Older Adults In Ontario Research Articles

Effectiveness of Inactivated Influenza Vaccines in Preventing Influenza-Associated Deaths and Hospitalizations among Ontario Residents Aged ≥65 Years: Estimates with Generalized Linear Models Accounting for Healthy Vaccinee Effects

BackgroundEstimates of the effectiveness of influenza vaccines in older adults may be biased because of difficulties identifying and adjusting for confounders of the vaccine-outcome association. We estimated vaccine effectiveness for prevention of serious influenza complications among older persons by using methods to account for underlying differences in risk for these complications.MethodsWe conducted a retrospective cohort study among Ontario residents aged ≥65 years from September 1993 through September 2008. We linked weekly vaccination, hospitalization, and death records for 1.4 million community-dwelling persons aged ≥65 years. Vaccine effectiveness was estimated by comparing ratios of outcome rates during weeks of high versus low influenza activity (defined by viral surveillance data) among vaccinated and unvaccinated subjects by using log-linear regression models that accounted for temperature and time trends with natural spline functions. Effectiveness was estimated for three influenza-associated outcomes: all-cause deaths, deaths occurring within 30 days of pneumonia/influenza hospitalizations, and pneumonia/influenza hospitalizations.ResultsDuring weeks when 5% of respiratory specimens tested positive for influenza A, vaccine effectiveness among persons aged ≥65 years was 22% (95% confidence interval [CI], −6%–42%) for all influenza-associated deaths, 25% (95% CI, 13%–37%) for deaths occurring within 30 days after an influenza-associated pneumonia/influenza hospitalization, and 19% (95% CI, 4%–31%) for influenza-associated pneumonia/influenza hospitalizations. Because small proportions of deaths, deaths after pneumonia/influenza hospitalizations, and pneumonia/influenza hospitalizations were associated with influenza virus circulation, we estimated that vaccination prevented 1.6%, 4.8%, and 4.1% of these outcomes, respectively.ConclusionsBy using confounding-reducing techniques with 15 years of provincial-level data including vaccination and health outcomes, we estimated that influenza vaccination prevented ∼4% of influenza-associated hospitalizations and deaths occurring after hospitalizations among older adults in Ontario.

From pharmaco-therapy to pharmaco-prevention: trends in prescribing to older adults in Ontario, Canada, 1997-2006

BackgroundThe developed world is undergoing a demographic transition with greater numbers of older adults and higher rates of chronic disease. Most elder care is now provided by primary care physicians, who prescribe the majority of medications taken by these patients. Despite these significant trends, little is known about population-level prescribing patterns to primary care patients aged 65+.MethodsWe conducted a population-based retrospective cohort study to examine 10-year prescribing trends among family physicians providing care to patients aged 65+ in Ontario, Canada.ResultsBoth crude number of prescription claims and prescription rates (i.e., claims per person) increased dramatically over the 10-year study period. The greatest change was in prescribing patterns for females aged 85+. Dramatic increases were observed in the prescribing of preventive medications, such as those to prevent osteoporosis (+2,347%) and lipid-lowering agents (+697%). And lastly, the number of unique classes of medications prescribed to older persons has increased, with the proportion of older patients prescribed more than 10 classes of medications almost tripling during the study period.ConclusionsPrescribing to older adults by family physicians increased substantially during the study period. This raises important concerns regarding quality of care, patient safety, and cost sustainability. It is evident that further research is urgently needed on the health outcomes (both beneficial and harmful) associated with these dramatic increases in prescribing rates.

Correlates of gambling-related problems among older adults in Ontario

Although the literature suggests that gambling among older adults is influenced by unique age-related factors, there is little information on the factors associated with the experience of gambling-related problems among older adults. The purpose of this study was to identify the sociodemographic health determinants and mental health-related problems, including alcohol and drug dependence, that are associated with the experience of gambling problems among older adults in Ontario. The research was an exploratory analysis of data from Ontario adults, aged 55 and over, who completed the Canadian Community Health Survey -Mental Health and Well-being, Cycle 1.2 (1,904 males and 2,622 females). Logistic regression analyses were conducted to identify sociodemographic, gambling behaviour, and mental health correlates of the experience of any gambling-related problems, as identified by responses to the Canadian Problem Gambling Index. Being married or living common law and having a higher education level were associated with reduced risk of gambling problems. Among mental health variables, alcohol dependence and any substance dependence significantly increased the odds of reporting a gambling problem. Gambling behaviour measures, such as more frequent gambling, participating in more types of gambling, and spending more on gambling were significant correlates of gambling problems.

