Canadian Geriatrics Society Research Articles

Abstracts from the 43rd Annual Scientific Meeting of the Canadian Geriatrics Society

Abstracts from the 43rd Annual Scientific Meeting of the Canadian Geriatrics Society

FC8: Revising Competencies in Geriatrics for Canadian Medical Students: Adding a Mental Health Perspective

In Canada, adults 85 years and older represent one of the fastest growing segments of the population1. Mood disorders and chronic illness often intersect, worsening health outcomes in late life2. In view of demographic trends, medical schools should ensure trainees are equipped with the knowledge, skills and attitudes to work with older adults. However, there continues to be much variation in how medical schools incorporate geriatric content into their curricula.In 2009, the Canadian Geriatrics Society (CGS) outlined 20 competencies in geriatrics to inform medical school curricula, but uptake was minimal. Of note, there were significant gaps in these competencies, which omitted mention of late-life depression. Geriatric mental health experts did not provide input.The objective of this project was to address gaps in geriatric competencies for medical students through an expert review process involving a biopsychosocial approach.Methods:The CGS established a 15-member national working group with representation from geriatric psychiatry, family medicine, a 95-year-old senior, geriatrics and medical trainees. Potential competencies were derived from existing Canadian geriatrics frameworks [Geriatrics 5M, CanMEDs] and 2009 competencies. A modified Delphi process yielded rankings for each competency using a 7-point Likert scale.Results:Between 2019 and 2021, 3 successive national surveys were completed. In the first (n=66), 34 competencies were identified. Agreement in the final survey was 87-95% (mean 90%). 51 participants completed all three. Significant topic omissions in the 2009 list of competencies were frailty, end-of-life care, delirium prevention, health promotion and the assessment and management of depression.Conclusions:Three national surveys expanded the core competencies in geriatrics for medical school curricula from 20 to 31. Expert consensus was high. Themes mapped along existing geriatrics frameworks and incorporated a holistic lens incorporating the perspectives of an older adult and geriatric psychiatrist. In addition to late-life depression, the importance of addressing ageism was also highlighted.Learning objectives for each competency are modifiable for level of training and individual program, offering flexibility. The CGS will continue to advocate for inclusion of updated, expanded competencies into training and licensure in geriatrics.1)Statistics Canada 2021, Canadian Government, accessed 1 January 2023, <. Accessed 20/01/23 <https://www12.statcan.gc.ca/census-recensement/2021/as-sa/98-200-X/2021004/98-200-x2021004-eng.cfm>1)Hall CA, Reynolds III CF. Late-life depression in the primary care setting: challenges, collaborative care and prevention. Maturitas. 2014 Oct; 79(2):147-52.

The Aging Care 5Ms Competencies: A Modified Delphi Study to Revise Medical Student Competencies for the Care of Older Adults.

To revise the 2009 Canadian Geriatrics Society (CGS) Core Competencies in the Care of Older Persons for Canadian Medical Students by applying current frameworks and using a modified Delphi process. The working group chose the Geriatric 5Ms model and CanMEDS framework to develop and structure the competencies. National (i.e., Canadian) Delphi participants were recruited, and 3 Delphi survey rounds were conducted from 2019 to 2021. Each survey round collected quantitative data using a 7-point Likert scale (LS) and qualitative data using free-text comments. The purpose of the first round was to establish the importance of the components of the proposed competencies (categorized into 13 subsections) and identify additional themes. The second round assessed agreement with 31 proposed competencies organized into 7 themes: aging, caring for older adults, mind, mobility, medications, multicomplexity, and matters the most. The third survey-rated agreement levels after further revisions to the competencies were applied. The final 33 competencies were shared with survey participants for feedback and other stakeholders for external validation. Mean LSs for the importance of the 13 competency component subsections on the first survey varied from 5.11 to 6.54, with an agreement level of 73%-93%. New themes emerged from the qualitative comments. Mean LSs for the 31 competencies on the second survey ranged from 5.57 to 6.81, with an agreement level of 80%-97%. Mean LSs for the revised competencies on the third survey ranged from 5.83 to 6.65, with an agreement level of 83%-95%. The authors developed the 33 Aging Care 5Ms Competencies for Canadian medical students using a consensus process. The competencies fulfill an important need in medical education, and ultimately, society. The authors strongly believe that the competencies can be woven into existing undergraduate medical curricula through purposeful integration and collaboration, including with other specialties.

