Care For Older Adults Research Articles

A frailty census of older adults in the emergency department and acute inpatient settings of a model 4 hospital in the Mid-West of Ireland

Abstract Background Frailty is a risk factor for presentation to the ED, in-hospital mortality, prolonged hospital stays and functional decline at discharge. Profiling the prevalence and level of frailty within the acute hospital setting is vital to ensure evidence-based practice and service development within the construct of frailty. The aim of this cross-sectional study was to establish the prevalence of frailty and co-morbidities among older adults in an acute hospital setting. Methods Data collection was undertaken by clinical research nurses and advanced nurse practitioners experienced in assessing older adults. All patients aged ≥ 65 years and admitted to a medical or surgical inpatient setting between 08:00 and 20:00 and who attended the ED over a 24-h period were screened using validated frailty and co-morbidity scales. Age and gender demographics, Clinical Frailty Scale (CFS), Charlson Co-morbidity Index (CCI) and admitting specialty (medical/surgical) were collected. Descriptive statistics were used to profile the cohort, and p values were calculated to ascertain the significance of results. Results Within a sample of 413 inpatients, 291 (70%) were ≥ 65 years and therefore were included in the study. 202 of these 291 older adults (70%) were ≥ 75 years. Frailty was investigated using validated clinical cut-offs on the CFS (not frail < 5; frail ≥ 5). Comorbidities were investigated using the Charlson Comorbidity Index (mild 1–2; moderate 3–4; severe ≥ 5). The median CFS was 6 indicating moderate frailty levels, and the median CCI score was 3 denoting moderate co-morbidity. In the inpatient cohort, 245 (84%) screened positive for frailty, while 223 (75%) had moderate-severe co-morbidity (CCI Mod 3–4, severe ≥ 5). No significant differences were observed across genders for CFS and CCI. In the ED, 81 patients who attended the ED were ≥ 65 years. The median CFS was 6 (moderate frailty), and the median CCI was 5 (severe co-morbidity level). Seventy-four percent (60) of participants screened positively for frailty (CFS ≥ 5), and 31% (25) had a CFS of 7 or greater (severely frail). Ninety-six percent (78) of patients had a moderate-severe level of comorbidity. No significant associations were found between the CFS and CCI and ED participants age, gender, and medical/surgical speciality usage. Conclusion There is a high prevalence of frailty and co-morbidity among older adults who present to the ED and require inpatient care. This may contribute to increased waiting times, lengths of stay, and the need for specialist intervention. With an increased focus on the integration of care for older adults across care transitions, there is a clear need for expansion of frailty-based services, staff training in frailty care and multidisciplinary team resources across the hospital and community setting.