New Thyroxine Treatment in Older Adults Beginning Lithium Therapy: Implications for Clinical Practice

The authors sought to determine the incidence of lithium-induced hypothyroidism in a population-based cohort of older adults beginning lithium therapy and thereby to inform clinical guidelines on the frequency of monitoring necessary in this group. The authors conducted a population-based observational cohort study using four administrative databases that contained information on over 1.3 million older adults in Ontario who receive universal healthcare coverage in terms of physician services, drugs, and hospitalizations. Over an 18-month period, they studied adults age>or=65 who were newly prescribed lithium or valproate, monitoring subjects for initiation of T4 therapy (as a proxy for hypothyroidism) while they continued their lithium use. The authors identified 1,705 new users of lithium and 2,406 new users of valproate with similar baseline characteristics. Lithium users were significantly more likely to be treated with T4 than were valproate users. The rate of T4 treatment per 100 person-years was 5.65 in the lithium group and 2.70 in the valproate group. T4 treatment was initiated in almost 6% of lithium-treated patients, suggesting the possibility that hypothyroidism developed twice as frequently among these patients as would be expected among a mixed-age population. Increased vigilance and continued monitoring of thyroid functioning for at least 2 years is necessary in older adults beginning lithium therapy.

New Thyroxine Treatment in Older Adults Beginning Lithium Therapy: Implications for Clinical Practice

Objective The authors sought to determine the incidence of lithium-induced hypothyroidism in a population-based cohort of older adults beginning lithium therapy and thereby to inform clinical guidelines on the frequency of monitoring necessary in this group. Methods The authors conducted a population-based observational cohort study using four administrative databases that contained information on over 1.3 million older adults in Ontario who receive universal healthcare coverage in terms of physician services, drugs, and hospitalizations. Over an 18-month period, they studied adults age ≥65 who were newly prescribed lithium or valproate, monitoring subjects for initiation of T 4 therapy (as a proxy for hypothyroidism) while they continued their lithium use. Results The authors identified 1,705 new users of lithium and 2,406 new users of valproate with similar baseline characteristics. Lithium users were significantly more likely to be treated with T 4 than were valproate users. The rate of T 4 treatment per 100 person-years was 5.65 in the lithium group and 2.70 in the valproate group. Conclusion T 4 treatment was initiated in almost 6% of lithium-treated patients, suggesting the possibility that hypothyroidism developed twice as frequently among these patients as would be expected among a mixed-age population. Increased vigilance and continued monitoring of thyroid functioning for at least 2 years is necessary in older adults beginning lithium therapy.

Use of angiotensin-converting enzyme inhibitor therapy and dose-related outcomes in older adults with new heart failure in the community.

To evaluate the dose-related benefit of angiotensin-converting enzyme (ACE) inhibitor therapy among older adults with heart failure and to evaluate whether low-dose ACE inhibitor therapy is better than none. Observational cohort study. Community-dwelling older adults in Ontario, Canada. We identified 16539 adults 66 years or older who survived 45 days following their first heart failure hospitalization discharge. Multivariate techniques including propensity scores were used to study the association between the dose of ACE inhibitor therapy dispensed and 3 outcomes: survival, survival or heart failure rehospitalization, and survival or all-cause hospitalization at 1 year of follow-up. Logistic regression models explored the association between initial dose dispensed and subsequent dose reduction or drug cessation. Overall, 10793 (65.3%) of patients were dispensed ACE inhibitor therapy, with more than a third (3935; 36.5%) initiated on low-dose therapy. Relative to dispensing of low-dose ACE inhibitor therapy, nonuse was associated with increased mortality (hazard ratio [HR], 1.12; 95% confidence interval [CI], 1.02 to 1.22). Dispensing medium-dose therapy provided a benefit similar to low-dose (HR, 0.94; CI, 0.86 to 1.03) and dispensing of high-dose therapy was associated with improved survival benefit (HR, 0.76; CI, 0.68 to 0.85). Relative to dispensing of low-dose ACE inhibitor therapy, dispensing high-dose conferred a benefit (HR, 0.87; CI, 0.80 to 0.95) on the composite outcome of 1-year mortality or heart failure hospitalization and the composite outcome of 1-year mortality or all-cause hospitalization (HR, 0.87; CI, 0.81 to 0.93). Relative to those dispensed low-dose ACE inhibitor therapy, those initially dispensed high-dose therapy were twice as likely to have their subsequent dose reduced or the therapy discontinued (odds ratio, 2.36; CI, 2.07 to 2.69). Our findings suggest that when possible, older adults should be titrated to the higher doses of ACE inhibitor therapy evaluated in clinical trials. If older adults cannot tolerate higher doses, then low-dose ACE inhibitor therapy is superior to none. High-dose ACE inhibitor therapy is not as well tolerated as lower doses.

