an older population: a prospective analysis from the Canadian Study of Health and Aging. Environ Health 2019; 18:57. [PMID: 31200706 PMCID: PMC6570931 DOI: 10.1186/s12940-019-0494-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 05/31/2019] [Indexed: 05/28/2023]
Abstract
BACKGROUND Little attention has been paid to neurotoxicants on the risk of dementia. Exposure to known neurotoxicants such as polychlorinated biphenyls (PCBs) and organochlorine (OC) pesticides is suspected to have adverse cognitive effects in older populations. OBJECTIVE To assess whether plasma concentrations of PCBs and OC pesticides are associated with the risk of cognitive decline, Alzheimer's disease (AD) and of all-cause dementia in the Canadian older population. METHODS Analyses were based on data from the Canadian Study of Health and Aging, a 3-phase, 10-year population-based study of individuals aged 65+ years. Analyses included 669 clinically assessed subjects, of which 156 developed dementia including 108 incident cases of AD. Subjects were screened at each phase with the 100-point Modified Mini-Mental State Examination (3MS), a measurement of global cognitive function. Statistical analyses included Cox proportional hazards model when the outcome was dementia or AD, and a repeated-measure mixed model when the outcome was the 3MS score. RESULTS No association of PCB and OC pesticides with the risk of dementia and AD was observed. Elevated concentrations of PCB congeners nos 118, 153, 156, 163, and OC pesticides 1,1,1-trichloro-2,2-bis(p-chlorophenyl)ethane (p,p'-DDT) and its metabolite 1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene (p,p'-DDE) were significantly associated with cognitive decline as assessed with the 3MS. A posteriori analyses suggested that only p,p'-DDE was significantly related to a higher cognitive decline in time based on the 3MS among incident cases of dementia compared to subjects remaining nondemented. CONCLUSION PCB and OC pesticide plasma concentrations were not related to the incident diagnosis of neither dementia, nor AD. Using the 3MS scores as the outcome, higher concentrations of four PCB congeners and two OC pesticides were associated with lower cognitive performances in subjects. The association of p,p'-DDE with cognitive decline in time in incident cases of dementia merits further investigation.
Collapse
Affiliation(s)
- Thierry Comlan Marc Medehouenou
- Département de Génie d'imagerie médicale et de radiobiologie, École Polytechnique d'Abomey-Calavi, University of Abomey-Calavi, P.O. Box 2009, Cotonou, Abomey-Calavi, Republic of Benin.
- Centre d'excellence sur le vieillissement de Québec, CHU de Québec-Université Laval Research Center, and Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Québec, Canada.
- Faculty of Pharmacy, Laval University, Québec, Canada.
| | - Pierre Ayotte
- Département de médecine sociale et préventive, Faculty of Medicine, Laval University, Québec, Canada
- Axe Santé des populations et pratiques optimales en santé, CHU de Québec-Université Laval Research Center, Québec, Canada
- Laboratoire de toxicologie, Institut national de santé publique du Québec, Québec, Canada
| | - Pierre-Hugues Carmichael
- Centre d'excellence sur le vieillissement de Québec, CHU de Québec-Université Laval Research Center, and Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Québec, Canada
| | - Edeltraut Kröger
- Centre d'excellence sur le vieillissement de Québec, CHU de Québec-Université Laval Research Center, and Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Québec, Canada
- Faculty of Pharmacy, Laval University, Québec, Canada
| | - René Verreault
- Centre d'excellence sur le vieillissement de Québec, CHU de Québec-Université Laval Research Center, and Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Québec, Canada
- Département de médecine sociale et préventive, Faculty of Medicine, Laval University, Québec, Canada
- Axe Santé des populations et pratiques optimales en santé, CHU de Québec-Université Laval Research Center, Québec, Canada
- Institut sur le vieillissement et la participation sociale des aînés, Université Laval, Québec, Canada
| | - Joan Lindsay
- Département de médecine sociale et préventive, Faculty of Medicine, Laval University, Québec, Canada
- Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Éric Dewailly
- Département de médecine sociale et préventive, Faculty of Medicine, Laval University, Québec, Canada
- Axe Santé des populations et pratiques optimales en santé, CHU de Québec-Université Laval Research Center, Québec, Canada
- Laboratoire de toxicologie, Institut national de santé publique du Québec, Québec, Canada
| | - Suzanne L Tyas
- School of Public Health and Health Systems, and Department of Psychology, University of Waterloo, Waterloo, Canada
| | - Alexandre Bureau
- Département de médecine sociale et préventive, Faculty of Medicine, Laval University, Québec, Canada
- Centre de recherche de l'Institut universitaire en santé mentale de Québec, Québec, Canada
| | - Danielle Laurin
- Centre d'excellence sur le vieillissement de Québec, CHU de Québec-Université Laval Research Center, and Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Québec, Canada
- Faculty of Pharmacy, Laval University, Québec, Canada
- Axe Santé des populations et pratiques optimales en santé, CHU de Québec-Université Laval Research Center, Québec, Canada
- Institut sur le vieillissement et la participation sociale des aînés, Université Laval, Québec, Canada
| |
Collapse
|
35
|
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.
Collapse
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
| |
Collapse
|
36
|
Wilchesky M, Mueller G, Morin M, Marcotte M, Voyer P, Aubin M, Carmichael PH, Champoux N, Monette J, Giguère A, Durand P, Verreault R, Arcand M, Kröger E. The OptimaMed intervention to reduce inappropriate medications in nursing home residents with severe dementia: results from a quasi-experimental feasibility pilot study. BMC Geriatr 2018; 18:204. [PMID: 30180821 PMCID: PMC6123948 DOI: 10.1186/s12877-018-0895-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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] [Received: 03/15/2018] [Accepted: 08/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medication regimens in nursing home (NH) residents with severe dementia should be frequently reviewed to avoid inappropriate medication, overtreatment and adverse drug events, within a comfort care approach. This study aimed at testing the feasibility of an interdisciplinary knowledge exchange (KE) intervention using a medication review guidance tool categorizing medications as either "generally", "sometimes" or "exceptionally" appropriate for NH residents with severe dementia. METHODS A quasi-experimental feasibility pilot study with 44 participating residents aged 65 years or over with severe dementia was carried out in three NH in Quebec City, Canada. The intervention comprised an information leaflet for residents' families, a 90-min KE session for NH general practitioners (GP), pharmacists and nurses focusing on the medication review guidance tool, a medication review by the pharmacists for participating residents with ensuing team discussion on medication changes, and a post-intervention KE session to obtain feedback from team staff. Medication regimens and levels of pain and of agitation of the participants were evaluated at baseline and at 4 months post-intervention. A questionnaire for team staff explored perceived barriers and facilitators. Statistical differences in measures comparing pre and post-intervention were assessed using paired t-tests and Cochran's-Q tests. RESULTS The KE sessions reached 34 NH team staff (5 GP, 4 pharmacists, 6 heads of care unit and 19 staff nurses). Forty-four residents participated in the study and were followed for a mean of 104 days. The total number of regular medications was 372 pre and 327 post-intervention. The mean number of regular medications per resident was 7.86 pre and 6.81 post-intervention. The odds ratios estimating the risks of using any regular medication or a "sometimes appropriate" medication post-intervention were 0.81 (95% CI: 0.71-0.92) and 0.83 (95% CI: 0.74-0.94), respectively. CONCLUSION A simple KE intervention using a medication review guidance tool categorizing medications as being either "generally", "sometimes" or "exceptionally" appropriate in severe dementia was well received and accompanied by an overall reduction in medication use by NH residents with severe dementia. Levels of agitation were unaffected and there was no clinically significant changes in levels of pain. Staff feedback provided opportunities to improve the intervention.
