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Bethell J, Andrew MK, Hothi S, Mick P, Morgan D, O'Connell ME, Phillips NA, Stewart S, Walker JD, Wittich W, McGilton KS. Does social connection mediate the association between neuroticism and cognition? Cross-sectional analysis of the Canadian Longitudinal Study on Aging. Aging Ment Health 2024; 28:482-490. [PMID: 37667914 DOI: 10.1080/13607863.2023.2252369] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/18/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVES This study tested the association between neuroticism and six cognitive measures, and examined the potential mediating roles of social connection (social isolation and loneliness) among middle-aged and older adults. METHODS This cross-sectional study was a secondary analysis of the Canadian Longitudinal Study on Aging (CLSA) Comprehensive Cohort, a sample of Canadians aged 45-85 years at baseline. Respondents with data collected at the first follow-up, between 2015 and 2018, were included (n = 27,765). Structural equation modelling was used to assess the association between neuroticism and six cognitive measures (Rey Auditory Verbal Learning Test immediate recall and delayed recall, Animal Fluency Test, Mental Alternation Test, Controlled Oral Word Association Test and Stroop Test interference ratio), with direct and indirect effects (through social isolation and loneliness). All analyses were stratified by sex, including females (n = 14,133) and males (n = 13,632). RESULTS In unadjusted models, there was evidence of associations between neuroticism and all cognitive measures, except the Stroop Test interference ratio, suggesting higher neuroticism was associated with lower scores on memory and executive function tests. In the models of these other five outcomes, there was consistent evidence of indirect effects (through social isolation and loneliness) and, in some cases, direct effects. The results are discussed in context with limitations, including the use of cross-sectional design and alternative hypotheses to explain the association between personality and cognition. CONCLUSION Among middle-aged and older adults, for both males and females, the findings suggest that the association between neuroticism and cognitive outcomes may be mediated by aspects of social connection.
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Affiliation(s)
- Jennifer Bethell
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Melissa K Andrew
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Canada
| | - Sobhneek Hothi
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Department of Health Studies, University College, University of Toronto, Toronto, Canada
| | - Paul Mick
- Department of Surgery, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Debra Morgan
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Megan E O'Connell
- Department of Psychology, University of Saskatchewan, Saskatoon, Canada
| | - Natalie A Phillips
- Department of Psychology, Centre for Research in Human Development, Concordia University, Montreal, Canada
| | - Steven Stewart
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Jennifer D Walker
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Walter Wittich
- School of Optometry, Université de Montréal, Montreal, Canada
| | - Katherine S McGilton
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
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Liougas MP, Sommerlad A, O'Rourke HM, McGilton KS, Bethell J. Social connection measures for older adults living in long-term care homes: a systematic review protocol. Syst Rev 2024; 13:67. [PMID: 38360642 PMCID: PMC10867987 DOI: 10.1186/s13643-024-02468-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/25/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Various measures have assessed social connection in long-term care (LTC) home residents. However, they use inconsistent terminology, conceptualizations, and operationalizations of social connection. In this systematic review protocol, we propose a study that will characterize measures that assess aspects of LTC home residents' social connection using a unified conceptual model. The objectives are to (1) describe and analyze the measures and (2) evaluate their measurement properties. METHODS A literature search was conducted in MEDLINE ALL (Ovid), Embase Classic and Embase (Ovid), Emcare Nursing (Ovid), APA PsycInfo (Ovid), Scopus, CINAHL Complete (EBSCOhost), AgeLine (EBSCOhost), and Sociological Abstracts (ProQuest). We will include primary research papers with no language limit, published from database inception. We will include studies of a measure of any aspect of social connection in LTC home residents that report at least one measurement property. Independently, two reviewers will screen titles and abstracts, review full-text articles against eligibility criteria, and extract data from included studies. In objective 1, we will analyze identified tools using an adapted framework method. In objective 2, we will evaluate each measure's measurement properties using COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology. We will engage experts and stakeholders to assist with interpreting results and translating knowledge. DISCUSSION Our findings will inform the social connection in long-term care home residents (SONNET) study's development of a novel, person-centered measure for social connection in LTC home settings. We will present our findings in academic and non-academic forums, including conferences, peer-reviewed journals, and other publications. SYSTEMIC REVIEW REGISTRATION Prospero-"Systematic review of measures of social connection used in long-term care home research." CRD42022303526 .
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Affiliation(s)
- Madalena P Liougas
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Suite 160, Toronto, ON, Canada.
- KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.
| | - Andrew Sommerlad
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Hannah M O'Rourke
- College of Health Sciences, Faculty of Nursing, University of Alberta, Alberta, Canada
| | - Katherine S McGilton
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Suite 160, Toronto, ON, Canada
- KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Jennifer Bethell
- KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Lee C, Tripp D, McVie M, Fineczko J, Ramsden G, Hothi S, Langston J, Gilhuly J, Collingwood B, McAiney C, McGilton KS, Bethell J. Empowering Ontario's long-term care residents to shape the place they call home: a codesign protocol. BMJ Open 2024; 14:e077791. [PMID: 38320841 PMCID: PMC10860031 DOI: 10.1136/bmjopen-2023-077791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 01/17/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Canada's long-term care (LTC) homes were founded on an institutional model that viewed residents as passive recipients of care. Many homes continue to follow this model leaving residents removed from operational decision-making within their homes. However, involving residents in the design of their LTC home's environment, programmes and operations can improve the residents' quality of life and other outcomes. This codesign project creates a toolkit/resource for LTC homes to facilitate meaningful resident engagement in their home's organisational design and governance. METHOD This three-part project consists of a scoping review, qualitative interviews, toolkit/resource development and prototyping. In part 1, we conduct a scoping review to synthesise existing knowledge on approaches to engaging LTC home residents in organisational design and governance of their LTC homes, as well as explore barriers, challenges and facilitators of engagement, considerations for diversity and cognitive change, and approaches to evaluation. In part 2, we will have interviews and focus groups with residents, team members (staff) and administrators to assess community capacity to implement and sustain a programme to engage LTC residents in organisational design and governance of their LTC homes. The third part of our project uses these findings to help codesign toolkit(s)/resource(s) to enable the engagement of LTC residents in the organisational design and governance of their LTC homes. ETHICS AND DISSEMINATION The project is conducted in partnership with the Ontario Association of Residents' Councils. We will leverage their communication to disseminate findings and support the use of the codesigned toolkit(s)/resource(S) with knowledge users. We will also publish the study results in an academic journal and present at conferences, webinars and workshops. These results can influence practices within LTC homes by inspiring an organisational culture where residents help shape the place they call home. The interviews and focus groups, conducted in part 2, have been submitted to the University Health Network Research Ethics Board.
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Affiliation(s)
- Chloe Lee
- Ontario Association of Residents' Councils, Markham, Ontario, Canada
| | - Dee Tripp
- Ontario Association of Residents' Councils, Markham, Ontario, Canada
| | - Melissa McVie
- Ontario Association of Residents' Councils, Markham, Ontario, Canada
| | - Julia Fineczko
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Gale Ramsden
- Ontario Association of Residents' Councils, Markham, Ontario, Canada
| | | | - Jennifer Langston
- Ontario Association of Residents' Councils, Markham, Ontario, Canada
| | - Jim Gilhuly
- Ontario Association of Residents' Councils, Markham, Ontario, Canada
| | - Beryl Collingwood
- Ontario Association of Residents' Councils, Markham, Ontario, Canada
| | - Carrie McAiney
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
| | - Katherine S McGilton
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
| | - Jennifer Bethell
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Krassikova A, Wills A, Vellani S, Sidani S, Keatings M, Boscart VM, Bethell J, McGilton KS. Development and Evaluation of a Nurse Practitioner Huddles Toolkit for Long Term Care Homes. Can J Aging 2023:1-9. [PMID: 38044629 DOI: 10.1017/s0714980823000740] [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: 12/05/2023] Open
Abstract
Long-term care homes (LTCHs) were disproportionately affected by the coronavirus disease (COVID-19) pandemic, creating stressful circumstances for LTCH employees, residents, and their care partners. Team huddles may improve staff outcomes and enable a supportive climate. Nurse practitioners (NPs) have a multifaceted role in LTCHs, including facilitating implementation of new practices. Informed by a community-based participatory approach to research, this mixed-methods study aimed to develop and evaluate a toolkit for implementing NP-led huddles in an LTCH. The toolkit consists of two sections. Section one describes the huddles' purpose and implementation strategies. Section two contains six scripts to guide huddle discussions. Acceptability of the intervention was evaluated using a quantitative measure (Treatment Acceptability Questionnaire) and through qualitative interviews with huddle participants. Descriptive statistics and manifest content analysis were used to analyse quantitative and qualitative data. The project team rated the toolkit as acceptable. Qualitative findings provided evidence on design quality, limitations, and recommendations for future huddles.
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Affiliation(s)
- Alexandra Krassikova
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Aria Wills
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Shirin Vellani
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Souraya Sidani
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, ON, Canada
| | - Margaret Keatings
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Veronique M Boscart
- School of Health and Life Sciences, Conestoga College, Kitchener, ON, Canada
| | - Jennifer Bethell
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Katherine S McGilton
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
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McGilton KS, Krassikova A, Wills A, Bethell J, Boscart V, Escrig-Pinol A, Iaboni A, Vellani S, Maxwell C, Keatings M, Stewart SC, Sidani S. Nurse practitioner led implementation of huddles for staff in long term care homes during the COVID-19 pandemic. BMC Geriatr 2023; 23:713. [PMID: 37919676 PMCID: PMC10623826 DOI: 10.1186/s12877-023-04382-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 10/05/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Staff working in long-term care (LTC) homes during COVID-19 frequently reported a lack of communication, collaboration, and teamwork, all of which are associated with staff dissatisfaction, health concerns, lack of support and moral distress. Our study introduced regular huddles to support LTC staff during COVID-19, led by a Nurse Practitioner (NP). The objectives were to evaluate the process of huddle implementation and to examine differences in outcomes between categories of staff (direct care staff, allied care and support staff, and management) who attended huddles and those who did not. METHODS All staff and management at one LTC home (< 150 beds) in Ontario, Canada were included in this pre-experimental design study. The process evaluation used a huddle observation tool and focused on the dose (duration, frequency) and fidelity (NP's adherence to the huddle guide) of implementation. The staff attending and non-attending huddles were compared on outcomes measured at post-test: job satisfaction, physical and mental health, perception of support received, and levels of moral distress. The outcomes were assessed with validated measures and compared between categories of staff using Bayesian models. RESULTS A total of 42 staff enrolled in the study (20 attending and 22 non-attending huddles). Forty-eight huddles were implemented by the NP over 15 weeks and lasted 15 min on average. Huddles were most commonly attended by direct care staff, followed by allied care/support, and management staff. All huddles adhered to the huddle guide as designed by the research team. Topics most often addressed during the huddles were related to resident care (46%) and staff well-being (34%). Differences were found between staff attending and non-attending huddles: direct care staff attending huddles reported lower levels of overall moral distress, and allied care and support staff attending huddles perceived higher levels of support from the NP. CONCLUSIONS NP-led huddles in LTC homes may positively influence staff outcomes. The process evaluation provided some understanding of why the huddles may have been beneficial: the NP addressed resident care issues which were important to staff, encouraged a collaborative approach to solving issues on the unit, and discussed their well-being. TRIAL REGISTRATION NUMBER NCT05387213, registered on 24/05/2022.