Abstracts: Abstracts from the 42nd Annual Scientific Meeting of the Canadian Geriatrics Society: Compassionate Care for All: Renewing Our Passion, Recalibrating our Compass; April 13-15, 2023; Vancouver, British Columbia.

Abstracts: Abstracts from the 42nd Annual Scientific Meeting of the Canadian Geriatrics Society: Compassionate Care for All: Renewing Our Passion, Recalibrating our Compass; April 13-15, 2023; Vancouver, British Columbia.

Survey on Current Practice of Canadian Physicians Regarding the Investigation in Older Patients with Delirium.

BackgroundThe current literature provides heterogeneous recommendation regarding the investigation of older delirious patients, which may lead to over-testing. Our study aims to describe Canadian physicians’ current practice for the investigation of older patients with delirium. Our secondary objective is to define specific indications for performing a CT head scan in this population.MethodsDesign: cross-sectional online survey. Participants: physicians who conduct their clinical practice in Canada and who care for older patients with delirium. Potential study participants were reached through Canadian associations: Canadian Geriatrics Society, the Canadian Association of Emergency Physicians, the Association des Médecins d’Urgence du Québec, and members of Choosing Wisely Canada.ResultsWe received 296 survey responses. More than 80% of respondents always order complete blood count, urea, and creatinine and electrolytes. Extended electrolytes, TSH, chest X-ray, electrocardiogram, urinalysis and urinary culture tests tend to be ordered somewhat frequently. Physicians mostly agreed to order a head CT scan for loss of consciousness, altered mental status, fall, and anticoagulation.ConclusionsPhysicians’ investigations for older patients with delirium are highly variable, even with the lack of evidence supporting a broad workup. Also, respondents mostly align with current recommendations of indications for CT head scans.

Canadian Geriatrics Society Scientific Sessions, April 7–9, 2022: Book of Abstracts

Canadian Geriatrics Society Scientific Sessions, April 7–9, 2022: Book of Abstracts

Consensus Statement Regarding the Application of Biogen to Health Canada for Approval of Aducanumab.

Alzheimer’s disease is a major cause of morbidity and mortality. Currently, there are no disease-modifying pharmacotherapies for this condition. Aducanumab, an amyloid beta-directed monoclonal antibody that targets aggregated forms of amyloid-beta in the brains of people with Alzheimer’s disease, has raised hopes that such a therapy has been discovered, but its approval by the US Food and Drug Administration has engendered a good deal of controversy. A similar application for approval has been submitted to Health Canada. In response to this, a group of Canadian clinical dementia experts representing a number of organizations, including the Canadian Geriatrics Society, was convened by the Canadian Consortium on Neurodegeneration in Aging (CCNA) to discuss the evidence currently available on this agent and seek consensus on what advice they would offer Health Canada on the application. There was wide-spread agreement that it would be premature for aducanumab to receive approval for the treatment of Alzheimer’s disease. It was also noted that the Canadian health-care system is poorly prepared at this time to deal with a disease-modifying therapeutic with targeting, administration, and monitoring characteristics like aducanumab. In this paper, the consensus reached is presented along with its underlying rationale.

Updated Inventory and Projected Requirements for Specialist Physicians in Geriatrics.

BackgroundThe predicted growth of Canadians aged 65+ and the resultant rise in the demand for specialized geriatric services (SGS) requires physician resource planning. We updated the 2011 Canadian Geriatrics Society physician resource inventory and created projections for 2025 and 2030.MethodsThe number and full-time equivalents (FTEs) of geriatricians and Care of the Elderly (COE) physicians working in SGS were determined. FTE counts for 2025 and 2030 were estimated by accounting for retirements and trainees. A ratio of 1.25/10,000 population 65+ was used to predict physician resource requirements.ResultsBetween 2011 and 2019 the number of geriatricians and COE physicians increased from 276 (235.8 FTEs) and 128 (89.9 FTEs), respectively, to 376 (319.6 FTEs) and 354 (115.5 FTEs). This increase did not keep pace with the 65+ population growth. The current gap between supply and need is expected to increase.DiscussionThe physician supply gap is projected to widen in 2025 and 2030. Increased recruitment and interdisciplinary team-based care, supported by enhanced funding models, and full integration of COE physicians in SGS could reduce this increasing gap. In contrast to pediatrician supply in Canada, the specialist physician resources available to the population 65+ reflect a disparity.