Collapse
Affiliation(s)
- Machelle Wilchesky
- Department of Family Medicine and Division of Geriatric Medicine, McGill University, 5858, Chemin de la Côte-des-Neiges, Montreal, Quebec, H3S 1Z1, Canada.,Donald Berman Maimonides Centre for Research in Aging, 5795 Caldwell Avenue, Montreal, Quebec, H4W 1W3, Canada
| | - Gerhard Mueller
- Department of Nursing Science and Gerontology, UMIT-The Health & Life Sciences University, Eduard-Wallnoefer-Zentrum 1, A-6060, Hall in Tyrol, Tyrol, Austria
| | - Michèle Morin
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 1050, Chemin Ste-Foy, room L2-30, Quebec City, Quebec, G1S 4L8, Canada.,Laval University, 1050, avenue de la Médecine, Quebec City, Quebec, G1V 0A6, Canada
| | - Martine Marcotte
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 1050, Chemin Ste-Foy, room L2-30, Quebec City, Quebec, G1S 4L8, Canada
| | - Philippe Voyer
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 1050, Chemin Ste-Foy, room L2-30, Quebec City, Quebec, G1S 4L8, Canada.,Laval University, 1050, avenue de la Médecine, Quebec City, Quebec, G1V 0A6, Canada
| | - Michèle Aubin
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 1050, Chemin Ste-Foy, room L2-30, Quebec City, Quebec, G1S 4L8, Canada
| | - Pierre-Hugues Carmichael
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 1050, Chemin Ste-Foy, room L2-30, Quebec City, Quebec, G1S 4L8, Canada
| | - Nathalie Champoux
- Faculté de médecine, Université de Montréal, 2900 Boulevard Edouard-Montpetit, Montreal, Quebec, H3T 1J4, Canada
| | - Johanne Monette
- Division of Geriatric Medicine, McGill University, Jewish General Hospital, 3755 Côte-Ste-Catherine, Montreal, Quebec, H3T 1E2, Canada
| | - Anik Giguère
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 1050, Chemin Ste-Foy, room L2-30, Quebec City, Quebec, G1S 4L8, Canada.,Laval University, 1050, avenue de la Médecine, Quebec City, Quebec, G1V 0A6, Canada
| | - Pierre Durand
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 1050, Chemin Ste-Foy, room L2-30, Quebec City, Quebec, G1S 4L8, Canada.,Laval University, 1050, avenue de la Médecine, Quebec City, Quebec, G1V 0A6, Canada
| | - René Verreault
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 1050, Chemin Ste-Foy, room L2-30, Quebec City, Quebec, G1S 4L8, Canada.,Laval University, 1050, avenue de la Médecine, Quebec City, Quebec, G1V 0A6, Canada
| | - Marcel Arcand
- Centre de recherche sur le vieillissement, affilié à l'Université de Sherbrooke, 1036, rue Belvédère Sud, Sherbrooke, Quebec, J1H 4C4, Canada
| | - Edeltraut Kröger
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 1050, Chemin Ste-Foy, room L2-30, Quebec City, Quebec, G1S 4L8, Canada. .,Laval University, 1050, avenue de la Médecine, Quebec City, Quebec, G1V 0A6, Canada.
| |
Collapse
|
37
|
Giguere AMC, Lawani MA, Fortier-Brochu É, Carmichael PH, Légaré F, Kröger E, Witteman HO, Voyer P, Caron D, Rodríguez C. Tailoring and evaluating an intervention to improve shared decision-making among seniors with dementia, their caregivers, and healthcare providers: study protocol for a randomized controlled trial. Trials 2018; 19:332. [PMID: 29941020 PMCID: PMC6019313 DOI: 10.1186/s13063-018-2697-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 05/17/2018] [Indexed: 11/13/2022] Open
Abstract
Background The increasing prevalence of Alzheimer’s disease and other forms of dementia raises new challenges to ensure that healthcare decisions are informed by research evidence and reflect what is important for seniors and their caregivers. Therefore, we aim to evaluate a tailored intervention to help healthcare providers empower seniors and their caregivers in making health-related decisions. Methods In two phases, we will: (1) design and tailor the intervention; and (2) implement and evaluate it. We will use theory and user-centered design to tailor an intervention comprising a distance professional training program on shared decision-making and five shared decision-making tools dealing with difficult decisions often faced by seniors with dementia and their caregivers. Each tool will be designed in two versions, one for clinicians and one for patients. We will recruit 49 clinicians and 27 senior/caregiver to participate in three cycles of design-evaluation-feedback of each intervention components. Besides think-aloud and interview approaches, users will also complete questionnaires based on the Theory of Planned Behavior to identify the factors most likely to influence their adoption of shared decision-making after exposure to the intervention. We will then modify the intervention by adding/enhancing behavior-change techniques targeting these factors. We will evaluate the effectiveness of this tailored intervention before/after implementation, in a two-armed, clustered randomized trial. We will enroll a convenience sample of six primary care clinics (unit of randomization) in the province of Quebec and recruit the clinicians who practice there (mostly family physicians, nurses, and social workers). These clinics will then be randomized to immediate exposure to the intervention or delayed exposure. Overall, we will recruit 180 seniors with dementia, their caregivers, and their healthcare providers. We will evaluate the impact of the intervention on patient involvement in the decision-making process, decisional comfort, patient and caregiver personal empowerment in relation to their own healthcare, patient quality of life, caregiver burden, and decisional regret. Discussion The intervention will empower patients and their caregivers in their healthcare, by fostering their participation as partners during the decision-making process and by ensuring they make informed decisions congruent with their values and priorities. Trial registration ClinicalTrials.org, NCT02956694. Registered on 31 October 2016. Electronic supplementary material The online version of this article (10.1186/s13063-018-2697-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Anik M C Giguere
- Department of Family Medicine and Emergency Medicine, Laval University, Pavillon Ferdinand-Vandry, room 2881-C, 1050 avenue de la Médecine, Quebec, QC, G1V 0A6, Canada. .,Quebec Centre for Excellence on Aging, St-Sacrement Hospital, Room L2-21, 1050, chemin Sainte-Foy, Quebec City, Quebec, Canada. .,Laval University Research Centre on Primary Care and Services, Quebec City, Quebec, Canada. .,Research Axis of Population Health and Practice-Changing Research Group, CHU de Quebec Research Centre, Quebec city, QC, Canada.