Patient Self-Guided Interventions to Reduce Sedative Use and Improve Sleep

Direct-to-patient interventions enabling transitions from long-term benzodiazepine receptor agonist (BZRA) use to cognitive behavioral therapy for insomnia (CBTI) by older adults has the potential to reduce BZRA use and related harms while improving sleep outcomes without requiring prearranged clinician involvement. To compare 2 direct-to-patient behavior change interventions with treatment as usual (TAU) on BZRA use, sleep, and other health outcomes, and uptake of CBTI techniques. The Your Answers When Needing Sleep in New Brunswick (YAWNS NB) study was a 3-arm, pragmatic, open-label, minimum-contact, randomized clinical trial. The study began November 2020 and ended June 2022. Participants were randomly allocated to 1 of 3 groups, including 2 different mailed behavior change interventions or no intervention (TAU). Participants were from communities across the province of New Brunswick, Canada, and included adults 65 years and older living independently with long-term use of BZRAs and current or past insomnia. The Sleepwell package (YAWNS-1) consisted of a cover letter and 2 booklets ("How to Stop Sleeping Pills" and "How to Get Your Sleep Back"). The other package (YAWNS-2) included updated versions of the 2 booklets ("You May Be at Risk" and "How to Get a Good Night's Sleep Without Medication") used in the Eliminating Medications Through Patient Ownership of End Results (EMPOWER) study. BZRA use at 6 months was the primary measure. Secondary measures included CBTI use, sleep, insomnia, daytime sleepiness, safety, anxiety, frailty, and quality of life. A total of 1295 individuals expressed interest in the study, and 565 (43.6%) completed a baseline assessment. Participants had a mean (SD) age of 72.1 (5.7) years, a mean (SD) BZRA use duration of 11.4 (9.1) years, and 362 (64.1%) were female. Discontinuations and dose reductions of 25% or greater were highest with YAWNS-1 (50 of 191 [26.2%]; 39 of 191 [20.4%]; total, 46.6%) compared with YAWNS-2 (38 of 187 [20.3%]; 27 of 187 [14.4%]; total, 34.8%, P = .02) and TAU (14 of 187 [7.5%]; 24 of 187 [12.8%]; total, 20.3%, P < .001). YAWNS-1 also demonstrated better uptake of CBTI techniques and sleep outcomes compared with YAWNS-2 (new CBTI techniques: 3.1 vs 2.4; P =.03; sleep efficiency change: 4.1% vs -1.7%; P =.001) and reduced insomnia severity and daytime sleepiness compared with TAU (insomnia severity index change: -2.0 vs 0.3; P <.001; Epworth Sleepiness Scale change: -0.8 vs 0.3; P =.001). Results of the YAWNS NB randomized clinical trial show that, as a simple, scalable, direct-to-patient intervention, YAWNS-1 substantially reduced BZRA use and improved sleep outcomes. It could be implemented to transform insomnia care for older adults at the population level. ClinicalTrials.gov Identifier: NCT04406103.

Training healthcare professionals in assessment of health needs in older adults living at home: a scoping review

BackgroundInterprofessional assessment and management of health needs for older adults living at home can help prioritize community service resources and enhance health, yet there is a shortage of professionals with the necessary competencies. Therefore, support and training for healthcare professionals in community settings to assess older adults’ health with the aim of for health promotion are needed.AimTo identify and provide an overview of published papers describing approaches for training healthcare professionals in assessing physical, mental, and social health needs in older adults living at home.MethodA systematic literature search of the Cinahl, Medline, Academic Search Ultimate, Scopus, Embase, and British Nursing Index databases was performed. We considered studies focusing on the training of healthcare professionals in assessing a single or multiple health needs of older adults aged 65 and above living at home. We considered studies published between 1990 – and March 2024. The review evaluated qualitative, quantitative, and mixed methods studies published in English-language peer-reviewed academic journals. A quality appraisal was conducted via the Mixed Methods Appraisal Tool (MMAT).ResultsTwenty-three studies focused on training healthcare professionals to assess health needs and plan care for older adults living at home were included. The majority of the included studies combined teacher-driven pedagogical approaches consisting of educational sessions, written materials or e-learning, and more participant-engaging pedagogical approaches such as knowledge exchange or various forms of interactive learning. Healthcare professionals were trained to detect and manage single and multiple health needs, and some studies additionally incorporated interprofessional collaboration. Healthcare professionals were satisfied with the training content and it increased their confidence and competencies in health needs assessment and care planning for older adults. Moreover, some studies have reported that training interventions foster the implementation of new and effective ways of working and lead to positive outcomes for older adults.ConclusionHealthcare professionals were satisfied with a combination of participant-engaging and teacher-driven pedagogical approaches used to train them in assessing health needs and planning care for older adults living at home. Such training can lead to enhanced assessment skills and facilitate improvements in practice and health promotion for older adults. Future research is recommended on interprofessional simulation training for conducting structured and comprehensive health needs assessments of older adults living at home, as well as on the implementation of such assessments and health-promoting interventions.

Clinical momentum in the care of older adults with advanced dementia: What evidence is there in the medical record?

Clinical momentum in the care of older adults with advanced dementia: What evidence is there in the medical record?