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Affiliation(s)
- Katherine S McGilton
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
| | - Alexandra Krassikova
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Aria Wills
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Jennifer Bethell
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Veronique Boscart
- School of Health and Life Sciences, Conestoga College, Kitchener, Canada
| | - Astrid Escrig-Pinol
- Mar School of Nursing, Universitat Pompeu Fabra, Barcelona, Spain
- Social Determinants and Health Education Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Andrea Iaboni
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Shirin Vellani
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Colleen Maxwell
- Schools of Pharmacy and Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Margaret Keatings
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Steven C Stewart
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Souraya Sidani
- Faculty of Nursing, Toronto Metropolitan University, Toronto, Canada
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Wills A, Krassikova A, Keatings M, Escrig-Pinol A, Bethell J, McGilton KS. Assessing the implementation of nurse practitioner-led huddles in long-term care using the Consolidated Framework for Implementation Research (CFIR). BMC Nurs 2023; 22:193. [PMID: 37286987 DOI: 10.1186/s12912-023-01354-1] [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: 10/25/2022] [Accepted: 05/23/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic created major challenges in long-term care (LTC) homes across Canada and globally. A nurse practitioner-led interdisciplinary huddle intervention was developed to support staff wellbeing in two LTC homes in Ontario, Canada. The objective of this study was to identify the constructs strongly influencing the process of implementation of huddles across both sites, capturing the overall barriers and facilitators and the intervention's intrinsic properties. METHODS Nineteen participants were interviewed about their experiences, pre-, post-, and during huddle implementation. The Consolidated Framework for Implementation Research (CFIR) was used to guide data collection and analysis. CFIR rating rules and a cross-comparison analysis was used to identify differentiating factors between sites. A novel extension to the CFIR analysis process was designed to assess commonly influential factors across both sites. RESULTS Nineteen of twenty selected CFIR constructs were coded in interviews from both sites. Five constructs were determined to be strongly influential across both implementation sites and a detailed description is provided: evidence strength and quality; needs and resources of those served by the organization; leadership engagement; relative priority; and champions. A summary of ratings and an illustrative quote are provided for each construct. CONCLUSION Successful huddles require long-term care leaders to consider their involvement, the inclusion all team members to help build relationships and foster cohesion, and the integration of nurse practitioners as full-time staff members within LTC homes to support staff and facilitate initiatives for wellbeing. This research provides an example of a novel approach using the CFIR methodology, extending its use to identify significant factors for implementation when it is not possible to compare differences in success.
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Affiliation(s)
- Aria Wills
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, 500 University Avenue, Toronto, ON, Canada
- Bruyère Research Institute, 43 Bruyère Street, Ottawa, ON, Canada
| | - Alexandra Krassikova
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, 500 University Avenue, Toronto, ON, Canada
| | - Margaret Keatings
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, 500 University Avenue, Toronto, ON, Canada
| | - Astrid Escrig-Pinol
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, 500 University Avenue, Toronto, ON, Canada
- ESIMar (Mar Nursing School), Parc de Salut Mar, Universitat Pompeu Fabra-affiliated, Barcelona, Spain
- SDHEd (Social Determinants and Health Education Research Group), IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Jennifer Bethell
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, 500 University Avenue, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, ON, Canada
| | - Katherine S McGilton
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, 500 University Avenue, Toronto, ON, Canada.
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON, Canada.
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Wunsch H, Hill AD, Bethell J, Fu L, Bateman BT, Ladha KS, Wijeysundera DN, Neuman MD. Surgeon Postoperative Opioid Prescribing Intensity and Risk of Persistent Opioid Use Among Opioid-naive Adult Patients: A Population-based Cohort Study. Ann Surg 2023; 277:767-774. [PMID: 35129483 PMCID: PMC9124725 DOI: 10.1097/sla.0000000000005318] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to determine the relationship between surgeon opioid prescribing intensity and subsequent persistent opioid use among patients undergoing surgery. SUMMARY BACKGROUND DATA The extent to which different postoperative prescribing practices lead to persistent opioid use among surgical patients is poorly understood. METHODS Retrospective population-based cohort study assessing opioid-naive adults who underwent 1 of 4 common surgeries. For each surgical procedure, the surgeons' opioid prescribing intensity was categorized into quartiles based on the median daily dose of morphine equivalents of opioids dispensed within 7 days of the surgical visit for all the surgeons' patients. The primary outcome was persistent opioid use in the year after surgery, defined as 180 days or more of opioids supplied within the year after the index date excluding prescriptions filled within 30 days of the index date. Secondary outcomes included a refill for an opioid within 30 days and emergency department visits and hospitalizations within 1 year. RESULTS Among 112,744 surgical patients, patients with surgeons in the highest intensity quartile (Q4) were more likely to fill an opioid prescription within 7 days after surgery compared with those in the lowest quartile (Q1) (83.3% Q4 vs 65.4% Q1). In the primary analysis, the incidence of persistent opioid use in the year after surgery was rare in both highest and lowest quartiles (0.3% Q4 vs 0.3% Q1), adjusted odds ratio (AOR) of 1.18, 95% CI 0.83-1.66). However, multiple analyses using stricter definitions of persistent use that included the requirement of a prescription filled within 7 days of discharge after surgery showed a significant association with surgeon quartile (up to an AOR 1.36, 95% CI 1.25, 1.47). Patients in Q4 were more likely to refill a prescription within 30 days (4.8% Q4 vs 4.0% Q1, AOR 1.14, 95% CI 1.04-1.24). CONCLUSIONS Surgeons' overall prescribing practices may contribute to persistent opioid use and represent a target for quality improvement. However, the association was highly sensitive to the definition of persistent use used.
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Affiliation(s)
- Hannah Wunsch
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Andrea D. Hill
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Jennifer Bethell
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | | | - Brian T. Bateman
- Department of Anesthesia, Perioperative, and Pain Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Karim S. Ladha
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia, St. Michael’s Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Duminda N. Wijeysundera
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia, St. Michael’s Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Mark D. Neuman
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
- Center for Perioperative Outcomes Research and Transformation, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Center for Pharmacoepidemiology Research and Training, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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McGilton KS, Haslam-Larmer L, Wills A, Krassikova A, Babineau J, Robert B, Heer C, McAiney C, Dobell G, Bethell J, Kay K, Keatings M, Kaasalainen S, Feldman S, Sidani S, Martin-Misener R. Nurse practitioner/physician collaborative models of care: a scoping review protocol. BMC Geriatr 2023; 23:98. [PMID: 36797669 PMCID: PMC9934505 DOI: 10.1186/s12877-023-03798-1] [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: 07/13/2022] [Accepted: 02/03/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Before the COVID-19 pandemic, many long-term care (LTC) homes experienced difficulties in providing residents with access to primary care, typically delivered by community-based family physicians or nurse practitioners (NPs). During the pandemic, legislative changes in Ontario, Canada enabled NPs to act in the role of Medical Directors thereby empowering NPs to work to their full scope of practice. Emerging from this new context, it remains unclear how NPs and physicians will best work together as primary care providers. NP/physician collaborative models appear key to achieving optimal resident outcomes. This scoping review aims to map available evidence on existing collaborative models of care between NPs and physicians within LTC homes. METHODS The review will be guided by the research question, "What are the structures, processes and outcomes of collaborative models of care involving NPs and Physicians in LTC homes?" This scoping review will be conducted according to the methods framework for scoping reviews outlined by Arksey and O'Malley and refined by Levac et al., Colquhoun et al., and Daudt et al., as well as the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Statement. Electronic databases (MEDLINE, Embase + Embase Classic, APA PsycInfo, Cochrane Central Register of Controlled Trials, AMED, CINAHL, Ageline, and Scopus), grey literature, and reference lists of included articles will be searched. English language studies that describe NP and physician collaborative models within the LTC setting will be included. DISCUSSION This scoping review will consolidate what is known about existing NP/physician collaborative models of care in LTC homes. Results will be used to inform the development of a collaborative practice framework for long-term care clinical leadership.
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Affiliation(s)
- Katherine S. McGilton
- grid.231844.80000 0004 0474 0428KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, 550 University Avenue, Toronto, ON M5G 2A2 Canada ,grid.17063.330000 0001 2157 2938Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON M5T 1P8 Canada
| | - Lynn Haslam-Larmer
- grid.231844.80000 0004 0474 0428KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, 550 University Avenue, Toronto, ON M5G 2A2 Canada ,grid.17063.330000 0001 2157 2938Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON M5T 1P8 Canada
| | - Aria Wills
- grid.231844.80000 0004 0474 0428KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, 550 University Avenue, Toronto, ON M5G 2A2 Canada ,grid.17063.330000 0001 2157 2938Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON M5T 1P8 Canada
| | - Alexandra Krassikova
- grid.231844.80000 0004 0474 0428KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, 550 University Avenue, Toronto, ON M5G 2A2 Canada
| | - Jessica Babineau
- grid.231844.80000 0004 0474 0428Library & Information Services, University Health Network, 550 University Avenue, Toronto, ON M5G 2A2 Canada ,grid.231844.80000 0004 0474 0428The Institute for Education Research, University Health Network, Toronto, Canada
| | - Ben Robert
- Perley Health, 1750 Russell Road, Ottawa, ON K1G 5Z6 Canada ,grid.28046.380000 0001 2182 2255Faculty of Medicine, University of Ottawa, 451 Smyth Road #2044, Ottawa, ON K1H 8M5 Canada
| | - Carrie Heer
- Brant Community Healthcare System, 200 Terrace Hill Street, Brantford, ON N3R 1G9 Canada ,grid.418792.10000 0000 9064 3333Bruyère Research Institute, 85 Primrose Ave, Ottawa, ON K1R 6M1 Canada
| | - Carrie McAiney
- grid.498777.2Schlegel-UW Research Institute for Aging, Waterloo, ON N2J 0E2 Canada ,grid.46078.3d0000 0000 8644 1405School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada
| | - Gail Dobell
- Ontario Health, 130 Bloor Street West, Toronto, ON M5S 1N5 Canada
| | - Jennifer Bethell
- grid.231844.80000 0004 0474 0428KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, 550 University Avenue, Toronto, ON M5G 2A2 Canada ,grid.17063.330000 0001 2157 2938Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, ON M5T 3M7 Canada
| | - Kelly Kay
- Provincial Geriatrics Leadership Ontario, Toronto, Canada ,grid.17063.330000 0001 2157 2938Ontario Institute for Studies in Education and the Institute for Life Course and Aging, University of Toronto, 246 Bloor Street West, Toronto, ON M5S 1V4 Canada
| | - Margaret Keatings
- grid.42327.300000 0004 0473 9646The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8 Canada
| | - Sharon Kaasalainen
- grid.25073.330000 0004 1936 8227School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Sid Feldman
- Baycrest Health Sciences, 3560 Bathurst Street, Toronto, ON M6A2E1 Canada ,grid.17063.330000 0001 2157 2938Department of Family and Community Medicine, Temerty Medicine, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8 Canada
| | - Souraya Sidani
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, 250 Victoria Street, Toronto, ON M5B 2K9 Canada
| | - Ruth Martin-Misener
- grid.55602.340000 0004 1936 8200School of Nursing, Dalhousie University, Room G26, Forrest Bldg., 5869 University Avenue, Halifax, NS B3H 4R2 Canada
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9
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McGilton K, Krassikova A, Wills A, Keatings M, Bethell J, Boscart V, Sidani S. NURSE PRACTITIONER–LED IMPLEMENTATION OF HUDDLES TO SUPPORT STAFF IN LONG-TERM CARE HOMES. Innov Aging 2022. [PMCID: PMC9766356 DOI: 10.1093/geroni/igac059.2039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Staff working in long-term care (LTC) homes frequently report experiencing moral distress related to lack of autonomy and not being able to provide quality care. Huddles have been used as a communication tool for many years in acute care settings to improve collaboration and safety culture. In LTC homes, huddles are implemented less often, despite evidence of their benefits in improving support and teamwork. In this pre-test post-test implementation study, huddles led by a nurse practitioner (NP) were introduced in a privately-owned not-for-profit LTC home with < 150 beds, located in a medium urban centre in Ontario, Canada. Objectives of the study were to 1) examine fidelity of huddle implementation; 2) examine the extent to which the huddles improved staff’ outcomes of moral distress, job satisfaction, and support provided by the NP estimated with Bayesian proportional odds model. A total of 48 huddles were carried out by the NP over 15 weeks. Huddles were most commonly attended by personal support workers (98%) and registered practical nurses (96%), with an average of 7 individuals per huddle. Topics most often addressed at huddles were related to resident care (46%) and staff concerns (34%). Strong statistical evidence of a reduction in overall moral distress was evident for staff attending the huddles, when compared to staff who did not (posterior probability =.9933). No changes in job satisfaction and support provided by the NP were observed. Introducing huddles in LTC homes may be effective at reducing moral distress experienced by staff.