| | - Moulikatou Adouni Lawani
- Department of Family Medicine and Emergency Medicine, Laval University, Pavillon Ferdinand-Vandry, room 2881-C, 1050 avenue de la Médecine, Quebec, QC, G1V 0A6, Canada.,Quebec Centre for Excellence on Aging, St-Sacrement Hospital, Room L2-21, 1050, chemin Sainte-Foy, Quebec City, Quebec, Canada.,Laval University Research Centre on Primary Care and Services, Quebec City, Quebec, Canada
| | - Émilie Fortier-Brochu
- Department of Family Medicine and Emergency Medicine, Laval University, Pavillon Ferdinand-Vandry, room 2881-C, 1050 avenue de la Médecine, Quebec, QC, G1V 0A6, Canada.,Quebec Centre for Excellence on Aging, St-Sacrement Hospital, Room L2-21, 1050, chemin Sainte-Foy, Quebec City, Quebec, Canada.,Laval University Research Centre on Primary Care and Services, Quebec City, Quebec, Canada
| | - Pierre-Hugues Carmichael
- Quebec Centre for Excellence on Aging, St-Sacrement Hospital, Room L2-21, 1050, chemin Sainte-Foy, Quebec City, Quebec, Canada
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Laval University, Pavillon Ferdinand-Vandry, room 2881-C, 1050 avenue de la Médecine, Quebec, QC, G1V 0A6, Canada.,Faculty of Nursing Sciences, Laval University, Pavillon Ferdinand-Vandry, room 2881-C, 1050, avenue de la Médecine, Quebec, QC, G1V 0A6, Canada
| | - Edeltraut Kröger
- Quebec Centre for Excellence on Aging, St-Sacrement Hospital, Room L2-21, 1050, chemin Sainte-Foy, Quebec City, Quebec, Canada.,Research Axis of Population Health and Practice-Changing Research Group, CHU de Quebec Research Centre, Quebec city, QC, Canada.,Faculty of Pharmacy, Laval University, St-Sacrement Hospital, Room L2-30, 1050, Chemin Sainte-Foy, Québec, QC, G1S 4L8, Canada
| | - Holly O Witteman
- Department of Family Medicine and Emergency Medicine, Laval University, Pavillon Ferdinand-Vandry, room 2881-C, 1050 avenue de la Médecine, Quebec, QC, G1V 0A6, Canada.,Quebec Centre for Excellence on Aging, St-Sacrement Hospital, Room L2-21, 1050, chemin Sainte-Foy, Quebec City, Quebec, Canada.,Research Axis of Population Health and Practice-Changing Research Group, CHU de Quebec Research Centre, Quebec city, QC, Canada
| | - Philippe Voyer
- Quebec Centre for Excellence on Aging, St-Sacrement Hospital, Room L2-21, 1050, chemin Sainte-Foy, Quebec City, Quebec, Canada.,Faculty of Nursing Sciences, Laval University, Pavillon Ferdinand-Vandry, room 2881-C, 1050, avenue de la Médecine, Quebec, QC, G1V 0A6, Canada
| | - Danielle Caron
- Department of Family Medicine and Emergency Medicine, Laval University, Pavillon Ferdinand-Vandry, room 2881-C, 1050 avenue de la Médecine, Quebec, QC, G1V 0A6, Canada
| | - Charo Rodríguez
- Department of Family Medicine, Faculty of Medicine, McGill University, 5858 chemin de la Cote-des-Neiges, 3rd floor, Suite 300, Room 328, Montreal, Quebec, Canada
| |
Collapse
|
38
|
Émond M, Boucher V, Carmichael PH, Voyer P, Pelletier M, Gouin É, Daoust R, Berthelot S, Lamontagne ME, Morin M, Lemire S, Minh Vu TT, Nadeau A, Rheault M, Juneau L, Le Sage N, Lee J. Incidence of delirium in the Canadian emergency department and its consequences on hospital length of stay: a prospective observational multicentre cohort study. BMJ Open 2018. [PMID: 29523559 PMCID: PMC5855334 DOI: 10.1136/bmjopen-2017-018190] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE We aim to determine the incidence of delirium and describe its impacts on hospital length of stay (LOS) among non-delirious community-dwelling older adults with an 8-hour exposure to the emergency department (ED) environment. DESIGN This is a prospective observational multicentre cohort study (March-July 2015). Patients were assessed two times per day during their entire ED stay and up to 24 hours on hospital ward. SETTING The study took place in four Canadian EDs. PARTICIPANTS 338 included patients: (1) aged ≥65 years; (2) who had an ED stay ≥8 hours; (3) were admitted to hospital ward and (4) were independent/semi-independent. MAIN OUTCOMES AND MEASURES The primary outcomes of this study were incident delirium in the ED or within 24 hours of ward admission and ED and hospital LOS. Functional and cognitive status were assessed using validated Older Americans Resources and Services and the modified Telephone Interview for Cognitive Status tools. The Confusion Assessment Method was used to detect incident delirium. Univariate and multivariate analyses were conducted to evaluate outcomes. RESULTS Mean age was 76.8 (±8.1), 17.7% were aged >85 years old and 48.8% were men. The mean incidence of delirium was 12.1% (n=41). Median IQR ED LOS was 32.4 (24.5-47.9) hours and hospital LOS was 146.6 (75.2-267.8) hours. Adjusted mean hospital LOS was increased by 105.4 hours (4.4 days) (95% CI 25.1 to 162.0, P<0.001) for patients who developed an episode of delirium compared with non-delirious patient. CONCLUSIONS An incident delirium was observed in one of eight independent/semi-independent older adults after an 8-hour ED exposure. An episode of delirium increases hospital LOS by 4 days and therefore has important implications for patients and could contribute to ED overcrowding through a deleterious feedback loop.