Social care provision for older adults in China: Regional disparities and driving factors

AbstractIn the context of rapid ageing, the scale and distribution of social care resources for older adults in China are undergoing significant changes. Based on the macroscopic samples of the National Statistical Yearbooks from 2011 to 2021, this study examines the regional disparities, dynamic evolution, and drivers of social care provision for older adults in China. The results reveal that while the overall level of social care provision for older adults has consistently improved, significant regional disparities persist. The most abundant social care resources have long been concentrated in the economically prosperous coastal regions. Although overall disparities have shown a fluctuating downward trend over time, the absolute gaps across certain economic regions continue to widen. Furthermore, this study identifies several driving factors behind senior social care provision, including regional economic conditions, government preferences for welfare fiscal expenditure, regional consumption patterns, and urbanisation rates. However, the increase in local financial autonomy has a negative impact on the provision of social care for older adults. The findings highlight the importance of developing a more scientific fiscal oversight mechanism, creating region‐specific policies, and addressing the needs of older migrants to achieve the goal of equalising social care provision for older adults.

Minimizing the Risk of Diagnostic Errors in Acute Care for Older Adults: An Interdisciplinary Patient Safety Challenge.

Modern healthcare systems are increasingly organized according to diagnosis-specific clinical pathways and treatment protocols. At the same time, the number of patients with complex problems and needs that do not fit the single-diagnosis approach is rising, contributing to a high prevalence of diagnostic errors. In this article, we focus on the risk of diagnostic errors arising from missed or incomplete diagnosis and assessment of older adult patients' care needs in the first hours of acute hospitalizations in EDs. This focus is important for improving patient safety, as clinical decisions made in EDs impact patient safety in the subsequent steps of the process, thereby potentially causing new risks to arise. Based on our discussion of clinical decision-making and diagnostic errors in the acute care context, we propose a more comprehensive interdisciplinary approach to improvements in patient safety that integrates organizational and clinical research and examines where, when, how, and why risks to patient safety arise in and across different clinical-organizational contexts.

Turning to digital: Examining the relationship between offline healthcare barriers and U.S. older adults’ emotional well-being via online patient–provider communication and perceived quality of care (2017–2020)

PurposeTo examine the association between offline healthcare barriers and emotional well-being and assess the mediation roles of online patient–provider communication (OPPC) and perceived quality of care. This study also investigates the trends in offline healthcare barriers, OPPC, perceived quality of care, and emotional well-being over four years among the old population in the U.S. MethodsData from the Health Information National Trends Survey (HINTS) 5 Cycles 1, 2, and 4 were used. Mediation analysis and comparison analysis were employed. ResultsThe results indicated an increment in OPPC and a decline in patient’s perceived quality of care between 2017 and 2020. Across the three years, offline healthcare barriers were consistently negatively associated with emotional well-being, and perceived quality of care remained a mediator in such a relationship. Moreover, the serial mediating roles of OPPC and perceived quality of care between offline healthcare barriers and emotional well-being turned from statistically non-significant (2017) to significant (2018, 2020). ConclusionOur results witness the growing adoption of OPPC among older adults and the evolution of OPPC as a complementary communication modality. The findings can support interventions to augment OPPC utilization and enhance the perception of quality care of older adults, contributing to their increased emotional well-being.

Embracing Connection: A Review of First-Ever Clinical Guidelines on Social Isolation and Loneliness in Older Adults.

Social isolation and loneliness are major public health concerns and are associated with morbidity and mortality. As this is an increasing issue in older adults, guidance for healthcare providers is a priority. The Canadian Coalition for Senior's Mental Health (CCSMH) has developed the first Canadian social isolation and loneliness guidelines to help providers recognize, assess, and manage social isolation and loneliness among older adults. We review and summarize these guidelines to support healthcare and social service providers to apply best practices and evidence-based care for older adults experiencing social isolation and loneliness.