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Affiliation(s)
- Katherine McGilton
- KITE Research Institute: Toronto Rehabilitation Institute-UHN, Toronto, Ontario, Canada
| | - Alexandra Krassikova
- Toronto Rehabilitation Institute, University Health Network, Thornhill, Ontario, Canada
| | - Aria Wills
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
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10
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Emdin A, Boblitz A, Maclagan L, Bethell J, Watt J, Harris D, Maxwell C, Bronskill S. DESCRIBING THE EVOLUTION OF MEDICATION USE OVER TIME IN PEOPLE LIVING WITH DEMENTIA USING NETWORK ANALYSIS. Innov Aging 2022. [DOI: 10.1093/geroni/igac059.2815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
Prescribing for community-dwelling older adults living with dementia is complex. Multiple medications may be used to manage symptoms associated with dementia and/or co-existing chronic conditions, and can lead to problematic polypharmacy. Our objective was to use network analysis, a data science method, to provide a comprehensive description of co-prescribed medications in persons with dementia and describe whether these patterns change over time. We created a population-based cohort of community-dwelling older adults (aged 67+ years) in Ontario, Canada, newly diagnosed with dementia (between April 2014 and January 2019), from health administrative data, and developed medication networks at one year prior to, at, and for up to five years following dementia diagnosis. Among 136,292 individuals newly diagnosed with dementia, the mean age was 82.2 years and 59% were female. The most common medication subclasses dispensed at diagnosis were primarily cardiovascular medications: statins (45.6%), proton pump inhibitors (27.3%), beta-blockers (27.0%), calcium blockers (25.1%), and ACE inhibitors (24.6%). Similar proportions of medication subclasses were found at five years after diagnosis, except cholinesterase inhibitors (34.0% at five years were dispensed cholinesterase inhibitors compared to 16.9% at diagnosis). The most frequent co-prescribed medication pairs at diagnosis included statins and beta-blockers (16.0%), proton pump inhibitors (16.0%), and ace inhibitors (15.4%), respectively. Co-prescription was similar at five years, but also included higher frequency of co-prescribing with cholinesterase inhibitors (e.g., 19.4% were prescribed cholinesterase inhibitors and statins). Network diagrams demonstrate the complexity of prescribing in this population and highlight concurrent prescribing which may require careful monitoring or deprescribing.
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Affiliation(s)
- Abby Emdin
- University of Toronto , Toronto, Ontario , Canada
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11
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Bechard LE, McGilton KS, Middleton LE, Chertkow H, Sivananthan S, Bethell J. Engaging People With Lived Experience of Dementia in Research: Perspectives From a Multi-disciplinary Research Network. Can Geriatr J 2022; 25:254-261. [PMID: 36117740 PMCID: PMC9427184 DOI: 10.5770/cgj.25.583] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Patient and public involvement/engagement in research on dementia is not new, but it is becoming increasingly common. The objective of this study was to describe researchers’ knowledge, attitudes, and activities related to engaging people with lived experience of dementia in research, and how these differ by research theme. Methods Data were from an online, anonymous survey of researchers within the Canadian Consortium on Neurodegeneration in Aging. Results Of the 84 researchers who completed the survey (response rate: 27%), 89% agreed they understood the meaning of engaging people with lived experience in research, although this was lower among biomedical researchers. Almost all (93%) agreed that people with lived experience could contribute meaningfully to research, and nearly two-thirds were already incorporating engagement in their research. Some engagement practices reported differed by research theme. Irrespective of the type of research they conduct, researchers were most often motivated by improving the relevance and quality of their research. Conclusions These findings support an optimistic outlook for engaging people with lived experience of dementia in research, but identify differences across research themes. Understanding approaches to incorporate, evaluate, and adapt engagement activities across research disciplines are needed to enable researchers, as well as others involved in research, to develop and target strategies for patient and public involvement/engagement in research on dementia.
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12
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Clemens S, Aelick K, Babineau J, Bretzlaff M, Edwards C, Gibson J, Hewitt Colborne D, Iaboni A, Lender D, Schon D, Snowball E, McGilton KS, Bethell J. Home‐ and community‐level predictors of social connection in nursing home residents: A scoping review. Health Sci Rep 2022; 5:e743. [PMID: 35873395 PMCID: PMC9297378 DOI: 10.1002/hsr2.743] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 11/09/2022] Open
Abstract
Background and Aims Methods Results Conclusion
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Affiliation(s)
- Sara Clemens
- KITE Research Institute Toronto Rehabilitation Institute‐University Health Network Toronto Ontario Canada
| | - Katelynn Aelick
- Behavioural Supports Ontario Provincial Coordinating Office North Bay Regional Health Centre North Bay Ontario Canada
| | - Jessica Babineau
- Library and Information Services University Health Network Toronto Ontario Canada
- The Institute for Education Research University Health Network Toronto Ontario Canada
| | - Monica Bretzlaff
- Behavioural Supports Ontario Provincial Coordinating Office North Bay Regional Health Centre North Bay Ontario Canada
| | | | - Josie‐Lee Gibson
- Ontario Association of Residents' Councils Newmarket Ontario Canada
| | - Debbie Hewitt Colborne
- Behavioural Supports Ontario Provincial Coordinating Office North Bay Regional Health Centre North Bay Ontario Canada
| | - Andrea Iaboni
- KITE Research Institute Toronto Rehabilitation Institute‐University Health Network Toronto Ontario Canada
- Department of Psychiatry University of Toronto Toronto Ontario Canada
| | - Dee Lender
- Ontario Association of Residents' Councils Newmarket Ontario Canada
| | - Denise Schon
- Lakeside Long‐Term Care Centre Family Council Toronto Ontario Canada
| | - Ellen Snowball
- KITE Research Institute Toronto Rehabilitation Institute‐University Health Network Toronto Ontario Canada
| | - Katherine S. McGilton
- KITE Research Institute Toronto Rehabilitation Institute‐University Health Network Toronto Ontario Canada
- Lawrence S. Bloomberg Faculty of Nursing University of Toronto Toronto Ontario Canada
| | - Jennifer Bethell
- KITE Research Institute Toronto Rehabilitation Institute‐University Health Network Toronto Ontario Canada
- Institute of Health Policy, Management and Evaluation University of Toronto Toronto Ontario Canada
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13
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Snowball E, Fernandez Loughlin R, Eagleson H, Barnett KM, McLellan E, O'Connor D, Kelly C, Thelker C, McGilton KS, Bethell J. Engagement of people with lived experience of dementia advisory group and cross-cutting program: reflections on the first year. Res Involv Engagem 2022; 8:28. [PMID: 35752841 PMCID: PMC9233803 DOI: 10.1186/s40900-022-00359-5] [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] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 05/27/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The objective of this paper is to describe the activities, challenges and mitigation strategies, lessons learned and reflections on the importance of engagement from the first year of the Canadian Consortium on Neurodegeneration in Aging (CCNA) Engagement of People with Lived Experience of Dementia (EPLED) Advisory Group and cross-cutting program. EPLED was created to support persons with dementia and care partners to be actively involved in the CCNA research process. MAIN BODY The Advisory Group was formed to work with CCNA researchers and programs to develop new ways to further collaborate and advance the methods of patient engagement in research on dementia. A role profile and recruitment poster were developed and, after interviews, 17 people were invited to join the Advisory Group. We planned three online EPLED meetings to take place between July-August of 2020, with one in-person meeting to be held in Canada. Due to COVID-19, we moved all of these meetings online. In the first year, EPLED and the Advisory Group met seven times formally, four times informally, developed a website, engaged with CCNA research projects, participated in CCNA "Central" activities and formulated an evaluation plan. For researchers and people with lived experience of dementia, motivations for patient engagement included challenging stigma, making meaning from their experience (such as building relationships and having their voices heard) and contributing to research. Common challenges to engagement were related to navigating the impact of COVID-19, such as difficulty in getting to know each other and technical issues with video-conference software. We learned that developing trusting relationships, providing education, offering support, being flexible and acknowledging tensions between research, practice and lived experience, were vital to the success of the Advisory Group. CONCLUSION The first year of the EPLED Advisory Group demonstrated the potential contributions of people with lived experience of dementia as partners in research. Building these collaborations with individuals and communities-people living with dementia, care partners, researchers and research institutions-has the potential for positive impact across these groups and, ultimately, improve the lives of people living with dementia and their care partners.
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Affiliation(s)
- Ellen Snowball
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada.