Collapse
Affiliation(s)
- Marcel Émond
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Département de médecine d’urgence, CHU de Québec-Université Laval, Québec, Canada
- Medicine, 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
| | - Valérie Boucher
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Medicine, 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
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Centre d’excellence sur le vieillissement de Québec, Québec, Canada
- Nursing, Université Laval, Québec, Canada
| | - Mathieu Pelletier
- Medicine, 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
- Medicine, Université de Montréal, Montréal, Canada
| | - Simon Berthelot
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Département de médecine d’urgence, CHU de Québec-Université Laval, Québec, Canada
- Medicine, Université Laval, Québec, Canada
| | - Marie-Eve Lamontagne
- Medicine, Université Laval, Québec, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Québec, Canada
| | - Michèle Morin
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Medicine, Université Laval, Québec, Canada
| | - Stéphane Lemire
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Medicine, Université Laval, Québec, Canada
- Centre d’excellence sur le vieillissement de Québec, Québec, Canada
| | - Thien Tuong Minh Vu
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montréal, Canada
- Centre hospitalier de l’Université de Montréal, Montréal, Canada
- Institut de gériatrie de l’Université de Montréal, Montréal, Canada
| | - Alexandra Nadeau
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Medicine, 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
| | | | - Lucille Juneau
- Centre Intégré Universitaire de Services Sociaux et de Santé de la Capitale-Nationale, Québec, Canada
| | - Natalie Le Sage
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Département de médecine d’urgence, CHU de Québec-Université Laval, Québec, Canada
- Medicine, Université Laval, Québec, Canada
| | - Jacques Lee
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Sunnybrook Health Sciences Center, Toronto, Canada
| |
Collapse
|
39
|
Abstract
BACKGROUND The Geriatric Anxiety Inventory (GAI) and a short form of this instrument (GAI-SF) were developed to assess the severity of anxiety symptoms in older adults in order to compensate for the lack of validated screening tools adapted to the elderly population. This study examined the psychometric properties of the French Canadian version of the GAI, in its complete (GAI-FC) and short form (GAI-FC-SF). METHOD A total of 331 community-dwelling seniors between 65 and 92 years old participated in this study. RESULTS Both the GAI-FC and the GAI-FC-SF have sound psychometric properties with, respectively, a high internal consistency (α = .94 and .83), an adequate convergent validity (r = .50 to .86 with instruments known to evaluate constructs similar to the GAI or related to anxiety), a good test-retest reliability (r = .89 and .85), in addition to a single-factor structure. CONCLUSIONS The results support the use of both the GAI-FC and the GAI-FC-SF. The GAI-FC-SF seems to be an interesting alternative to the GAI-FC as a screening tool when time available for assessment is limited.
Collapse
Affiliation(s)
| | - Philippe Landreville
- a School of Psychology , Université Laval , Québec , Canada.,b Centre d'Excellence sur le Vieillissement , CHU de Quebec Research Center , Québec , Canada
| | - Patrick Gosselin
- c Department of Psychology , Université de Sherbrooke , Sherbrooke , Canada.,d Axis Adult Capacity Development , Institut universitaire de première ligne en santé et services sociaux - Centre intégré universitaire en santé et services sociaux de l'Estrie - CHUS (CIUSSS de l'Estrie - CHUS) , Sherbrooke , Canada
| | | |
Collapse
|
40
|
Bernier PJ, Gourdeau C, Carmichael PH, Beauchemin JP, Verreault R, Bouchard RW, Kröger E, Laforce R. Validation and diagnostic accuracy of predictive curves for age-associated longitudinal cognitive decline in older adults. CMAJ 2017; 189:E1472-E1480. [PMID: 29203616 DOI: 10.1503/cmaj.160792] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The Mini-Mental State Examination continues to be used frequently to screen for cognitive impairment in older adults, but it remains unclear how to interpret changes in its score over time to distinguish age-associated cognitive decline from an early degenerative process. We aimed to generate cognitive charts for use in clinical practice for longitudinal evaluation of age-associated cognitive decline. METHODS We used data from the Canadian Study of Health and Aging from 7569 participants aged 65 years or older who completed a Mini-Mental State Examination at baseline, and at 5 and 10 years later to develop a linear regression model for the Mini-Mental State Examination score as a function of age and education. Based on this model, we generated cognitive charts designed to optimize accuracy for distinguishing participants with dementia from healthy controls. We validated our model using a separate data set of 6501 participants from the National Alzheimer's Coordinating Center's Uniform Data Set. RESULTS For baseline measurement, the cognitive charts had a sensitivity of 80% (95% confidence interval [CI] 75% to 84%) and a specificity of 89% (95% CI 88% to 90%) for distinguishing healthy controls from participants with dementia. Similar sensitivities and specificities were observed for a decline over time greater than 1 percentile zone from the first measurement. Results in the validation sample were comparable, albeit with lower sensitivities. Negative predictive value was 99%. INTERPRETATION Our innovative model, which factors in age and education, showed validity and diagnostic accuracy for determining whether older patients show abnormal performance on serial Mini-Mental State Examination measurements. Similar to growth curves used in pediatrics, cognitive charts allow longitudinal cognitive evaluation and enable prompt initiation of investigation and treatment when appropriate.