Quality of care for community-dwelling older adults living with dementia in BC: an interrupted time-series analysis to examine the effect of the COVID-19 pandemic

ObjectiveQuality care for older adults living with dementia (OALwD) is a priority in Canada, nationally, and British Columbia (BC), provincially. The COVID-19 pandemic likely changed care quality, but this has not been assessed. We are examining the effect of pandemic-related policy changes on quality of care for community-dwelling OALwD in BC. ApproachThis population-based retrospective cohort study uses linked administrative data to examine trends in population-level indicators of quality care from 2016-2023. We will compare effects among community-dwelling BC residents aged 65+ with dementia and those without dementia. Indicators including hospitalization rate and medication use were selected, based on the Institute of Medicine’s six dimensions of quality (e.g., effectiveness, safety). Interrupted time series (ITS) analysis will examine changes between “pre-pandemic” and “in-pandemic” periods. Equity will be assessed through stratification by sociodemographic variables. Anticipated ResultsPercent change in the level and slope of each indicator’s trend will be reported. Single ITS will identify the effect of the pandemic on each outcome in the dementia group only. Controlled ITS will identify whether changes differ from those observed in older adults without dementia. Together, observed changes in the indicators and differences across equity factors will inform an interpretation of the overall effect of the pandemic on quality of care for community-dwelling OALwD in BC. ImplicationsWe will determine whether quality of care changed for older adults because of the pandemic and whether changes differed for OALwD. This knowledge will inform practice and policy for delivery of high quality, proactive dementia care.

Understanding Patterns of Care for Older Adults: Data to Action

ObjectiveOlder adult population is growing rapidly, the current system is not adequately designed to meet the needs of individuals to live safely and independently in the place of their choice. To understand the variations in care and identify where to intervene, we examined the transitions in care of community-dwelling older adults (COA) leading up to 24-hour assisted living at special care homes (SCH). ApproachWe conducted a retrospective-cohort study using health administrative data from a Canadian province with a long history of comprehensive, longitudinal data. Using process mining techniques, health service utilization of COA, 65 and older, was mapped as a journey rather than independent care events. We examined the common patterns experienced leading up to SCH admission by sequencing transitions between care settings. Consideration was given to geography that the individual resides in and their health status to understand variations. ResultsOverall health utilization patterns revealed predominant reliance on acute care and SCH admissions. However, geographic variations were identified (regions and urban/rural). More than 2000 transition patterns between emergency department, hospital, community, and SCH were observed. ConclusionThe ability for COA to age in place is dependent on the individual, where they live, and the availability of and access to services to meet their needs. To minimize undesirable and early admissions to SCH, a multifaceted, collaborative approach to align community-based supports for COA is required. The results of these analyses will help inform areas in which to focus interventions and serve as a baseline while evaluating impact.

Indonesian dentists' views on providing oral health care for older adults

BackgroundWith demographic changes in aging populations, dentists require special care protocols to treat older adults with diverse and complex oral health needs and problems. Knowledge, positive attitudes, and sufficient practice experience are essential components for promptly treating older adults. However, many dentists encounter multiple barriers influencing their willingness to provide care for older adults. This study assessed Indonesian dentists' knowledge, attitudes, and practices (KAP) in providing oral health care (OHC) for older adults, including their willingness and barriers.MethodsA cross‐sectional survey was conducted with 392 dentists employing an online questionnaire between April and June 2022. The respondents' KAP was categorised utilising a modified Blooms' cut‐off point of ≥60%. Data were analysed using descriptive statistics, the x2 test, and logistic regression.ResultsMost dentists demonstrated adequate knowledge (62.2%), a positive attitude (95.4%), sufficient practice experience (91.6%), and a high willingness (98%) to provide OHC services for older adults. However, 91.4% encountered barriers primarily related to interpersonal communication, disease complexity and polypharmacy, and patient functional status. Significant associations were found between dentists' attitudes toward practices and willingness to attend geriatric dentistry training with knowledge.ConclusionImplementation of continuing professional development (CPD) in geriatric dentistry, the inclusion of geriatric dentistry into the undergraduate curriculum, and enhancing clinic accessibility for older adults may improve dentists' preparedness and benefit the future provision of OHC for older adults in Indonesia.

Assessment of needs, challenges, and re-design considerations for culturally sensitive provision and delivery of palliative care supports and services for older adults who prefer to age and die in place in diverse India.