Investigation and treatment of asymptomatic bacteriuria in older patients with delirium: a cross-sectional survey of Canadian physicians.

Current guidelines suggest assessing non-infectious causes and careful observation before giving antibiotics to delirious patients with asymptomatic bacteriuria. Our study aims to describe the current practice of Canadian physicians regarding the investigation and treatment of asymptomatic bacteriuria in delirious older patients (aged ≥ 65years). Our team of medical experts designed and reviewed a cross-sectional online survey. Study participants were physicians who conduct their clinical practice in Canada and care for older patients with delirium in their current practice. Potential study participants were reached through Canadian associations: Canadian Geriatrics Society, the Canadian Association of Emergency Physicians, the Association des Médecins d'Urgence du Québec and members of Choosing Wisely Canada. 297 physicians were included. The main results show 79.4% of our participants request a urine dipstick or urinalysis in delirious patients and 52.4% immediately order a urine culture with the urinalysis. If bacteriuria is found in delirious but afebrile patients without urinary symptoms, 38% of physicians immediately treat with antibiotics, 33.8% wait for culture before initiating treatment, 14.4% treat if no other cause is found for delirium and only 13.7% would refrain from giving antibiotics. Results from respondents were similar for delirious patients with known cognitive impairment. Participants were almost unanimous (92.5%) in saying they need clear guidelines regarding the treatment of bacteriuria in older delirious patients. This survey highlights the heterogeneous clinical management of asymptomatic bacteriuria in delirious patients and the need for clear guidelines for patients.

Age Alone is not Adequate to Determine Health-care Resource Allocation During the COVID-19 Pandemic.

BackgroundThe Canadian Geriatrics Society (CGS) fosters the health and well-being of older Canadians and older adults worldwide. Although severe COVID-19 illness and significant mortality occur across the lifespan, the fatality rate increases with age, especially for people over 65 years of age. The dichotomization of COVID-19 patients by age has been proposed as a way to decide who will receive intensive care admission when critical care unit beds or ventilators are limited. We provide perspectives and evidence why alternative approaches should be used.MethodsPractitioners and researchers in geriatric medicine and gerontology have led in the development of alternative approaches to using chronological age as the sole criterion for allocating medical resources. Evidence and ethical based recommendations are provided.ResultsAge alone should not drive decisions for health-care resource allocation during the COVID-19 pandemic. Decisions on health-care resource allocation should take into consideration the preferences of the patient and their goals of care, as well as patient factors like the Clinical Frailty Scale score based on their status two weeks before the onset of symptoms.ConclusionsAge alone does not accurately capture the variability of functional capacities and physiological reserve seen in older adults. A threshold of 5 or greater on the Clinical Frailty Scale is recommended if this scale is utilized in helping to decide on access to limited health-care resources such as admission to a critical care unit and/or intubation during the COVID-19 pandemic.

Canadian Geriatrics Society COVID-19 Recommendations for Older Adults. What Do Older Adults Need To Know?

Canadian Geriatrics Society COVID-19 Recommendations for Older Adults. What Do Older Adults Need To Know?

#CGS2015: An Evaluation of Twitter Use at the Canadian Geriatrics Society Annual Scientific Meeting.