- Engagement of People with Lived Experience of Dementia Advisory Group and Cross-Cutting Program, Canadian Consortium on Neurodegeneration in Aging, Montreal, Canada.
| | - Rosette Fernandez Loughlin
- Engagement of People with Lived Experience of Dementia Advisory Group and Cross-Cutting Program, Canadian Consortium on Neurodegeneration in Aging, Montreal, Canada
| | - Heather Eagleson
- Engagement of People with Lived Experience of Dementia Advisory Group and Cross-Cutting Program, Canadian Consortium on Neurodegeneration in Aging, Montreal, Canada
| | - Karen Myers Barnett
- Engagement of People with Lived Experience of Dementia Advisory Group and Cross-Cutting Program, Canadian Consortium on Neurodegeneration in Aging, Montreal, Canada
| | - Emily McLellan
- Engagement of People with Lived Experience of Dementia Advisory Group and Cross-Cutting Program, Canadian Consortium on Neurodegeneration in Aging, Montreal, Canada
| | - Denis O'Connor
- Engagement of People with Lived Experience of Dementia Advisory Group and Cross-Cutting Program, Canadian Consortium on Neurodegeneration in Aging, Montreal, Canada
| | - Catherine Kelly
- Engagement of People with Lived Experience of Dementia Advisory Group and Cross-Cutting Program, Canadian Consortium on Neurodegeneration in Aging, Montreal, Canada
| | - Christine Thelker
- Engagement of People with Lived Experience of Dementia Advisory Group and Cross-Cutting Program, Canadian Consortium on Neurodegeneration in Aging, Montreal, Canada
| | - Katherine S McGilton
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
- Engagement of People with Lived Experience of Dementia Advisory Group and Cross-Cutting Program, Canadian Consortium on Neurodegeneration in Aging, Montreal, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON, M5T 1P8, Canada
| | - Jennifer Bethell
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
- Engagement of People with Lived Experience of Dementia Advisory Group and Cross-Cutting Program, Canadian Consortium on Neurodegeneration in Aging, Montreal, Canada
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 1P8, Canada
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14
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Marulappa N, Anderson NN, Bethell J, Bourbonnais A, Kelly F, McMurray J, Rogers HL, Vedel I, Gagliardi AR. How to implement person-centred care and support for dementia in outpatient and home/community settings: Scoping review. BMC Health Serv Res 2022; 22:541. [PMID: 35459214 PMCID: PMC9034625 DOI: 10.1186/s12913-022-07875-w] [Citation(s) in RCA: 5] [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: 07/08/2021] [Accepted: 03/30/2022] [Indexed: 11/17/2022] Open
Abstract
Background Little prior research focused on person-centred care and support (PCCS) for dementia in home, community or outpatient care. We aimed to describe what constitutes PCCS, how to implement it, and considerations for women who comprise the majority of affected persons (with dementia, carers). Methods We conducted a scoping review by searching multiple databases from 2000 inclusive to June 7, 2020. We extracted data on study characteristics and PCCS approaches, evaluation, determinants or the impact of strategies to implement PCCS. We used summary statistics to report data and interpreted findings with an existing person-centred care framework. Results We included 22 studies with qualitative (55%) or quantitative/multiple methods design (45%) involving affected persons (50%), or healthcare workers (50%). Studies varied in how PCCS was conceptualized; 59% cited a PCC definition or framework. Affected persons and healthcare workers largely agreed on what constitutes PCCS (e.g. foster partnership, promote autonomy, support carers). In 4 studies that evaluated care, barriers of PCCS were reported at the affected person (e.g. family conflict), healthcare worker (e.g. lack of knowledge) and organizational (e.g. resource constraints) levels. Studies that evaluated strategies to implement PCCS approaches were largely targeted to healthcare workers, and showed that in-person inter-professional educational meetings yielded both perceived (e.g. improved engagement of affected persons) and observed (e.g. use of PCCS approaches) beneficial outcomes. Few studies reported results by gender or other intersectional factors, and none revealed if or how to tailor PCCS for women. This synthesis confirmed and elaborated the PCC framework, resulting in a Framework of PCCS for Dementia. Conclusion Despite the paucity of research on PCCS for dementia, synthesis of knowledge from diverse studies into a Framework provides interim guidance for those planning or evaluating dementia services in outpatient, home or community settings. Further research is needed to elaborate the Framework, evaluate PCCS for dementia, explore determinants, and develop strategies to implement and scale-up PCCS approaches. Such studies should explore how to tailor PCCS needs and preferences based on input from persons with dementia, and by sex/gender and other intersectional factors such as ethnicity or culture. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07875-w.
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Affiliation(s)
- Nidhi Marulappa
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, 13EN-228, Toronto, ON, M5G2C4, Canada
| | - Natalie N Anderson
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, 13EN-228, Toronto, ON, M5G2C4, Canada
| | - Jennifer Bethell
- Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
| | - Anne Bourbonnais
- Faculty of Nursing, Université de Montréal, PO Box 6128, Montreal, QC, H3C 3J7, Canada
| | - Fiona Kelly
- Division of Nursing, Queen Margaret University, Queen Margaret University Drive, Musselburgh, East Lothian, EH21 6UU, UK
| | - Josephine McMurray
- Lazaridis School of Business and Economics/Health Studies, Wilfrid Laurier University, 73 George Street, Brantford, ON, N3T 3Y3, Canada
| | - Heather L Rogers
- Biocruces Bizkaia Health Research Institute and Ikerbasque Basque Foundation for Science, Bilbao, Spain, Plaza Cruces s/n, E-48903, Barakaldo, Spain
| | - Isabelle Vedel
- Department of Family Medicine, McGill University, 5858 Côte-des-Neiges, Montreal, QC, H3S 1Z1, Canada
| | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, 13EN-228, Toronto, ON, M5G2C4, Canada.
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15
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Lem K, McGilton KS, Aelick K, Iaboni A, Babineau J, Hewitt Colborne D, Edwards C, Bretzlaff M, Lender D, Gibson JL, Bethell J. Social connection and physical health outcomes among long-term care home residents: a scoping review. BMC Geriatr 2021; 21:722. [PMID: 34922469 PMCID: PMC8683818 DOI: 10.1186/s12877-021-02638-4] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 11/16/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Social connection is recognized as an important determinant of health and well-being. The negative health impacts of poor social connection have been reported in research in older adults, however, less is known about the health impacts for those living in long-term care (LTC) homes. This review seeks to identify and summarize existing research to address the question: what is known from the literature about the association between social connection and physical health outcomes for people living in LTC homes? METHODS A scoping review guided by the Arksey & O'Malley framework was conducted. Articles were included if they examined the association between social connection and a physical health outcome in a population of LTC residents. RESULTS Thirty-four studies were included in this review. The most commonly studied aspects of social connection were social engagement (n = 14; 41%) and social support (n = 10; 29%). A range of physical health outcomes were assessed, including mortality, self-rated health, sleep, fatigue, nutrition, hydration, stress, frailty and others. Findings generally support the positive impact of social connection for physical health among LTC residents. However, most of the studies were cross-sectional (n = 21; 62%) and, of the eleven cohort studies, most (n = 8; 73%) assessed mortality as the outcome. 47% (n = 16) were published from 2015 onwards. CONCLUSIONS Research has reported positive associations between social connection and a range of physical health outcomes among LTC residents. These findings suggest an important role for social connection in promoting physical health. However, further research is needed to consider the influence of different aspects of social connection over time and in different populations within LTC homes as well as the mechanisms underlying the relationship with health.
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Affiliation(s)
- Kaitlyn Lem
- Faculty of Arts & Sciences, University of Toronto, Toronto, ON, Canada
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
| | - Katherine S McGilton
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Katelynn Aelick
- Behavioural Supports Ontario Provincial Coordinating Office, North Bay Regional Health Centre, North Bay, ON, Canada
| | - Andrea Iaboni
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Jessica Babineau
- Library and Information Services, University Health Network, Toronto, ON, Canada
| | - Debbie Hewitt Colborne
- Behavioural Supports Ontario Provincial Coordinating Office, North Bay Regional Health Centre, North Bay, ON, Canada
| | | | - Monica Bretzlaff
- Behavioural Supports Ontario Provincial Coordinating Office, North Bay Regional Health Centre, North Bay, ON, Canada
| | - Dee Lender
- Ontario Association of Residents' Councils, Newmarket, ON, Canada
| | - Josie-Lee Gibson
- Ontario Association of Residents' Councils, Newmarket, ON, Canada
| | - Jennifer Bethell
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
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16
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Krassikova A, Stewart S, Bethell J, Davis A, McGilton K. Social Support and Living Situation of Older Adults With Hip-Fracture: A Retrospective Cohort Study. Innov Aging 2021. [PMCID: PMC8681048 DOI: 10.1093/geroni/igab046.2352] [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: 11/12/2022] Open
Abstract
Abstract
Sustaining a hip-fracture is a life-changing event negatively affecting older adults. Although, social support is a known determinant of health outcomes, the relationship between social support and living situation of older adults with hip fracture remains under researched. For this study social support is conceptualized using the Finfgeld-Connett framework, where social support is seen as being composed of emotional and instrumental support. The objectives were to examine the relationship between two domains of social support and living situation: 1) after discharge; 2) 3-months after discharge; and 3) 6-months after discharge from an inpatient rehabilitation facility in a sample of older adults with hip fracture. Emotional support was measured as frequency of interaction with someone one week prior to hip fracture, whereas instrumental support was measured as help received in instrumental activities of daily living. Logistic regression was performed to examine the association between social support and living situation. Majority of study participants (N=139) were older (mean age 81.31), female (77.70%), had no cognitive impairment (68.35%), were not married (58.99%), and lived with someone (51.80%) in their own house (71.95%). Older adults with more emotional support were more likely to be discharged home, however little can be said about the effect of the association (OR 6.80, 95% CI 1.08, 22.31, P<.001). Persons receiving more instrumental support had less odds of living at home 3-months (OR 0.41, 95% CI 0.21, 0.78; P=.007) and 6-months after discharge (OR 0.59, 95% CI 0.38, 0.91, P=0.017). Social support is important for older adults during recovery.
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Affiliation(s)
| | - Steven Stewart
- Toronto Rehabilitation Institute, Toronto Rehabilitation Institute, Ontario, Canada
| | - Jennifer Bethell
- Toronto Rehabiliitation Institute, Toronto Rehabilitation Institute, Ontario, Canada
| | - Aileen Davis
- University of Toronto, University of Toronto, Ontario, Canada
| | - Katherine McGilton
- KITE-Toronto Rehabilitation, University Health Network, Toronto, Ontario, Canada
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17
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Bacsu JD, Fraser S, Chasteen AL, Cammer A, Grewal KS, Bechard LE, Bethell J, Green S, McGilton KS, Morgan D, O'Rourke HM, Poole L, Spiteri RJ, O'Connell ME. Using Twitter to Examine Stigma Against People with Dementia During COVID-19: Infodemiology Study (Preprint). JMIR Aging 2021; 5:e35677. [PMID: 35290197 PMCID: PMC9015751 DOI: 10.2196/35677] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/14/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- Juanita-Dawne Bacsu
- Department of Psychology, Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, SK, Canada
| | - Sarah Fraser
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Alison L Chasteen
- Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Allison Cammer
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | - Karl S Grewal
- Department of Psychology, Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, SK, Canada
| | - Lauren E Bechard
- Department of Kinesiology and Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, Canada
| | - Jennifer Bethell
- Knowledge, Innovation, Talent and Everywhere (KITE) - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Shoshana Green
- Department of Psychology, Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, SK, Canada
| | - Katherine S McGilton
- Knowledge, Innovation, Talent and Everywhere (KITE) - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Debra Morgan
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Lisa Poole
- Dementia Advocacy Canada, Calgary, AB, Canada
| | - Raymond J Spiteri
- Department of Computer Science, University of Saskatchewan, Saskatoon, SK, Canada
| | - Megan E O'Connell
- Department of Psychology, Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, SK, Canada
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18
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Gaulton TG, Wunsch H, Gaskins LJ, Leonard CE, Hennessy S, Ashburn M, Brensinger C, Newcomb C, Wijeysundera D, Bateman BT, Bethell J, Neuman MD. Preoperative Sedative-hypnotic Medication Use and Adverse Postoperative Outcomes. Ann Surg 2021; 274:e108-e114. [PMID: 31415004 PMCID: PMC7053280 DOI: 10.1097/sla.0000000000003556] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine the association between preoperative benzodiazepine and nonbenzodiazepine receptor agonist ("Z-drugs") use and adverse outcomes after surgery. BACKGROUND Prescriptions for benzodiazepines and Z-drugs have increased over the past decade. Despite this, the association of preoperative benzodiazepines and Z-drug receipt with adverse outcomes after surgery is unknown. METHODS Using the Optum Clinformatics Datamart, we performed a retrospective cohort study of adults 18 years or older who underwent any of 10 common surgical procedures between 2010 and 2015. The principal exposure was one or more filled prescriptions for a benzodiazepine or Z-drug in the 90 days before surgery. The primary outcome was any emergency department visit or hospital admission for either (1) a drug related adverse medical event or overdose or (2) a traumatic injury in the 30 days after surgery. RESULTS Of 785,346 patients meeting inclusion criteria, 94,887 (12.1%) filled a preoperative prescription for a benzodiazepine or Z-drug. From multivariable logistic regression, benzodiazepine or Z-drug use was associated with an increased odds of an adverse postoperative event [odds ratio 1.13; 95% confidence interval: 1.08-1.18). In a separate regression, coprescription of benzodiazepines or Z-drugs with opioids was associated with a 1.45 odds of an adverse postoperative event (95% confidence interval: 1.37-1.53). CONCLUSIONS Preoperative benzodiazepines and Z-drug use is common and associated with increased odds of adverse outcomes after surgery, particularly when coprescribed with opioids. Counseling on appropriate benzodiazepine and Z-drug use in advance of elective surgery may potentially increase the safety of surgical care.