As the global older adult population continues to grow, challenges related to managing multiple chronic conditions (MCCs) or multimorbidity underscore the growing need for palliative care. Palliative care preferences and needs vary significantly based on context, location, and culture. As a result, there is a need for more clarity on what constitutes palliative care in diverse settings. Our objective was to present an international perspective on palliative care in India, a culturally diverse and large ancient Eastern middle-income country. In this narrative review article, we considered three questions when re-designing palliative care for older adults aging-in-place in India: (I) what are the needs for palliative care for persons and their families? (II) Which palliative care domains are essential in assessing improvements in the quality of life (QoL)? (III) What patientreported measures are essential considerations for palliative care? To address these questions, we provide recommendations based on the following key domains: social, behavioral, psychological, cultural, spiritual, medical, bereavement, legal, and economic. Using an established and widely reported conceptual framework on aging and health disparities, we provide how these domains map across multiple levels of influence, such as individual or family members, community, institutions, and health systems for achieving the desired QoL. For greater adoption, reach, and accessibility across diverse India, we conclude palliative care must be carefully and systematically re-designed to be culturally appropriate and community-focused, incorporating traditions, individual preferences, language(s), supports and services from educational and health institutions, community organizations and the government. In addition, national government insurance schemes such as the Ayushman Bharat Yojna can include explicit provisions for palliative care so that it is affordable to all, regardless of ability to pay. In summary, our considerations for incorporating palliative care domains to care of whole person and their families, and provision of supports of services from an array of stakeholders broadly apply to culturally diverse older adults aging in place in India and around the globe who prefer to age and die in place.

Age-related disparities in older adults in trauma

As the population of older adults (≥65 years of age) continues to grow, the incidence of traumatic injuries in this demographic is also increasing nationwide. It has been well established that older adults experience worse outcomes, that is, an increased morbidity and mortality, when compared to younger adults. Moreover, survivors often experience accelerated cognitive and functional decline, loss of independence, and recurring injuries and hospitalizations. This manuscript examines the multifaceted challenges and disparities faced by older adults in trauma care. Factors such as age-related physiological changes, racial disparities, access to health care, and structural ageism that contribute to poor outcomes in geriatric patients who experience trauma. This is exacerbated by the sparsity of geriatric-specific practice management guidelines, thier poor implementation, and the critical under-representation of older adults in trauma research. However, significant efforts are being made to improve the care of older adults, including geriatric patients who experience trauma, through age-friendly systems, and initiatives aimed at promoting inclusive and effective care. These endeavors hold promise for a future where trauma care for older adults is comprehensive and equitable.

Appropriateness of Nursing Home to Emergency Department Transitional Care for Older Adults With Dementia: A Scoping Review.

To systematically identify knowledge patterns and gaps in the appropriateness of nursing home (NH) to emergency department (ED) transitional care for older adults with dementia. A systematic search of multiple information sources was performed from July to August 2023 using predesigned search strategies. From 13 articles, 54 identified pieces of specific care evidence were grouped into six major care domains: (1) Resource Support for Assessing Transfer Needs and Patient Status; (2) Resource Support, Shared Decision Making, and Early Advance Care Planning; (3) Standardized Multimodal Information Transfer; (4) Designated ED and NH Transition Coordinators; (5) Enhanced Interfacility Collaboration; and (6) Appropriate Transitional Care Education, Research, and Policy Beyond the Transfer Interface. A comprehensive, consensus-based body of evidence is lacking. Despite person-centered, standardized, and professional resources supporting transitional care, reorienting NH cultural models remains unclear. Gaps include evidence tailored to diverse participants and contexts. Thus, a focus on policies, education, and research is required. [Journal of Gerontological Nursing, 50(9), 37-45.].

Enhancing Care for Older Adults and Dementia Patients With Large Language Models: Proceedings of the National Institute on Aging-Artificial Intelligence & Technology Collaboratory for Aging Research Symposium.