Collapse
Affiliation(s)
- Patrick J Bernier
- Services Gériatriques Spécialisés (Bernier), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale; CÉGEP de Limoilou (Gourdeau); Centre d'excellence sur le vieillissement de Québec (Carmichael, Verreault, Kröger); Institut universitaire de cardiologie et de pneumologie de Québec (Beauchemin); Faculté de médecine (Verreault, Laforce), Université Laval; Clinique interdisciplinaire de mémoire (Bouchard, Laforce), Centre hospitalier universitaire (CHU) de Québec; Faculté de pharmacie (Kröger), Université Laval, Québec, Que
| | - Christian Gourdeau
- Services Gériatriques Spécialisés (Bernier), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale; CÉGEP de Limoilou (Gourdeau); Centre d'excellence sur le vieillissement de Québec (Carmichael, Verreault, Kröger); Institut universitaire de cardiologie et de pneumologie de Québec (Beauchemin); Faculté de médecine (Verreault, Laforce), Université Laval; Clinique interdisciplinaire de mémoire (Bouchard, Laforce), Centre hospitalier universitaire (CHU) de Québec; Faculté de pharmacie (Kröger), Université Laval, Québec, Que
| | - Pierre-Hugues Carmichael
- Services Gériatriques Spécialisés (Bernier), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale; CÉGEP de Limoilou (Gourdeau); Centre d'excellence sur le vieillissement de Québec (Carmichael, Verreault, Kröger); Institut universitaire de cardiologie et de pneumologie de Québec (Beauchemin); Faculté de médecine (Verreault, Laforce), Université Laval; Clinique interdisciplinaire de mémoire (Bouchard, Laforce), Centre hospitalier universitaire (CHU) de Québec; Faculté de pharmacie (Kröger), Université Laval, Québec, Que
| | - Jean-Pierre Beauchemin
- Services Gériatriques Spécialisés (Bernier), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale; CÉGEP de Limoilou (Gourdeau); Centre d'excellence sur le vieillissement de Québec (Carmichael, Verreault, Kröger); Institut universitaire de cardiologie et de pneumologie de Québec (Beauchemin); Faculté de médecine (Verreault, Laforce), Université Laval; Clinique interdisciplinaire de mémoire (Bouchard, Laforce), Centre hospitalier universitaire (CHU) de Québec; Faculté de pharmacie (Kröger), Université Laval, Québec, Que
| | - René Verreault
- Services Gériatriques Spécialisés (Bernier), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale; CÉGEP de Limoilou (Gourdeau); Centre d'excellence sur le vieillissement de Québec (Carmichael, Verreault, Kröger); Institut universitaire de cardiologie et de pneumologie de Québec (Beauchemin); Faculté de médecine (Verreault, Laforce), Université Laval; Clinique interdisciplinaire de mémoire (Bouchard, Laforce), Centre hospitalier universitaire (CHU) de Québec; Faculté de pharmacie (Kröger), Université Laval, Québec, Que
| | - Rémi W Bouchard
- Services Gériatriques Spécialisés (Bernier), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale; CÉGEP de Limoilou (Gourdeau); Centre d'excellence sur le vieillissement de Québec (Carmichael, Verreault, Kröger); Institut universitaire de cardiologie et de pneumologie de Québec (Beauchemin); Faculté de médecine (Verreault, Laforce), Université Laval; Clinique interdisciplinaire de mémoire (Bouchard, Laforce), Centre hospitalier universitaire (CHU) de Québec; Faculté de pharmacie (Kröger), Université Laval, Québec, Que
| | - Edeltraut Kröger
- Services Gériatriques Spécialisés (Bernier), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale; CÉGEP de Limoilou (Gourdeau); Centre d'excellence sur le vieillissement de Québec (Carmichael, Verreault, Kröger); Institut universitaire de cardiologie et de pneumologie de Québec (Beauchemin); Faculté de médecine (Verreault, Laforce), Université Laval; Clinique interdisciplinaire de mémoire (Bouchard, Laforce), Centre hospitalier universitaire (CHU) de Québec; Faculté de pharmacie (Kröger), Université Laval, Québec, Que
| | - Robert Laforce
- Services Gériatriques Spécialisés (Bernier), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale; CÉGEP de Limoilou (Gourdeau); Centre d'excellence sur le vieillissement de Québec (Carmichael, Verreault, Kröger); Institut universitaire de cardiologie et de pneumologie de Québec (Beauchemin); Faculté de médecine (Verreault, Laforce), Université Laval; Clinique interdisciplinaire de mémoire (Bouchard, Laforce), Centre hospitalier universitaire (CHU) de Québec; Faculté de pharmacie (Kröger), Université Laval, Québec, Que.
| |
Collapse
|
41
|
Beaunoyer E, Landreville P, Carmichael PH. Older Adults’ Knowledge of Anxiety Disorders. J Gerontol B Psychol Sci Soc Sci 2017; 74:806-814. [DOI: 10.1093/geronb/gbx128] [Citation(s) in RCA: 4] [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] [Received: 06/26/2017] [Accepted: 09/26/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Philippe Landreville
- École de psychologie, Université Laval, Québec, Canada
- Centre d’excellence sur le vieillissement de Québec, CHU de Québec, Québec, Canada
| | | |
Collapse
|
42
|
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]
|
43
|
Abstract
Background: There are few studies of the association between the use of antioxidant vitamin supplements and the risk of Alzheimer’s disease (AD). Cognitive decline is generally viewed as part of the continuum between normal aging and AD. Objective: To evaluate whether the use of vitamin E and C supplements is associated with reduced risks of cognitive impairment, not dementia (CIND), AD, or all-cause dementia in a representative sample of older persons ≥65 years old. Methods: Data from the Canadian Study of Health and Aging (1991-2002), a cohort study of dementia including 3 evaluation waves at 5-yearly intervals, were used. Exposure to vitamins E and C was self-reported at baseline in a risk factor questionnaire and/or in a clinical examination. Results: The data set included 5269 individuals. Compared with those not taking vitamin supplements, the age-, sex-, and education-adjusted hazard ratios of CIND, AD, and all-cause dementia were, respectively, 0.77 (95% CI = 0.60-0.98), 0.60 (95% CI = 0.42-0.86), and 0.62 (95% CI = 0.46-0.83) for those taking vitamin E and/or C supplements. Results remained significant in fully adjusted models except for CIND. Similar results were observed when vitamins were analyzed separately. Conclusions: This analysis suggests that the use of vitamin E and C supplements is associated with a reduced risk of cognitive decline. Further investigations are needed to determine their value as a primary prevention strategy.