Geographic variations in dental services provided to older adults in Ontario, Canada

Abstract– In an initial study, Leake et al. (J Public Health Dent 1996; 52: 182–90) found that older Ontarians living in metropolitan communities received almost twice the amount of dental care than older Ontarians living in non‐metropolitan communities. Since data were collected for the 2 years prior to the enrolment of subjects in a longitudinal study, factors responsible for this variation could not be explored. This paper extends thesendings by examining the volume of dental services received by these subjects in the 3 years between the baseline and follow‐up phases of the longitudinal study. During this 3‐year period, geographic variations in the volume of services provided were also observed. In a regression analysis, geographic location remained a significant predictor of the number of services received after controlling for six other explanatory variables: insurance coverage, number of teeth, restorative treatment need, self‐rated oral health, regular dental visits and use of specialist services. Together, these explained only 24% of the variance in service provision. Since patient‐reported outcomes were better in the communities with higher volumes of provision, further research concerning the patient and dentist factors inuencing treatment provision is warranted.

Geographic variations in dental services provided to older adults in Ontario, Canada.

In an initial study, Leake et al. (J Public Health Dent 1996; 52: 182-90) found that older Ontarians living in metropolitan communities received almost twice the amount of dental care than older Ontarians living in non-metropolitan communities. Since data were collected for the 2 years prior to the enrollment of subjects in a longitudinal study, factors responsible for this variation could not be explored. This paper extends these findings by examining the volume of dental services received by these subjects in the 3 years between the baseline and follow-up phases of the longitudinal study. During this 3-year period, geographic variations in the volume of services provided were also observed. In a regression analysis, geographic location remained a significant predictor of the number of services received after controlling for six other explanatory variables: insurance coverage, number of teeth, restorative treatment need, self-rated oral health, regular dental visits and use of specialist services. Together, these explained only 24% of the variance in service provision. Since patient-reported outcomes were better in the communities with higher volumes of provision, further research concerning the patient and dentist factors influencing treatment provision is warranted.

Coronal and root decay experience in older adults in Ontario, Canada.

This paper describes the coronal and root caries experience of subjects aged 50 years and older living in four communities in Ontario, Canada. The data were obtained as part of a comprehensive epidemiologic study of the oral health and treatment needs of this population. Caries experience was defined as the number of decayed and filled coronal and root surfaces per subject. Of 907 subjects interviewed and clinically examined, 78.3 percent were dentate and retained a mean of 18.9 teeth. The mean number of coronal decayed and filled surfaces was 23.9; 95.6 percent of subjects had at least one coronal DFS. The mean number of decayed and filled root surfaces was 3.6; 70.9 percent had at least one root DFS. The percent D/DFS was 3.5 for coronal and 20.0 for root caries. In linear regression analysis the number of teeth, making regular preventive visits, being born in Canada, and educational status emerged as predictors of coronal DFS. Predictors of root DFS were the number of surfaces with recession, the number of coronal DFS, the number of teeth, age, sex, and smoking status. These variables accounted for 42 percent and 35 percent of the variance in the number of coronal and root DFS, respectively.

Effects of non‐response on estimates derived from an oral health survey of older adults

A major source of bias in health surveys is non-response on the part of those selected to take part in a study. In a survey of the oral health of older adults in Ontario, Canada, we used an initial telephone survey based on random digit dialing with a personal interview and clinical examination follow-up. The telephone survey was completed by 3033 individuals (78.0%) of those sampled. The follow-up was completed by only 907 (30.0%) of these subjects. Nevertheless, there were no major differences in the characteristics of those completing the telephone survey and those subsequently participating in the follow-up. Non-response bias analysis indicated that differences between crude and adjusted estimates of the prevalence of oral conditions were small and the effect of non-response on estimates of the relationship between socioeconomic status and oral health in this population were also small. These results indicate that response rates lower than those conventionally regarded as acceptable do not necessarily compromise the results of epidemiological studies.

Periodontal attachment loss in independently living older adults in Ontario, Canada.

This paper describes the periodontal disease experience of a community-dwelling population aged 50 years and older, living in four communities in Ontario, Canada. The periodontal status of this population was assessed using attachment loss and the extent and severity index. Attachment loss was measured at two sites on each tooth using a pressure-sensitive periodontal probe. Complete periodontal data were obtained on 624 subjects. The mean number of sites per subject was 37.9. In line with recent US studies, the diagnostic threshold for a diseased or previously diseased site was set at 2 mm of loss. The overall mean attachment loss was 2.95 mm, with 19.7 percent of subjects having an overall mean attachment loss of 4.00 mm or more. The proportion of sites examined with loss of attachment of 2 mm or more was 77 percent. The severity of disease, defined as the average distance between the base of the sulcus or pocket and a point 1.00 mm apical to the cemento-enamel junction in sites with loss of 2 mm or more was 2.44 mm. These data indicate that the extent and severity of disease in this population were greater than that reported by some recent studies in the US. Taken together, the results of these studies suggest that there is some variation in the periodontal disease experience of population subgroups across North America.