Large Language Models (LLMs) stand on the brink of reshaping the field of aging and dementia care, challenging the one-size-fits-all paradigm with their capacity for precision medicine and individualized treatment strategies. The "Large Pre-Trained Models with a Focus on AD/ADRD and Healthy Aging" symposium, organized by the National Institute on Aging and the Johns Hopkins Artificial Intelligence & Technology Collaboratory for Aging Research, served as a platform for exploring this potential. The symposium brought together diverse experts to discuss the integration of LLMs in aging and dementia care. They highlighted the roles LLMs can play in clinical decision support and predictive analytics, while also addressing critical ethical concerns including bias, privacy, and the responsible use of artificial intelligence (AI). The discussions focused on the need to balance technological advancement with ethical considerations in AI deployment. In conclusion, the symposium projected a future where LLMs not only revolutionize healthcare practices but also pose significant challenges that require careful navigation.

Spatial accessibility of home visiting nursing: An exploratory ecological study.

Japan is one of the oldest societies worldwide and manages a system of care for older adults in the community. In the 2000s, a community-based integrated care system was introduced to enable older adults to live in their neighborhoods. Home visiting nursing (HVN) is a crucial component of this system; however, the current and future shortage of home visiting nurses is a concern. Thus, HVN services may not be available in some areas; however, no indicators of the accessibility of HVN services have been developed. Developing accessibility indicators will serve as a standard for considering the allocation of health care resources and supporting future nursing policies that improve regional disparities. We estimated the population-weighted spatial accessibility index (PWSAI) of HVN services in Hokkaido, using the two-step floating catchment area method (2SFCA). The 2SFCA comprised population, location of HVN agencies, number of home visiting nurses, and travel time. A multivariate regression model was run for the number of HVN users in each municipality as the objective variable to test the validity of the PWSAI; the number of home care support clinics, home care support hospitals, HVN agencies, home visiting nurses, home visiting nurses (24/7), total beds in health care facilities for older adults, and nursing homes for older adults were included as other explanatory variables. The PWSAI was median 9.0 [interquartile range: 6.2-11.8]. The distribution of the PWSAI was mapped to visualize the existence of regional differences. As a result of the conditional autoregressive model, PWSAI and home visiting nurses (24/7) were significant, Exp(β) and 95% credible interval were 1.043 [1.015-1.076] and 1.021 [1.006-1.036], respectively. The PWSAI was positively correlated with the number of HVN users in each municipality and can serve as an indicator for assessing the accessibility of HVN.

Clinician Perspectives on Palliative Care for Older Adults With Serious Mental Illnesses: A Multisite Qualitative Study

ObjectivesApproximately 5.5% of the population live with serious mental illnesses (SMI). Older adults with SMI experience a high burden of serious medical illnesses and disparities in advance care planning, symptom management, and caregiver support. The objectives of this study are to explore interdisciplinary clinician perspectives on the palliative care needs of older adults with SMI and serious medical illnesses. Design, setting, and participantsThis qualitative study utilized thematic analysis of semi-structured interviews of interdisciplinary clinicians practicing palliative care, geriatrics, or geriatric/consultation-liaison psychiatry at four hospitals within an urban health system. MeasurementsThemes related to care of older adults with serious mental illness and serious medical illness with respect to clinician experiences, challenges in care, and opportunities to improve care. ResultsThe authors interviewed 45 clinicians. Major themes identified were: (1) Current paradigms of palliative care do not meet the needs of patients with SMI; (2) Clinicians are motivated to care for this population but require more training and interdisciplinary practice; (3) There is a need for structural integration of psychiatric and palliative care services. ConclusionsThe study underscores the inadequacy of current palliative care models in meeting the unique needs of older adults with SMI. Models of integrated psychiatric and serious illness care and enhanced training are needed to improve the delivery of palliative care. Integrated care models and workforce development at the interface of serious illness care and psychiatric have the potential to improve outcomes for this vulnerable population.

Factors Associated With the Suspension of Domiciliary Dental Care for Older Adults During the First Wave of the Coronavirus Disease 2019 (COVID-19) Pandemic: A Comparative Study in the Japanese Local Government.