BackgroundTwitter is a microblogging platform increasingly used in medicine to overcome geographic barriers and promote international connections. Tweets, the 280-character microblogs, are catalogued by hashtags (#). This study evaluates and describes the participation, content, and impact of Twitter at the 2015 Canadian Geriatrics Society (CGS) Annual Scientific Meeting, during which #CGS2015 was the official conference hashtag.MethodsTwitter transcripts of #CGS2015 were obtained from Symplur to prospectively analyze tweets for content and quantitative metrics. TweetReach was used to retrospectively analyze tweets with the hashtag #CGS2014 from the 2014 meeting for growth analysis. The impact of Twitter on the conference experience was derived from questionnaires.ResultsThere were 1,491 #CGS2015 tweets, 40% of which were original. Tweet content was categorized into conference sessions (38.8%), networking (29.2%), resource sharing (17.6%), and conference promotion (14.3%). Of the 279 participants, 60% were non-Canadian. The questionnaire data from 86 respondents demonstrated generally positive experiences with Twitter, particularly with facilitating collegial interactions, resource sharing, and insight into sessions not attended live. The most cited drawback was divided attention when using personal devices. Analysis comparing #CGS2014 to #CGS2015 demonstrated increases in total participants (50 to 279), number of tweets (434 to 1,491) and impressions (155,600 to 943,825).ConclusionsTwitter engagement at the CGS 2015 annual meeting enabled international participation in networking, resource sharing, and online discussions of sessions. Future conferences may benefit from a workshop on Twitter basics for attendees and presenters.

Canadian Geriatrics Society 36th Annual Scientific Meeting Abstracts

The flipped classroom is a reversal of conventional teaching models: learners obtain first exposure to material through independent study and then in-class time is dedicated to activities for learners to apply the knowledge. Cards are a novel method of “flipping the classroom” using adaptive multiple-choice questions with patient cases containing randomized demographic data. The purpose of this project was to implement a flipped classroom model on Geriatrics topics to determine if Cards provide an additional benefit to podcasts in learning outcomes for second-year medical students.Three distinct modalities were used: traditional lectures, podcasts, and Cards. All of the material was covered in lectures and podcasts. Half of the material was randomized to be presented in Cards. Recall and comprehension were tested as part of a formative examination. After the exam, students were asked to evaluate each teaching method based on a Likert scale: 1 (strongly disagree) to 5 (strongly agree).Students performed better on exams when faced with material covered by Cards compared to material covered by only lectures and podcasts (37.8 ± 16.5% correct responses versus 30.3 ± 14.3%; n= 131; p < 0.01). The students viewed Cards as a valuable supplement to lecture material (4.2 ± 0.56; n= 41) that helped add to their knowledge about the topics (4.2 ± 0.61). The majority would want more instructors to incorporate Cards into their teaching (4.2 ± 0.67) and preferred Cards over the traditional lectures (3.8 ± 0.92).Further studies will be required to see if Cards alone can show improved learning outcomes or if the other components of the flipped classroom are needed to supplement Cards.Cards reinforce knowledge acquisition through repetition and are a well-received teaching method.

Fall Issue, 2015.

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Abstracts from the 35th Annual Scientific Meeting of the Canadian Geriatrics Society, Montreal, April 2015

Optimizing heath care services for seniors in emergency departments (ED) is a core component of the “Senior Friendly Hospital Approach” being implemented in Quebec. We measured the availability of geriatric expertise in Quebec EDs and its relationship with ED characteristics such as university affiliation, number of stretchers, and geographical location.We surveyed (2013–2014) head nurses and head physicians at 116 adult, non-psychiatric Quebec EDs. We defined high level of availability in the three following components of geriatric expertise: 1) geriatric care coordinatioN = a designated clinician coordinating the care of older adults available every day; 2) multidisciplinarity = 4 or 5 different nonmedical professionals, i.e., specialized nurse, social worker, occupational therapist, physiotherapist, and pharmacist, available almost always/often (nurse-reported); and 3) geriatric consultation = a specialist or a general practitioner specialized in geriatrics available almost always/often (physician-reported). We performed descriptive analyses and Fisher’s exact test.Among participating EDs (N = 83), 73 (88%) nurses and 67 (81%) physicians participated in the survey. 18% of EDs had high level of geriatric care coordination, 41% provided high level of multidisciplinarity, and 33% received high level of geriatric consultation. We found that EDs that had greater number of stretchers were more likely to have high level of geriatric care coordination (p < .05) and consultation (p < .001). EDs in metropolitan areas were also more likely to receive high level of geriatric consultation (p < .01). High level of multidisciplinarity was not associated with any ED characteristics.2/5 of Quebec EDs provide high level of multidisciplinarity varying in their characteristics, whereas smaller and non-metropolitan EDs lack geriatric care coordination and consultation.There is a need for reorganisation and finding innovative ways to use existing human resources in Quebec EDs.