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Affiliation(s)
- Timothy G. Gaulton
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
- Center for Perioperative Outcomes Research and Transformation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Hannah Wunsch
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Anesthesia and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lakisha J. Gaskins
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Center for Perioperative Outcomes Research and Transformation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Charles E. Leonard
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
- Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Center for Therapeutic Effectiveness Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sean Hennessy
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
- Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Center for Therapeutic Effectiveness Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Michael Ashburn
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Colleen Brensinger
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Craig Newcomb
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Duminda Wijeysundera
- Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Anesthesia, St. Michael’s Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Brian T. Bateman
- Department of Anesthesia, Perioperative, and Pain Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | | | - Mark D. Neuman
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
- Center for Perioperative Outcomes Research and Transformation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Center for Therapeutic Effectiveness Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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19
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McGilton KS, Campitelli MA, Bethell J, Guan J, Vellani S, Krassikova A, Omar A, Maxwell CJ, Bronskill SE. Impact of Dementia on Patterns of Home Care After Inpatient Rehabilitation Discharge for Older Adults After Hip Fractures. Arch Phys Med Rehabil 2021; 102:1972-1981. [PMID: 34242626 DOI: 10.1016/j.apmr.2021.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 07/15/2020] [Revised: 06/02/2021] [Accepted: 06/24/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To describe differences in home care use in the 30 days after discharge from inpatient rehabilitation after a hip fracture among older adults with dementia compared with those without dementia. DESIGN Retrospective cohort study of individually linked health administrative data. SETTING Community-dwelling older adults after discharge from inpatient rehabilitation facilities in Ontario, Canada. PARTICIPANTS A total of 17,263 older adults (N=17,263), of whom 2489 had dementia (14.4%), who were treated for hip fracture in acute care and then admitted to inpatient rehabilitation facilities between January 1, 2011 and March 31, 2017. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The proportion receiving home care services and number of visits (physiotherapy, occupational therapy, nursing, personal/homemaking) in the 30 days after discharge were compared by dementia status with multivariate models, stratified by sex. RESULTS Compared with those without dementia, adults with dementia were older, had lower functional scores, and were more likely to receive home care services in the 30 days after discharge from inpatient rehabilitation (87.0% vs 79.0%, P<.001), including personal/homemaking services (66.1% vs 46.4%, P<.001) and occupational therapy (45.3% vs 37.4, P<.001) but not physiotherapy (55.8% vs 56.2%, P=.677) or nursing (19.6% vs 18.7%, P=.268). After adjustment, older adults with dementia were more likely to receive home care in both men (odds ratio [OR] =2.01; 95% confidence interval [CI], 1.57-2.57) and women (OR=1.50; 95% CI, 1.30-1.74) as well as more services (rate ratio men=1.60; 95% CI, 1.44-1.79; rate ratio women=1.50; 95% CI, 1.41-1.60). CONCLUSIONS Among older adults discharged from inpatient rehabilitation, older adults with dementia received home care services more often than older adults without dementia. However, irrespective of sex and dementia status, almost half of this population (44%) did not receive physiotherapy. We recommend that, resources permitting, all older adults receive physiotherapy to facilitate recovery.
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Affiliation(s)
- Katherine S McGilton
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario; Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, Toronto, Ontario.
| | | | - Jennifer Bethell
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario; Institute for Clinical Evaluative Science, Toronto, Ontario; Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
| | - Jun Guan
- Institute for Clinical Evaluative Science, Toronto, Ontario
| | - Shirin Vellani
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario; Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, Toronto, Ontario
| | - Alexandra Krassikova
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario; Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Abeer Omar
- Trent/Fleming School of Nursing, Trent University, Peterborough, Ontario
| | - Colleen J Maxwell
- Institute for Clinical Evaluative Science, Toronto, Ontario; Schools of Pharmacy and Public Health & Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Susan E Bronskill
- Institute for Clinical Evaluative Science, Toronto, Ontario; Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
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20
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Bethell J, O'Rourke HM, Eagleson H, Gaetano D, Hykaway W, McAiney C. Social Connection is Essential in Long-Term Care Homes: Considerations During COVID-19 and Beyond. Can Geriatr J 2021; 24:151-153. [PMID: 34079609 PMCID: PMC8137460 DOI: 10.5770/cgj.24.488] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
COVID-19 has had a profound impact on long-term care (LTC) homes in Canada. But the measures put in place to control infection within LTC homes have also had devastating impacts on the health and well-being of residents through the effects on social connection. Here, we offer guiding principles to enable social connection and promote health and quality of life for LTC residents during COVID-19 and beyond. These principles were generated by a working group of the COVID-19 and Dementia Task Force, convened by the Alzheimer Society of Canada to identify the urgent and emerging issues raised by COVID-19 for Canadians with dementia.
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Affiliation(s)
- Jennifer Bethell
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | | | - Heather Eagleson
- Canadian Consortium on Neurodegeneration in Aging (CCNA) Engagement of People with Lived Experience of Dementia Advisory Group (https://ccna-ccnv.ca/contact/)
| | - Daniel Gaetano
- Canadian Consortium on Neurodegeneration in Aging (CCNA) Engagement of People with Lived Experience of Dementia Advisory Group (https://ccna-ccnv.ca/contact/)
| | - Wayne Hykaway
- Canadian Consortium on Neurodegeneration in Aging (CCNA) Engagement of People with Lived Experience of Dementia Advisory Group (https://ccna-ccnv.ca/contact/)
| | - Carrie McAiney
- University of Waterloo, Waterloo, ON.,Schlegel-University of Waterloo Research Institute for Aging, Waterloo, ON, Canada
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21
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Bethell J, Neuman MD, Bateman BT, Ladha KS, Hill A, Li G, Wijeysundera DN, Wunsch H. Association between mothers' postoperative opioid prescriptions and opioid-related events in their children: A population-based cohort study. Health Rep 2021; 31:12-19. [PMID: 32672924 DOI: 10.25318/82-003-x202000600002-eng] [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] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
BACKGROUND Postoperative opioid prescriptions may be associated with risks of unintentional poisoning and drug diversion in other household members. The objective of this study was to explore the association between mothers' postoperative opioid prescriptions and incidence of opioid-related events in their children (aged 1 to 24 years). DATA AND METHODS This retrospective cohort study used individually linked administrative health data from Ontario, Canada. A population-based sample of 170,156 opioid-naïve mothers (aged 15 to 64) (see Figure 1) who underwent surgery between 2013 and 2017 in Ontario was linked through birth records to create a cohort of their 283,550 opioid-naïve children (aged 1 to 24). The association between postoperative opioid analgesic prescriptions filled by mothers within seven days of discharge after surgery and opioid-related events (emergency department presentations or inpatient admissions for opioid poisoning, or mental and behavioural disorders attributable to opioid use) in their children within one year of their mother's discharge was assessed. RESULTS Overall, 60.4% of the children in the cohort had a mother who filled a postoperative opioid prescription. The incidence of opioid-related events in children in the year after a mother's surgery was low overall (n=36/283,550, 0.01%), but higher among children whose mother filled a postoperative opioid prescription (n=29/171,139, 0.02%, vs. n=7/112,411, 0.01%, p=0.02), including in an analysis adjusting for child's age, mother's age, rural residence, neighbourhood income quintile and mother's Charlson comorbidity index score (adjusted odds ratio, 2.42 [95% confidence interval (CI), 1.05 to 5.54], p=0.04). DISCUSSION Postoperative opioid prescriptions for mothers may contribute to opioid-related events in their children. These findings further underscore the importance of safe, effective opioid prescribing, as well as of patient and public education about the use, storage and disposal of these medications.
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Affiliation(s)
- Jennifer Bethell
- Sunnybrook Research Institute, ICES, the Toronto Rehabilitation Institute at the University Health Network, and the Institute of Health Policy Management and Evaluation at the University of Toronto, Toronto, Ontario
| | - Mark D Neuman
- The Department of Anesthesiology and Critical Care, the Center for Perioperative Outcomes Research and Transformation, and the Center for Pharmacoepidemiology Research and Training at the University of Pennsylvania Perelman School of Medicine, and the Leonard Davis Institute of Health Economics at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brian T Bateman
- The Department of Anesthesia, Perioperative, and Pain Medicine, and the Division of Pharmacoepidemiology and Pharmacoeconomics in the Department of Medicine at Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Karim S Ladha
- The Department of Anesthesia at St. Michael's Hospital, and the Department of Anesthesia at the University of Toronto, Toronto, Ontario
| | - Andrea Hill
- Sunnybrook Research Institute, and the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Guohua Li
- The Department of Epidemiology, Mailman School of Public Health, and the Department of Anesthesiology, College of Physicians and Surgeons at Columbia University, and the Center for Injury Epidemiology and Prevention, Columbia University Medical Center, New York, New York
| | - Duminda N Wijeysundera
- ICES, the Institute of Health Policy Management and Evaluation and the Department of Anesthesia at the University of Toronto, and the Department of Anesthesia at St. Michael's Hospital, Toronto, Ontario
| | - Hannah Wunsch
- Sunnybrook Research Institute, ICES, the Department of Anesthesia at the University of Toronto, the Department of Critical Care Medicine at the Sunnybrook Health Sciences Centre, and the Interdepartmental Division of Critical Care Medicine at the University of Toronto, Toronto, Ontario
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22
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McGilton KS, Vellani S, Krassikova A, Robertson S, Irwin C, Cumal A, Bethell J, Burr E, Keatings M, McKay S, Nichol K, Puts M, Singh A, Sidani S. Understanding transitional care programs for older adults who experience delayed discharge: a scoping review. BMC Geriatr 2021; 21:210. [PMID: 33781222 PMCID: PMC8008524 DOI: 10.1186/s12877-021-02099-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/18/2021] [Indexed: 11/28/2022] Open
Abstract
Background Many hospitalized older adults cannot be discharged because they lack the health and social support to meet their post-acute care needs. Transitional care programs (TCPs) are designed to provide short-term and low-intensity restorative care to these older adults experiencing or at risk for delayed discharge. However, little is known about the contextual factors (i.e., patient, staff and environmental characteristics) that may influence the implementation and outcomes of TCPs. This scoping review aims to answer: 1) What are socio-demographic and/or clinical characteristics of older patients served by TCPs?; 2) What are the core components provided by TCPs?; and 3) What patient, caregiver, and health system outcomes have been investigated and what changes in these outcomes have been reported for TCPs? Methods The six-step scoping review framework and PRISMA-ScR checklist were followed. Studies were included if they presented models of TCPs and evaluated them in community-dwelling older adults (65+) experiencing or at-risk for delayed discharge. The data synthesis was informed by a framework, consistent with Donabedian’s structure-process-outcome model. Results TCP patients were typically older women with multiple chronic conditions and some cognitive impairment, functionally dependent and living alone. The review identified five core components of TCPs: assessment; care planning and monitoring; treatment; discharge planning; and patient, family and staff education. The main outcomes examined were functional status and discharge destination. The results were discussed with a view to inform policy makers, clinicians and administrators designing and evaluating TCPs as a strategy for addressing delayed hospital discharges. Conclusion TCPs can influence outcomes for older adults, including returning home. TCPs should be designed to incorporate interdisciplinary care teams, proactively admit those at risk of delayed discharge, accommodate persons with cognitive impairment and involve care partners. Additional studies are required to investigate the contributions of TCPs within integrated health care systems. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02099-9.