Collapse
Affiliation(s)
- Luta Luse Basambombo
- Centre d’excellence sur le vieillissement de Québec, CHU de Québec Research Center, Québec, QC, Canada
| | - Pierre-Hugues Carmichael
- Centre d’excellence sur le vieillissement de Québec, CHU de Québec Research Center, Québec, QC, Canada
| | - Sharlène Côté
- Centre de santé et de services sociaux de Chicoutimi, Saguenay, QC, Canada
| | - Danielle Laurin
- Centre d’excellence sur le vieillissement de Québec, CHU de Québec Research Center, Québec, QC, Canada
| |
Collapse
|
44
|
Parrott MD, Fiocco AJ, Carmichael PH, Anderson ND, Laurin D, Greenwood CE, Ferland G, Shatenstein B, Gaudreau P, Payette H, Belleville S, Morais JA, Kergoat MJ. P2‐421: Indicators of Cognitive Reserve Moderate the Adverse Relationship Between Poor Diet Quality and Cognitive Decline in Independent Older Adults: The Nuage Study. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.06.1633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | | | | | | | | | | | - Guylaine Ferland
- Institut Universitaire de Gériatrie de MontréalMontrealQC Canada
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Allès B, Samieri C, Lorrain S, Jutand MA, Carmichael PH, Shatenstein B, Gaudreau P, Payette H, Laurin D, Barberger-Gateau P. Nutrient Patterns and Their Food Sources in Older Persons from France and Quebec: Dietary and Lifestyle Characteristics. Nutrients 2016; 8:225. [PMID: 27104557 PMCID: PMC4848693 DOI: 10.3390/nu8040225] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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: 10/05/2015] [Revised: 03/24/2016] [Accepted: 03/31/2016] [Indexed: 12/21/2022] Open
Abstract
Background: Dietary and nutrient patterns have been linked to health outcomes related to aging. Food intake is influenced by environmental and genetic factors. The aim of the present study was to compare nutrient patterns across two elderly populations sharing a common ancestral cultural background, but living in different environments. Methods: The diet quality, lifestyle and socioeconomic characteristics of participants from the Three-City Study (3C, France, n = 1712) and the Québec Longitudinal Study on Nutrition and Successful Aging (NuAge, Quebec, Canada, n = 1596) were analyzed. Nutrient patterns and their food sources were identified in the two samples using principal component analysis. Diet quality was compared across sample-specific patterns by describing weekly food intake and associations with the Canadian Healthy Eating Index (C-HEI). Results: Three nutrient patterns were retained in each study: a healthy, a Western and a more traditional pattern. These patterns accounted for 50.1% and 53.5% of the total variance in 3C and NuAge, respectively. Higher education and non-physical occupations over lifetime were associated with healthy patterns in both studies. Other characteristics such as living alone, having a body mass index lower than 25 and being an ex-smoker were associated with the healthy pattern in NuAge. No association between these characteristics and the nutrient patterns was noted in 3C. The healthy and Western patterns from each sample also showed an inverse association with C-HEI. Conclusion: The two healthy patterns showed important similarities: adequate food variety, consumption of healthy foods and associations with common sociodemographic factors. This work highlights that nutrient patterns derived using a posteriori methods may be useful to compare the nutritional quality of the diet of distinct populations.
Collapse
Affiliation(s)
- Benjamin Allès
- Centre INSERM U897-Epidemiologie-Biostatistique, University of Bordeaux, ISPED, Bordeaux, F-33000, France.
- Centre INSERM U897-Epidemiologie-Biostatistique, INSERM, ISPED, Bordeaux, F-33000, France.
- Québec Center of Excellence on Aging, CHU de Québec Research Center, Quebec City, QC G1S 4L8, Canada.
- Faculty of Pharmacy, Laval University, Quebec City, QC G1V 0A6, Canada.
| | - Cécilia Samieri
- Centre INSERM U897-Epidemiologie-Biostatistique, University of Bordeaux, ISPED, Bordeaux, F-33000, France.
- Centre INSERM U897-Epidemiologie-Biostatistique, INSERM, ISPED, Bordeaux, F-33000, France.
| | - Simon Lorrain
- Centre INSERM U897-Epidemiologie-Biostatistique, University of Bordeaux, ISPED, Bordeaux, F-33000, France.
- Centre INSERM U897-Epidemiologie-Biostatistique, INSERM, ISPED, Bordeaux, F-33000, France.
| | - Marthe-Aline Jutand
- Centre INSERM U897-Epidemiologie-Biostatistique, University of Bordeaux, ISPED, Bordeaux, F-33000, France.
- Centre INSERM U897-Epidemiologie-Biostatistique, INSERM, ISPED, Bordeaux, F-33000, France.
| | - Pierre-Hugues Carmichael
- Québec Center of Excellence on Aging, CHU de Québec Research Center, Quebec City, QC G1S 4L8, Canada.
| | - Bryna Shatenstein
- Département de Nutrition, Université de Montréal, Montréal, QC H3T 1A8, Canada.
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, CIUSSS du Centre-est-de-l'Île-de-Montréal, Montréal, QC H3W 1W5, Canada.
| | - Pierrette Gaudreau
- Department of Medicine, University of Montreal, Montreal, QC H3C 3J7, Canada.
- Centre Hospitalier de l'Université de Montréal Research Center (CRCHUM), Montréal, QC H2X 0A9, Canada.
| | - Hélène Payette
- Research Center on Aging-Centre Intégré Universitaire de Santé et des Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (CIUSS de l'Estrie-CHUS), Sherbrooke, QC J1H 4C4, Canada.
- Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, QC J1K 2R1, Canada.
| | - Danielle Laurin
- Québec Center of Excellence on Aging, CHU de Québec Research Center, Quebec City, QC G1S 4L8, Canada.
- Faculty of Pharmacy, Laval University, Quebec City, QC G1V 0A6, Canada.
| | - Pascale Barberger-Gateau
- Centre INSERM U897-Epidemiologie-Biostatistique, University of Bordeaux, ISPED, Bordeaux, F-33000, France.
- Centre INSERM U897-Epidemiologie-Biostatistique, INSERM, ISPED, Bordeaux, F-33000, France.
| |
Collapse
|
46
|
Voyer P, Champoux N, Desrosiers J, Landreville P, McCusker J, Monette J, Savoie M, Carmichael PH, Richard H, Richard S. RADAR: A Measure of the Sixth Vital Sign? Clin Nurs Res 2015; 25:9-29. [PMID: 26337503 DOI: 10.1177/1054773815603346] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of this study was to investigate the potential of RADAR (Recognizing Active Delirium As part of your Routine) as a measure of the sixth vital sign. This study was a secondary analysis of a study (N = 193) that took place in one acute care hospital and one long-term care facility. The primary outcome was a positive sixth vital sign, defined as the presence of both an altered level of consciousness and inattention. These indicators were assessed using the Confusion Assessment Method. RADAR identified 30 of the 43 participants as having a positive sixth vital sign and 58 of the 70 cases as not, yielding a sensitivity and specificity of 70% and 83%, respectively. Positive predictive value was 71%. RADAR's characteristics, including its brevity and acceptability by nursing staff, make this tool a good candidate as a measure of the sixth vital sign. Future studies should address the generalizability of RADAR among various populations and clinical settings.