Objective The novel coronavirus has reduced the availability of dental services, including domiciliary dental care. The suspension of dental treatment worsens the dental condition. However, the impact on domiciliary dental care during the coronavirus disease 2019 (COVID-19) pandemic remains unclear. Therefore, the aim of this study is to determine the impacts of the COVID-19 pandemic on domiciliary dental care and associated factors. Materials and methods This comparative study used Japanese prefectural claims data, including data from older adults who utilized domiciliary dental care. We compared the suspension of dental treatment during the firstwave of the COVID-19 pandemic with that before the COVID-19 pandemic. The outcome was the completion of four consecutive months of treatment. The chi-squared test, t-test, and logistic regression were applied. Result Approximately 23.4% of participants suspended home dental services during the first wave of the COVID-19 pandemic, whereas 11.7% suspended these services before COVID-19. Logistic regression clarified the effect of the following variables (during the first wave of COVID-19 vs. before COVID-19): care need level of long-term care was 1-5 (=severe) (odds ratio (OR): 0.92 vs. no significance (NS)), visit by hospital dentists (OR: 1.83 vs. NS), volume of patients in the visited place (2-9 people, OR: NS vs. 0.72; over 10 people, OR: 0.58 vs. 0.32), planned physicians' visit (OR: 0.71 vs. 0.77), and taxed income per population (OR: NS vs. 1.00). Discussion Domiciliary dental care, especially those in care facilities, were a vulnerable population during the pandemic. This may contribute to the delivery of domiciliary dental care during any future pandemics.

Characteristics of family physicians with additional training or focused practices in caring for older adults: Population-based retrospective cohort study.

To identify FPs with additional training and focused practice activities relevant to the needs of older patients within health administrative data and to describe their medical practices and service provision in community-based primary care settings. Retrospective cohort study. Ontario. Family physicians with Certificates of Added Competence in care of the elderly from the College of Family Physicians of Canada or focused practice billing designations in care of the elderly. Evidence of additional training or certification in care of the elderly or practice activities relevant to the care of older adults. Of 14,123 FPs, 242 had evidence of additional scope to better support older adults. These FPs mainly practised in team-based care models, tended to provide comprehensive care, and billed for core primary care services. In an unadjusted analysis, factors statistically significantly associated with greater likelihood of having additional training or focused practices relevant to the care of older patients included physician demographic characteristics (eg, female sex, having completed medical school in Canada, residential instability at the community level), primary care practice model (ie, focused practice type), primary care activities (eg, more likely to provide consultations, practise in long-term care, refer patients to psychiatry and geriatrics, bill for complex house call assessments, bill for home care applications, and bill for long-term care health report forms), and patient characteristics (ie, older average age of patients). The FP workforce with additional training or focused practices in caring for older patients represents a small but specialized group of providers who contribute a portion of the total primary care activities for older adults. Health human resource planning should consider the contributions of all FPs who care for older adults, and enhancing geriatric competence across the family medicine workforce should be emphasized.

Promoting Person-Centered Care for Older Adults: Development of the Long-Term Care Unit Environment Assessment Tool (LTCU-EAT)

Providing older people with quality long-term care (LTC) contributes to the Sustainable Development Goal (SDG) 3—Good Health and Well-being. Person-Centered Care (PCC) is the optimal approach that enhances the quality of life for older adults residing in LTC facilities. This study develops the Long-Term Care Unit Environment Assessment Tool (LTCU-EAT) to assess how LTC environments support PCC goals. The study was conducted in five steps. (1) Reviewing and revising assessment items based on existing literature; (2) Preliminary assessment and protocolling with expert opinions; (3) On-site assessments conducted by two raters among 21 LTC units across 13 facilities; (4) Reliability test of assessment items; (5) Scoring and reliability test of LTC unit samples. The LTCU-EAT, comprising 89 items distributed across 12 subscales within four themes, was developed based on a summary of 14 PCC goals. A total of 83 items (93.26%) demonstrated strong inter-rater reliability. The assessments of all LTC unit samples displayed good criterion-related validity. The LTCU-EAT is a valuable tool for conducting post-occupancy evaluation (POE) of LTC facilities, systematically evaluating the level of environment support for PCC, and providing empirical evidence for future research, policy and practice.