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Affiliation(s)
- Katherine S McGilton
- KITE-Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, Ontario, Canada. .,Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
| | - Shirin Vellani
- KITE-Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, Ontario, Canada.,Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Alexandra Krassikova
- KITE-Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sheryl Robertson
- KITE-Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, Ontario, Canada.,Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Constance Irwin
- KITE-Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, Ontario, Canada.,Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Alexia Cumal
- KITE-Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, Ontario, Canada.,Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Bethell
- KITE-Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, Ontario, Canada
| | - Elaine Burr
- Care Transitions, Health Sciences North, Sudbury, Ontario, Canada
| | - Margaret Keatings
- KITE-Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, Ontario, Canada
| | - Sandra McKay
- Visiting Homemakers Association Home Healthcare, Toronto, Ontario, Canada
| | - Kathryn Nichol
- Visiting Homemakers Association Home Healthcare, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Martine Puts
- Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Anita Singh
- Ontario Ministry of Health and Long-Term Care, Toronto, Ontario, Canada
| | - Souraya Sidani
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada
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23
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McGilton KS, Stewart S, Bethell J, Chu CH, Mateos JT, Pastells-Peiró R, Blanco-Blanco J, Rodriguez-Monforte M, Escrig-Pinol A, Gea-Sánchez M. Factors Influencing Nurse Assistants' Job Satisfaction in Nursing Homes in Canada and Spain: A Comparison of Two Cross-Sectional Observational Studies. J Appl Gerontol 2020; 41:235-244. [PMID: 33353479 DOI: 10.1177/0733464820980567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] Open
Abstract
OBJECTIVES To access associations between job satisfaction and supervisory support as moderated by stress. METHODS For this cross-sectional study, data collected from 591 nursing assistants in 42 nursing homes in Canada and Spain were analyzed with mixed-effects regression. RESULTS In both countries, stress related to residents' behaviors was negatively associated with job satisfaction, and, in Canada, it moderated the positive association between supervisory support and job satisfaction. Stress related to family conflict issues moderated the positive association of supervisory support and job satisfaction differently in each location: in Canada, greater stress was associated with a weaker association between supervisory support and job satisfaction; in Spain, this was also observed but only when supervisory support was sufficiently weak. DISCUSSION Stress was associated with lower job satisfaction and moderated the association of supervisory support and job satisfaction, reinforcing the importance of supervisors supporting nursing assistants, especially during the COVID-19 pandemic.
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Affiliation(s)
- Katherine S McGilton
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada
| | - Steven Stewart
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Jennifer Bethell
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Charlene H Chu
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada
| | - Jose T Mateos
- Department of Nursing and Physiotherapy, University of Lleida, Spain.,Research Group of Health Care (GRECS), Biomedical Research Institute of Lleida (IRB Lleida), Lleida, Spain
| | - Roland Pastells-Peiró
- Department of Nursing and Physiotherapy, University of Lleida, Spain.,Research Group of Health Care (GRECS), Biomedical Research Institute of Lleida (IRB Lleida), Lleida, Spain
| | - Joan Blanco-Blanco
- Department of Nursing and Physiotherapy, University of Lleida, Spain.,Research Group of Health Care (GRECS), Biomedical Research Institute of Lleida (IRB Lleida), Lleida, Spain
| | - Miriam Rodriguez-Monforte
- GRoW Research Group; Facultat de Ciències de la Salut Blanquerna; Universitat Ramon Llull, Barcelona, Spain
| | - Astrid Escrig-Pinol
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Montserrat Gea-Sánchez
- Department of Nursing and Physiotherapy, University of Lleida, Spain.,Research Group of Health Care (GRECS), Biomedical Research Institute of Lleida (IRB Lleida), Lleida, Spain.,Ciber Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
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24
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McGilton K, Vellani S, Krassikova A, Cumal A, Robertson S, Irwin C, Bethell J, Sidani S. Enhancing Our Understanding of Transitional Care Programs. Innov Aging 2020. [PMCID: PMC7741963 DOI: 10.1093/geroni/igaa057.448] [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: 11/16/2022] Open
Abstract
Many hospitalized older adults experience delayed discharge. Transitional care programs (TCPs) provide short-term care to these patients to prepare them for transfer to nursing homes or back to the community. There are knowledge gaps related to the processes and outcomes of TCPs. We conducted a scoping review following Arksey & O’Malley’s framework to identify the: 1) characteristics of older patients served by TCPs, 2) services provided within TCPs, and 3) outcomes used to evaluate TCPs. We searched bibliographic databases and grey literature. We included papers and reports involving community-dwelling older adults aged ≥ 65 years and examined the processes and/or outcomes of TCPs. The search retrieved 4828 references; 38 studies and 2 reports met the inclusion criteria. Most studies were conducted in Europe (n=19) and America (n=13). Patients admitted to TCPs were 59-86 years old, had 2-10 chronic conditions, 26-74% lived alone, the majority were functionally dependent and had mild cognitive impairment. Most TCPs were staffed by nurses, physiotherapists, occupational therapists, social workers and physicians, and support staff. The TCPs provided 5 major types of services: assessment, care planning, treatment, evaluation/care monitoring and discharge planning. The outcomes most frequently assessed were discharge destination, mortality, hospital readmission, length of stay, cost and functional status. TCPs that reported significant improvement in older adults’ functions (which was the main goal of the TCPs) included multiple services delivered by multidisciplinary teams. There is a wide variation in the operationalization of TCPs within and between countries.
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Affiliation(s)
| | - Shirin Vellani
- Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
| | - Alexandra Krassikova
- Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
| | - Alexia Cumal
- Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
| | - Sheryl Robertson
- Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
| | - Constance Irwin
- Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
| | - Jennifer Bethell
- Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
| | - Souraya Sidani
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Canada
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25
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Bethell J, Chertkow H, Sivananthan S, McGilton KS. Patient engagement in research on dementia: Perceptions from researchers in a multidisciplinary research consortium. Alzheimers Dement 2020. [DOI: 10.1002/alz.043794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jennifer Bethell
- KITE Toronto Rehabilitation Institute ‐ University Health Network Toronto ON Canada
| | | | | | - Katherine S McGilton
- KITE Toronto Rehabilitation Institute ‐ University Health Network Toronto ON Canada
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26
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Bethell J, Aelick K, Babineau J, Bretzlaff M, Edwards C, Gibson JL, Hewitt Colborne D, Iaboni A, Lender D, Schon D, McGilton KS. Social Connection in Long-Term Care Homes: A Scoping Review of Published Research on the Mental Health Impacts and Potential Strategies During COVID-19. J Am Med Dir Assoc 2020; 22:228-237.e25. [PMID: 33347846 PMCID: PMC9186333 DOI: 10.1016/j.jamda.2020.11.025] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [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: 10/21/2020] [Revised: 11/16/2020] [Accepted: 11/20/2020] [Indexed: 01/23/2023]
Abstract
Objectives Good social connection is associated with better health and wellbeing. However, social connection has distinct considerations for people living in long-term care (LTC) homes. The objective of this scoping review was to summarize research literature linking social connection to mental health outcomes, specifically among LTC residents, as well as research to identify strategies to help build and maintain social connection in this population during COVID-19. Design Scoping review. Settings and Participants Residents of LTC homes, care homes, and nursing homes. Methods We searched MEDLINE(R) ALL (Ovid), CINAHL (EBSCO), PsycINFO (Ovid), Scopus, Sociological Abstracts (ProQuest), Embase and Embase Classic (Ovid), Emcare Nursing (Ovid), and AgeLine (EBSCO) for research that quantified an aspect of social connection among LTC residents; we limited searches to English-language articles published from database inception to search date (July 2019). For the current analysis, we included studies that reported (1) the association between social connection and a mental health outcome, (2) the association between a modifiable risk factor and social connection, or (3) intervention studies with social connection as an outcome. From studies in (2) and (3), we identified strategies that could be implemented and adapted by LTC residents, families and staff during COVID-19 and included the articles that informed these strategies. Results We included 133 studies in our review. We found 61 studies that tested the association between social connection and a mental health outcome. We highlighted 12 strategies, informed by 72 observational and intervention studies, that might help LTC residents, families, and staff build and maintain social connection for LTC residents. Conclusions and Implications Published research conducted among LTC residents has linked good social connection to better mental health outcomes. Observational and intervention studies provide some evidence on approaches to address social connection in this population. Although further research is needed, it does not obviate the need to act given the sudden and severe impact of COVID-19 on social connection in LTC residents.
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Affiliation(s)
- Jennifer Bethell
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
| | - Katelynn Aelick
- Behavioural Supports Ontario Provincial Coordinating Office, North Bay Regional Health Centre, North Bay, Canada
| | - Jessica Babineau
- Library and Information Services, University Health Network, Toronto, Canada; The Institute for Education Research, University Health Network, Toronto, Canada
| | - Monica Bretzlaff
- Behavioural Supports Ontario Provincial Coordinating Office, North Bay Regional Health Centre, North Bay, Canada
| | | | | | - Debbie Hewitt Colborne
- Behavioural Supports Ontario Provincial Coordinating Office, North Bay Regional Health Centre, North Bay, Canada
| | - Andrea Iaboni
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Dee Lender
- Ontario Association of Residents' Councils, Newmarket, Canada
| | - Denise Schon
- Lakeside Long-Term Care Centre Family Council, Toronto, Canada
| | - Katherine S McGilton
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
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Rodríguez-Monforte M, Bethell J, Stewart S, Chu CH, Escrig-Pinol A, Gea-Sánchez M, McGilton KS. The influence of supervisory support, work effectiveness, work empowerment and stress secondary to residents' responsive behaviours on job satisfaction of nursing staff: A multisite cross-sectional study. J Nurs Manag 2020; 29:497-507. [PMID: 33030771 DOI: 10.1111/jonm.13173] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/18/2020] [Accepted: 09/30/2020] [Indexed: 11/27/2022]
Abstract
AIM To examine the association between stress secondary to residents' responsive behaviours and job satisfaction of nurses and nursing assistants working in nursing homes. To test whether supervisory support, work effectiveness and work empowerment confound this relationship. BACKGROUND Understanding how the stress secondary to residents' responsive behaviours influences job satisfaction for staff and determining the factors influencing this relationship are important for retention of staff in nursing homes. The term 'responsive behaviours' refers to the subset of behavioural and psychological symptoms of dementia. METHODS Survey responses from 191 nursing assistants and 81 nurses in five nursing homes in Ontario were analysed. RESULTS Staff's stress attributed to residents' responsive behaviours was negatively associated with job satisfaction. This direct effect was weakened by more than a third through the confounding net effects of supervisory support, work effectiveness and work empowerment. CONCLUSION The work environment created by leaders in nursing homes can lessen the influence of stress secondary to residents' responsive behaviours on staffs' job satisfaction. IMPLICATIONS FOR NURSING MANAGEMENT Supervisors need training and education to support and mentor their staff effectively, and to guide their use of evidence-based practices that integrate the patient-centred care approach in order to effectively respond and minimize responsive behaviours.