Collapse
Affiliation(s)
- Philippe Voyer
- Laval University, Quebec City, Canada Centre for Excellence in Aging-Research Unit, Quebec City, Canada
| | | | | | | | - Jane McCusker
- St Mary's Hospital, Montreal, Quebec, Canada McGill University, Montreal, Quebec, Canada
| | - Johanne Monette
- Jewish General Hospital, Montreal, Quebec, Canada Donald Berman Maimonides Geriatric Center, Montreal, Quebec, Canada
| | | | | | - Hélène Richard
- Centre for Excellence in Aging-Research Unit, Quebec City, Canada
| | - Sylvie Richard
- Centre for Excellence in Aging-Research Unit, Quebec City, Canada
| |
Collapse
|
47
|
Kröger E, Mouls M, Wilchesky M, Berkers M, Carmichael PH, van Marum R, Souverein P, Egberts T, Laroche ML. Adverse Drug Reactions Reported With Cholinesterase Inhibitors. Ann Pharmacother 2015; 49:1197-206. [DOI: 10.1177/1060028015602274] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: No worldwide pharmacovigilance study evaluating the spectrum of adverse drug reactions (ADRs) induced by cholinesterase inhibitors (ChEI) in Alzheimer’s disease has been conducted since their emergence on the market. Objective: To describe ChEI related ADRs in Alzheimer’s disease (donepezil, rivastigmine, and galantamine) and characterize their seriousness as reported by national pharmacovigilance systems to VigiBase, a World Health Organization International Drug Monitoring Program database, between 1998 and 2013. Methods: All ChEI related reports, submitted to VigiBase between 1998 and 2013 from the five continents were extracted. Analyses were carried out for general, serious, and nonserious ADRs. Results: A total of 18 955 reports (43 753 ADRs) from 58 countries were reported: 60.1% in women; mean age 77.4 ± 9.1 years. Most reports originated from Europe (47.6%) and North America (40.4%). Rivastigmine and donepezil were involved in most reports (41.4% each). The most frequently reported ADRs were neuropsychiatric (31.4%), gastrointestinal (15.9%), general (11.9%), and cardiovascular (11.7%) disorders. During the 2006-2013 period, serious ADRs remained more often reported than nonserious ones; the most serious were neuropsychiatric (34.0%), general (14.0%), cardiovascular (12.1%), and gastrointestinal (11.6%) disorders. Medication errors were reported in 2.0% of serious cases. Death occurred in 2.3% of the reports. Conclusions: This international pharmacovigilance study highlights the ADR pattern induced by ChEIs. Neuropsychiatric events were the most frequently reported ADRs. Serious cardiovascular events were frequently reported, suggesting that their significance has probably been previously underestimated. Given the frailty of the patients and the frequent comedications, caution is advised before introducing a ChEI.
Collapse
Affiliation(s)
- Edeltraut Kröger
- Centre de Recherche du CHU de Québec, Canada
- Université Laval, Québec, Canada
| | - Marie Mouls
- Service de Pharmacologie-Toxicologie-Pharmacovigilance, Limoges, France
| | - Machelle Wilchesky
- McGill University, Montréal, Canada
- Centre for Clinical Epidemiology Jewish General Hospital–Lady Davis Research Institute, Montréal, Canada
- Donald Berman Maimonides Geriatric Centre, Montréal, Canada
| | | | | | - Rob van Marum
- Jeroen-Bosch Ziekenhuis, ‘s-Hertogenbosch, Netherlands
- EMGO Institute for Health and Care Research VU University Medical Center Amsterdam, Netherlands
| | | | - Toine Egberts
- Utrecht University, Netherlands
- University Medical Centre, Utrecht, Netherlands
| | - Marie-Laure Laroche
- Service de Pharmacologie-Toxicologie-Pharmacovigilance, Limoges, France
- Université de Limoges, Limoges, France
| |
Collapse
|
48
|
Provencher V, Desrosiers J, Demers L, Carmichael PH. Optimizing social participation in community-dwelling older adults through the use of behavioral coping strategies. Disabil Rehabil 2015. [PMID: 26208243 DOI: 10.3109/09638288.2015.1070297] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE This study aimed to (1) determine the categories of behavioral coping strategies most strongly correlated with optimal seniors' social participation in different activity and role domains and (2) identify the demographic, health and environmental factors associated with the use of these coping strategies optimizing social participation. METHOD The sample consisted of 350 randomly recruited community-dwelling older adults (≥65 years). Coping strategies and social participation were measured, respectively, using the Inventory of Coping Strategies Used by the Elderly and Assessment of Life Habits questionnaires. Information about demographic, health and environmental factors was also collected during the interview. RESULTS Regression analyses showed a strong relationship between the use of cooking- and transportation-related coping strategies and optimal participation in the domains of nutrition and community life, respectively. Older age and living alone were associated with increased use of cooking-related strategies, while good self-rated health and not living in a seniors' residence were correlated with greater use of transportation-related strategies. CONCLUSIONS Our study helped to identify useful behavioral coping strategies that should be incorporated in disability prevention programs designed to promote community-dwelling seniors' social participation. However, the appropriateness of these strategies depends on whether they are used in relevant contexts and tailored to specific needs. IMPLICATIONS FOR REHABILITATION Our results support the relevance of including behavioral coping strategies related to cooking and transportation in disability prevention programs designed to promote community-dwelling seniors' social participation in the domains of nutrition and community life, respectively. Older age and living alone were associated with increased use of cooking-related strategies, while good self-rated health and not living in a seniors' residence were correlated with greater use of transportation-related strategies. These factors should be considered in order to optimize implementation of these useful strategies in disability prevention programs. The appropriateness of these selected strategies depends on whether they are used in relevant contexts and tailored to specific needs.