The future of medical care for older adults in Canada.

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Poster Abstracts from the 34(th) Annual Scientific Meeting of the Canadian Geriatrics Society, Edmonton, April 2013.

Background Information:Limited research has suggested that rural residents are at increased risk of dementia.Objective:The objective of this study is to determine if rural residence is associated with dementia using both cross-sectional and prospective analyses.Methods:In 1991, 1763 community-dwelling adults aged 65+ participated in the Manitoba Study of Health and Aging (MSHA), which sampled all regions of the province of Manitoba. Baseline measures included age, gender, years of education, the Modified Mini-Mental State Examination (3MS), and rural/urban status. Rural was defined as a census subdivision with a population <20,000 and urban as 20,000+. Dementia was diagnosed in participants with a 3MS score <78 and clinical examination applying DSMIIIR criteria at baseline and at follow-up five years later. All other participants were categorized as not demented. Two analyses were conducted: 1) a cross-sectional analysis (N=1,763), and 2) a prospective analysis of those who did not have dementia at time 1, and who survived to time 2 (N=1,079).Results:Forty per cent (n=703) of participants were rural residents. Participants in urban areas had a mean 3MS score of 86.1 vs. 84.2 in rural areas (p = .001). Mean number of years of education in urban areas was 10.0 vs. 8.3 in rural areas (p <.001). In multivariate logistic regression models adjusting for age, gender, and education, living in a rural area was not significantly associated with dementia in either cross-sectional (adjusted Odds Ratio (AOR)=1.03, 95% CI=0.59–1.81) or prospective analyses (AOR=0.78; 95% CI=0.51–1.21).Conclusion:Rural residents had significantly lower educational attainment and 3MS scores than urban residents. However, rural residence was not associated with dementia in either cross-sectional or prospective analyses. Further study into heterogeneity between rural areas is warranted.

Reasons and Outcomes for Long‐Term Care Transfers to the Hospital: A Retrospective Review

Reasons and Outcomes for Long‐Term Care Transfers to the Hospital: A Retrospective Review

Abstracts from the Canadian Consensus Conference on Dementia

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Abstracts from the 33rd Annual Scientific Meeting of the Canadian Geriatrics Society Toronto, April 2013

Background/Purpose:The 85+-year-old population – the “oldest old” – is now the fastest growing age segment in Canada. Although existing research demonstrates high health services utilization and prescribed medications in this population, little epidemiological evidence is available to guide care for this age group.Objective:To describe the epidemiological characteristics of common health conditions and medication prescriptions in the “oldest old”.Methods:We conducted a retrospective chart review of all family practice patients aged ≥ 85 (N = 564; 209M:355F) at Sunnybrook Health Sciences Centre, Toronto. Electronic medical records were reviewed for all current chronic conditions and medication prescriptions, and then stratified by sex and age subgroup (85–−89, 90–94, 95+) for descriptive analysis.Results:On average, patients experienced 6.4 concurrent chronic conditions and took 6.8 medications. Most conditions were related to cardiovascular (79%) and bone health (65%). Hypertension (65%) was the most common condition. Bone-related conditions (e.g., osteoarthritis, osteoporosis) and hypothyroidism predominantly affected women (p < .001), while coronary artery disease and T2DM were more prevalent in men (p < .05). The top two prescribed medications were Atorvastatin (33%) and ASA 81 mg (33%). Males were more likely to be prescribed lipid-lowering medications, while females were more likely to receive osteoporosis therapy (p < .001). Patients received less lipid-lowering therapy with increasing age (p < .001).Discussion & Conclusion:Multimorbidity and polypharmacy are highly prevalent in patients over 85. Most clinical concerns in this population relate to cardiovascular and bone health; medications predominantly treat risk factors. In the absence of epidemiological data to guide clinical decision-making, this study provides a first look at the common health concerns and medication profiles in this population.