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Affiliation(s)
- Míriam Rodríguez-Monforte
- Blanquerna School of Health Sciences - Ramon Llull University, Barcelona, Spain.,Global Research on Wellbeing (GRoW) Research Group, Blanquerna School of Health Sciences - Ramon Llull University, Barcelona, Spain
| | - Jennifer Bethell
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Steven Stewart
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Charlene H Chu
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Astrid Escrig-Pinol
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Mar Nursing School (ESIMar), Pompeu Fabra University, Barcelona, Spain
| | - Montserrat Gea-Sánchez
- Department of Nursing and Physiotherapy, GESEC Group, University of Lleida, Lleida, Spain.,Group of Health Care Research (GRECS), IRB Lleida, Lleida, Spain
| | - Katherine S McGilton
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
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Jivraj NK, Raghavji F, Bethell J, Wijeysundera DN, Ladha KS, Bateman BT, Neuman MD, Wunsch H. Persistent Postoperative Opioid Use: A Systematic Literature Search of Definitions and Population-based Cohort Study. Anesthesiology 2020; 132:1528-1539. [PMID: 32243330 PMCID: PMC8202398 DOI: 10.1097/aln.0000000000003265] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND While persistent opioid use after surgery has been the subject of a large number of studies, it is unknown how much variability in the definition of persistent use impacts the reported incidence across studies. The objective was to evaluate the incidence of persistent use estimated with different definitions using a single cohort of postoperative patients, as well as the ability of each definition to identify patients with opioid-related adverse events. METHODS The literature was reviewed to identify observational studies that evaluated persistent opioid use among opioid-naive patients requiring surgery, and any definitions of persistent opioid use were extracted. Next, the authors performed a population-based cohort study of opioid-naive adults undergoing 1 of 18 surgical procedures from 2013 to 2017 in Ontario, Canada. The primary outcome was the incidence of persistent opioid use, defined by each extracted definition of persistent opioid use. The authors also assessed the sensitivity and specificity of each definition to identify patients with an opioid-related adverse event in the year after surgery. RESULTS Twenty-nine different definitions of persistent opioid use were identified from 39 studies. Applying the different definitions to a cohort of 162,830 opioid-naive surgical patients, the incidence of persistent opioid use in the year after surgery ranged from 0.01% (n = 10) to 14.7% (n = 23,442), with a median of 0.7% (n = 1,061). Opioid-related overdose or diagnosis associated with opioid use disorder in the year of follow-up occurred in 164 patients (1 per 1,000 operations). The sensitivity of each definition to identify patients with the composite measure of opioid use disorder or opioid-related toxicity ranged from 0.01 to 0.36, while specificity ranged from 0.86 to 1.00. CONCLUSIONS The incidence of persistent opioid use reported after surgery varies more than 100-fold depending on the definition used. Definitions varied markedly in their sensitivity for identifying adverse opioid-related event, with low sensitivity overall across measures.
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Affiliation(s)
- Naheed K Jivraj
- From the Department of Anesthesiology and Pain Medicine (N.K.J., D.N.W., K.S.L., H.W.) Interdepartmental Division of Critical Care Medicine (H.W.), University of Toronto, Toronto, Canada the Institute of Health Policy Management and Evaluation, Toronto, Canada (N.K.J., D.N.W., K.S.L., H.W.) the University of Limerick, Limerick, Ireland (F.R.) the Sunnybrook Research Institute, Toronto, Canada (J.B., H.W.) the Department of Anesthesia and Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada (D.N.W., K.S.L.) the Department of Anesthesia, Perioperative, and Pain Medicine, and Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (B.T.B.) the Department of Anesthesiology and Critical Care, Perelman School of Medicine and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania (M.D.N.) the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada (H.W.)
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Bethell J, Neuman MD, Bateman BT, Hill A, Ladha KS, Wijeysundera DN, Wunsch H. Age and postoperative opioid prescriptions: a population-based cohort study of opioid-naïve adults. Pharmacoepidemiol Drug Saf 2020; 29:504-509. [PMID: 32056336 PMCID: PMC7188586 DOI: 10.1002/pds.4964] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 09/06/2019] [Revised: 01/08/2020] [Accepted: 01/12/2020] [Indexed: 01/18/2023]
Abstract
PURPOSE Opioids are commonly prescribed for acute pain after surgery. However, it is unclear whether these prescriptions are usually modified to account for patient age and, in particular, opioid-related risks among older adults. We therefore sought to describe postoperative opioid prescriptions filled by opioid-naïve adults undergoing four common surgical procedures. METHODS This retrospective cohort study used individually linked surgery and prescription opioid dispensing data from Ontario, Canada to create a population-based sample of 135 659 opioid-naïve adults who underwent one of four surgical procedures (laparoscopic cholecystectomy, laparoscopic appendectomy, knee meniscectomy, or breast excision) between 2013 and 2017. Patient age, in years, was categorized as 18 to 64, 65 to 69, 70 to 74, and 75 and over. Postoperative opioid prescriptions were identified as those filled on or within 6 days of surgical discharge date. For those who filled a prescription, we assessed the total morphine milligram equivalent (MME) dose, types of opioids, and any subsequent opioid prescriptions filled within 30 days of surgical discharge date. Results were presented stratified by surgical procedure. RESULTS For three of the four surgical procedures we assessed, the proportion of patients who filled a postoperative opioid prescription decreased with age (P < 0.001 for trend), and there was a small shift in the type of opioid (more codeine or tramadol and less oxycodone; P < 0.001 for trend). However, the total MME dose of the initial prescription(s) filled showed minimal age-related trends. CONCLUSIONS The proportion of opioid-naïve patients filling postoperative opioid prescriptions decreases with age. However, postoperative opioid prescription dosage is not typically different in older adults.
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Affiliation(s)
- Jennifer Bethell
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Mark D. Neuman
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
- Center for Perioperative Outcomes Research and Transformation, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Center for Pharmacoepidemiology Research and Training, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Brian T. Bateman
- Department of Anesthesia, Perioperative, and Pain Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Andrea Hill
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Karim S. Ladha
- Department of Anesthesia, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
| | - Duminda N. Wijeysundera
- ICES, Toronto, Ontario, Canada
- Department of Anesthesia, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Hannah Wunsch
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
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Jivraj NK, Scales DC, Gomes T, Bethell J, Hill A, Pinto R, Wijeysundera DN, Wunsch H. Evaluation of opioid discontinuation after non-orthopaedic surgery among chronic opioid users: a population-based cohort study. Br J Anaesth 2020; 124:281-291. [PMID: 32000975 DOI: 10.1016/j.bja.2019.12.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/29/2019] [Accepted: 12/09/2019] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Many patients use opioids chronically before surgery; it is unclear if surgery alters the likelihood of ongoing opioid consumption in these patients. METHODS We performed a population-based matched cohort study of adults in Ontario, Canada undergoing one of 16 non-orthopaedic surgical procedures and who were chronically using opioids, defined as (1) an opioid prescription that overlapped the index date and (2) either a total of 120 or more cumulative calendar days of filled opioid prescriptions, or 10 or more prescriptions filled in the prior year. Each surgical patient was matched based on age, sex, Charlson comorbidity index, and daily preoperative opioid dose to three non-surgical patients who were also chronic opioid users. The primary outcome was time to opioid discontinuation. RESULTS The cohort included 4755 surgical and 14 265 matched non-surgical patients. After adjustment for sociodemographic characteristics and comorbidities, surgery was associated with an increased likelihood of opioid discontinuation (adjusted hazard ratio: 1.34, 95% confidence interval [CI]: 1.27, 1.42). Among surgical patients, factors associated with a reduced odds of discontinuation included a mean preoperative opioid dose above 90 morphine milligram equivalents (adjusted odds ratio [aOR]: 0.39; 95% CI: 0.32, 0.49) or filling a prescription for oxycodone (aOR: 0.73; 95% CI: 0.56, 0.98). Receipt of an in-patient Acute Pain Service consultation (aOR: 1.34; 95% CI: 1.06, 1.69) or residing in the highest neighbourhood income quintile (aOR: 1.35; 95% CI: 1.04, 1.79) were associated with a greater odds of opioid discontinuation. CONCLUSIONS For chronic opioid users, surgery was associated with an increased likelihood of discontinuation of opioids in the following year compared with non-surgical chronic opioid users.
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Affiliation(s)
- Naheed K Jivraj
- Department of Anaesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy Management and Evaluation, Toronto, ON, Canada; ICES, Toronto, ON, Canada.
| | - Damon C Scales
- Institute of Health Policy Management and Evaluation, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Sunnybrook Research Institute, Toronto, ON, Canada; ICES, Toronto, ON, Canada
| | - Tara Gomes
- Institute of Health Policy Management and Evaluation, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; ICES, Toronto, ON, Canada
| | | | - Andrea Hill
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Sunnybrook Research Institute, Toronto, ON, Canada
| | - Ruxandra Pinto
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Duminda N Wijeysundera
- Institute of Health Policy Management and Evaluation, Toronto, ON, Canada; Department of Anaesthesia and Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; ICES, Toronto, ON, Canada
| | - Hannah Wunsch
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Sunnybrook Research Institute, Toronto, ON, Canada; ICES, Toronto, ON, Canada
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McGilton KS, Vellani S, Babineau J, Bethell J, Bronskill SE, Burr E, Keatings M, McElhaney JE, McKay S, Nichol K, Omar A, Puts MTE, Singh A, Tamblyn Watts L, Wodchis WP, Sidani S. Understanding transitional care programmes for older adults who experience delayed discharge: a scoping review protocol. BMJ Open 2019; 9:e032149. [PMID: 31848166 PMCID: PMC6937058 DOI: 10.1136/bmjopen-2019-032149] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Many hospitalised older adults experience delayed discharges due to increased postacute health and social support needs. Transitional care programmes (TCPs) provide short-term care to these patients to prepare them for transfer to nursing homes or back to the community with supports. There are knowledge gaps related to the development, implementation and evaluation of TCPs. The aims of this scoping review (ScR) are to identify the characteristics of older patients served by TCPs; criteria for transfer, components and services provided by TCPs; and outcomes used to evaluate TCPs. METHODS AND ANALYSIS The study involves six-step ScR and is informed by a collaborative/participatory approach whereby stakeholders engage in the development of the research questions, identification of literature, data abstraction and synthesis; and participation in consultation workshop. The search for scientific literature will be done in the Medline, PsychINFO, Emcare and CINAHL databases; as well, policies and reports that examined models of transitional care and the outcomes used to evaluate them will be reviewed. Records will be selected if they involve community dwelling older adults aged 65 years or older, or indigenous persons 45 years or older; and presented in English, French, Dutch and German languages. Records will be screened, reviewed and abstracted by two independent reviewers. Extracted data will be analysed using descriptive statistics and a narrative analysis, and organised according to Donabedian's model of structure (characteristics of older adults experiencing delayed discharge and served by TCPs), process (TCP components and services) and outcome. ETHICS AND DISSEMINATION This ScR does not require ethics approval. Dissemination activities include integrated knowledge translation (KT) (consultation with stakeholders throughout the study) and end-of-grant KT strategies (presentations at national and international conferences; and publication in peer-reviewed interdisciplinary journal).