Collapse
Affiliation(s)
- Véronique Provencher
- a School of Rehabilitation, Université de Sherbrooke , Sherbrooke , QC , Canada .,b Centre de Recherche sur le Vieillissement , Sherbrooke , QC , Canada
| | - Johanne Desrosiers
- a School of Rehabilitation, Université de Sherbrooke , Sherbrooke , QC , Canada .,b Centre de Recherche sur le Vieillissement , Sherbrooke , QC , Canada
| | - Louise Demers
- c School of Rehabilitation, Université de Montréal , Montréal , QC , Canada .,d Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal , Montréal , QC , Canada , and
| | | |
Collapse
|
49
|
Bernier PJ, Gourdeau C, Carmichael PH, Beauchemin JP, Verreault R, Bouchard RW, Kröger E, Laforce R. P3‐207: Applying ‘growth curves’ to age‐associated cognitive decline: An innovative method to help determine normal versus abnormal longitudinal cognitive changes in the elderly. Alzheimers Dement 2015. [DOI: 10.1016/j.jalz.2015.06.1579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | | | | | - René Verreault
- Centre d'Excellence sur le Vieillissement du CHU de QuébecQuébecQCCanada
- Université LavalQuebec CityQCCanada
| | - Remi W. Bouchard
- Clinique Interdisciplinaire de mémoire du CHU de QuébecQuébecQCCanada
| | - Edeltraut Kröger
- Centre d'Excellence sur le Vieillissement du CHU de QuébecQuébecQCCanada
- Université LavalQuebec CityQCCanada
| | - Robert Laforce
- Clinique Interdisciplinaire de mémoire du CHU de QuébecQuébecQCCanada
- Université LavalQuébecQCCanada
| |
Collapse
|
50
|
Giguere AM, Labrecque M, Légaré F, Grad R, Cauchon M, Greenway M, Haynes RB, Pluye P, Syed I, Banerjee D, Carmichael PH, Martin M. Feasibility of a randomized controlled trial to evaluate the impact of decision boxes on shared decision-making processes. BMC Med Inform Decis Mak 2015; 15:13. [PMID: 25880757 PMCID: PMC4350632 DOI: 10.1186/s12911-015-0134-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 01/27/2015] [Indexed: 12/04/2022] Open
Abstract
Background Decision boxes (DBoxes) are two-page evidence summaries to prepare clinicians for shared decision making (SDM). We sought to assess the feasibility of a clustered Randomized Controlled Trial (RCT) to evaluate their impact. Methods A convenience sample of clinicians (nurses, physicians and residents) from six primary healthcare clinics who received eight DBoxes and rated their interest in the topic and satisfaction. After consultations, their patients rated their involvement in decision-making processes (SDM-Q-9 instrument). We measured clinic and clinician recruitment rates, questionnaire completion rates, patient eligibility rates, and estimated the RCT needed sample size. Results Among the 20 family medicine clinics invited to participate in this study, four agreed to participate, giving an overall recruitment rate of 20%. Of 148 clinicians invited to the study, 93 participated (63%). Clinicians rated an interest in the topics ranging 6.4-8.2 out of 10 (with 10 highest) and a satisfaction with DBoxes of 4 or 5 out of 5 (with 5 highest) for 81% DBoxes. For the future RCT, we estimated that a sample size of 320 patients would allow detecting a 9% mean difference in the SDM-Q-9 ratings between our two arms (0.02 ICC; 0.05 significance level; 80% power). Conclusions Clinicians’ recruitment and questionnaire completion rates support the feasibility of the planned RCT. The level of interest of participants for the DBox topics, and their level of satisfaction with the Dboxes demonstrate the acceptability of the intervention. Processes to recruit clinics and patients should be optimized. Electronic supplementary material The online version of this article (doi:10.1186/s12911-015-0134-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Anik Mc Giguere
- Research Centre for Excellence in Aging, CHU de Quebec, Saint-Sacrement Hospital, 1050 chemin Ste-Foy, Québec, Québec, G1S 4L8, Canada. .,Department of Family and Emergency Medicine, Laval University, Pavillon Ferdinand-Vandry, 1050 avenue de la Medecine, Quebec City, Quebec, G1V 0A6, Canada.
| | - Michel Labrecque
- Department of Family and Emergency Medicine, Research Center of the CHU de Quebec, Saint-Francois d'Assise Hospital, Laval University, 10 rue de l'Espinay, D6-730, Quebec City, QC, G1L 3L5, Canada
| | - France Légaré
- Department of Family and Emergency Medicine, Research Center of the CHU de Quebec, Saint-Francois d'Assise Hospital, Laval University, 10 rue de l'Espinay, D6-730, Quebec City, QC, G1L 3L5, Canada
| | - Roland Grad
- Department of Family Medicine, McGill University, Herzl Family Practice Centre, 3755 Cote Sainte Catherine, Montreal, QC H3T 1E2, Canada
| | - Michel Cauchon
- Department of Family and Emergency Medicine, Laval University, Pavillon Ferdinand-Vandry, 1050 avenue de la Medecine, Quebec City, Quebec, G1V 0A6, Canada
| | - Matthew Greenway
- Department of Family Medicine, McMaster University, 118 Lake Street, St. Catharines, ON, Canada
| | - R Brian Haynes
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, CRL-125, Hamilton, ON, L8S 4K1, Canada.,Department of Medicine, DeGroote School of Medicine, McMaster University, 1280 Main Street West, CRL-125, Hamilton, ON, L8S 4K1, Canada
| | - Pierre Pluye
- Department of Family Medicine, McGill University, 5858 Côte-des-neiges, 3rd Floor, Suite 300, Montreal, QC, H3S 1Z1, Canada
| | - Iqra Syed
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, CRL-125, Hamilton, ON, L8S 4K1, Canada
| | - Debi Banerjee
- The University of Toronto, Faculty of Medicine, 1 King's College Circle, Medical Sciences Building (Rm. 2109), Toronto, ON, M5S-1A8, Canada
| | - Pierre-Hugues Carmichael
- Research Centre for Excellence in Aging, CHU de Quebec, Saint-Sacrement Hospital, 1050 chemin Ste-Foy, Québec, Québec, G1S 4L8, Canada
| | - Mélanie Martin
- Research Centre for Excellence in Aging, CHU de Quebec, Saint-Sacrement Hospital, 1050 chemin Ste-Foy, Québec, Québec, G1S 4L8, Canada.,Department of Family and Emergency Medicine, Laval University, Pavillon Ferdinand-Vandry, 1050 avenue de la Medecine, Quebec City, Quebec, G1V 0A6, Canada
| |
Collapse
|