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Affiliation(s)
- Katherine S McGilton
- Research, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Shirin Vellani
- Research, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Jessica Babineau
- Research, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
| | - Jennifer Bethell
- Research, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
| | - Susan E Bronskill
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Elaine Burr
- North East Local Health Integration Network, Sudbury, Ontario, Canada
| | - Margaret Keatings
- Research, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
| | | | - Sandra McKay
- Visiting Homemakers Association Home Healthcare, Toronto, Ontario, Canada
| | - Kathryn Nichol
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Abeer Omar
- Research, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
| | - Martine T E Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Anita Singh
- Ontario Ministry of Health and Long-Term Care, Toronto, Ontario, Canada
| | - Laura Tamblyn Watts
- Policy and Research, Canadian Association of Retired Persons (CARP), Toronto, Ontario, Canada
| | - Walter P Wodchis
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Souraya Sidani
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada
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Bethell J, Babineau J, Iaboni A, Green R, Cuaresma-Canlas R, Karunananthan R, Schon B, Schon D, McGilton KS. Social integration and loneliness among long-term care home residents: protocol for a scoping review. BMJ Open 2019; 9:e033240. [PMID: 31822544 PMCID: PMC6924697 DOI: 10.1136/bmjopen-2019-033240] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 11/13/2019] [Accepted: 11/19/2019] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Social well-being is associated with better physical and mental health. It is also important for quality of life, including from the perspectives of those living in long-term care (LTC) homes. However, given the characteristics of the LTC home environment and the people who live there, the nature and influence of social integration and loneliness, and strategies to address them, may differ in this population compared with those living in the community. The objective of this scoping review is to provide an overview of the nature and extent of research on social integration and loneliness among LTC home residents, including a summary of how these concepts have been operationalised and any evidence from specific groups. METHODS AND ANALYSIS This study protocol describes the methods of a scoping review of peer-reviewed literature related to social integration and loneliness among LTC home residents. A literature search was developed by an Information Specialist and will be conducted in MEDLINE(R) ALL (in Ovid, including Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily) and then translated into CINAHL (EBSCO), PsycINFO (Ovid), Scopus, Sociological Abstracts (Proquest), Embase and Embase Classic (Ovid), Emcare Nursing (Ovid) and AgeLine (EBSCO). Two reviewers will independently screen titles and abstracts of articles identified in the search. Two reviewers will then independently review full text articles for inclusion. Data extraction will also be carried out in duplicate. We will engage LTC home community members, including residents, family and staff, to refine the review questions, assist in interpreting the results and participate in knowledge translation. ETHICS AND DISSEMINATION Ethics approval is not required. We will present findings at conferences and publish in a peer-reviewed journal. Ultimately, we hope to inform future observational and interventional research aimed at improving the health and quality of life of LTC home residents.
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Affiliation(s)
- Jennifer Bethell
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Jessica Babineau
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Andrea Iaboni
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Robin Green
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Barbara Schon
- Lakeside Long-Term Care Centre, Toronto, Ontario, Canada
| | - Denise Schon
- Lakeside Long-Term Care Centre, Toronto, Ontario, Canada
| | - Katherine S McGilton
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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McGilton KS, Omar A, Stewart SS, Chu CH, Blodgett MB, Bethell J, Davis AM. Factors That Influence the Reintegration to Normal Living for Older Adults 2 Years Post Hip Fracture. J Appl Gerontol 2019; 39:1323-1331. [PMID: 31729274 PMCID: PMC7645607 DOI: 10.1177/0733464819885718] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objectives: This study aims to identify factors that influence older adults' reintegration to normal living 2 years following a hip fracture and the association between caregiver burden and reintegration over time. Methods: This longitudinal cohort study followed 76 community-dwelling older adults and their caregivers for 2 years post-hip fracture. The primary outcome was Reintegration to Normal Living Index (RNLI), and the secondary outcome was caregiver burden. Results: Older adults scored significantly lower on RNLI at 18 to 24 months if they had few social interactions, cognitive impairment, or lower pre-fracture functional status. During follow-up, greater independence in activities of daily living and greater mobility were each positively associated with RNLI. Caregiver burden reduced if reintegration improved. Implications: Results suggest a need for targeted interventions for older adults' post-hip fracture to improve their function to enhance their reintegration to normal living and to support caregivers in decreasing their burden of care.
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Affiliation(s)
- Katherine S McGilton
- Toronto Rehabilitation Institute; University Health Network, Toronto, Ontario, Canada.,University of Toronto, Ontario, Canada
| | - Abeer Omar
- Trent University, Peterborough, Ontario, Canada
| | - Steven S Stewart
- Toronto Rehabilitation Institute; University Health Network, Toronto, Ontario, Canada
| | | | - Meagan B Blodgett
- Toronto Rehabilitation Institute; University Health Network, Toronto, Ontario, Canada
| | - Jennifer Bethell
- Toronto Rehabilitation Institute; University Health Network, Toronto, Ontario, Canada.,University of Toronto, Ontario, Canada
| | - Aileen M Davis
- Toronto Rehabilitation Institute; University Health Network, Toronto, Ontario, Canada.,University of Toronto, Ontario, Canada
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Ladha KS, Neuman MD, Broms G, Bethell J, Bateman BT, Wijeysundera DN, Bell M, Hallqvist L, Svensson T, Newcomb CW, Brensinger CM, Gaskins LJ, Wunsch H. Opioid Prescribing After Surgery in the United States, Canada, and Sweden. JAMA Netw Open 2019; 2:e1910734. [PMID: 31483475 PMCID: PMC6727684 DOI: 10.1001/jamanetworkopen.2019.10734] [Citation(s) in RCA: 133] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Small studies and anecdotal evidence suggest marked differences in the use of opioids after surgery internationally; however, this has not been evaluated systematically across populations receiving similar procedures in different countries. OBJECTIVE To determine whether there are differences in the frequency, amount, and type of opioids dispensed after surgery among the United States, Canada, and Sweden. DESIGN, SETTING, AND PARTICIPANTS This cohort study included patients without previous opioid prescriptions aged 16 to 64 years who underwent 4 low-risk surgical procedures (ie, laparoscopic cholecystectomy, laparoscopic appendectomy, arthroscopic knee meniscectomy, and breast excision) between January 2013 and December 2015 in the United States, between July 2013 and March 2016 in Canada, and between January 2013 and December 2014 in Sweden. Data analysis was conducted in all 3 countries from July 2018 to October 2018. MAIN OUTCOMES AND MEASURES The main outcome was postoperative opioid prescriptions filled within 7 days after discharge; the percentage of patients who filled a prescription, the total morphine milligram equivalent (MME) dose, and type of opioid dispensed were compared. RESULTS The study sample consisted of 129 379 patients in the United States, 84 653 in Canada, and 9802 in Sweden. Overall, 52 427 patients (40.5%) in the United States were men, with a mean (SD) age of 45.1 (12.7) years; in Canada, 25 074 patients (29.6%) were men, with a mean (SD) age of 43.5 (13.0) years; and in Sweden, 3314 (33.8%) were men, with a mean (SD) age of 42.5 (13.0). The proportion of patients in Sweden who filled an opioid prescription within the first 7 days after discharge for any procedure was lower than patients treated in the United States and Canada (Sweden, 1086 [11.1%]; United States, 98 594 [76.2%]; Canada, 66 544 [78.6%]; P < .001). For patients who filled a prescription, the mean (SD) MME dispensed within 7 days of discharge was highest in United States (247 [145] MME vs 169 [93] MME in Canada and 197 [191] MME in Sweden). Codeine and tramadol were more commonly dispensed in Canada (codeine, 26 136 patients [39.3%]; tramadol, 12 285 patients [18.5%]) and Sweden (codeine, 170 patients [15.7%]; tramadol, 315 patients [29.0%]) than in the United States (codeine, 3210 patients [3.3%]; tramadol, 3425 patients [3.5%]). CONCLUSIONS AND RELEVANCE The findings indicate that the United States and Canada have a 7-fold higher rate of opioid prescriptions filled in the immediate postoperative period compared with Sweden. Of the 3 countries examined, the mean dose of opioids for most surgical procedures was highest in the United States.
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Affiliation(s)
- Karim S. Ladha
- Department of Anesthesia, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Mark D. Neuman
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia
- Penn Center for Perioperative Outcomes Research and Transformation (CPORT), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Gabriella Broms
- Division of Epidemiology and Centre for Pharmacoepidemiology, Karolinska Institutet, Solna, Sweden
- Department of Internal Medicine, Danderyd University Hospital, Danderyd, Sweden
| | - Jennifer Bethell
- ICES Central, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Brian T. Bateman
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Duminda N. Wijeysundera
- Department of Anesthesia, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- ICES Central, Toronto, Ontario, Canada
| | - Max Bell
- Section for Anaesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Solna, Sweden
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden
| | - Linn Hallqvist
- Section for Anaesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Solna, Sweden
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden
| | - Tobias Svensson
- Clinical Epidemiology Division, Karolinska Institutet, Solna, Sweden
| | - Craig W. Newcomb
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Colleen M. Brensinger
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Lakisha J. Gaskins
- Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia
- Penn Center for Perioperative Outcomes Research and Transformation (CPORT), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Hannah Wunsch
- Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
- ICES Central, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
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Bethell J, Puts MTE, Sattar S, Andrew MK, Choate AS, Clarke B, Cowan K, DeAngelis C, Elliott J, Fitch MI, Frank C, Hominick K, Keatings M, McElhaney JE, McKay SM, Pitters E, Ploeg J, Sidani S, McGilton KS. The Canadian Frailty Priority Setting Partnership: Research Priorities for Older Adults Living with Frailty. Can Geriatr J 2019; 22:23-33. [PMID: 31501680 PMCID: PMC6707135 DOI: 10.5770/cgj.22.336] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background Patient engagement in research priority-setting is intended to democratize research and increase impact. The objectives of the Canadian Frailty Priority Setting Partnership (PSP) were to engage people with lived or clinical experience of frailty, and produce a list of research priorities related to care, support, and treatment of older adults living with frailty. Methods The Canadian Frailty PSP was supported by the Canadian Frailty Network, coordinated by researchers in Toronto, Ontario and followed the methods of the James Lind Alliance, which included establishing a Steering Group, inviting partner organizations, gathering questions related to care, support and treatment of older adults living with frailty, processing the data and prioritizing the questions. Results In the initial survey, 799 submissions were provided by 389 individuals and groups. The 647 questions that were within scope were categorized, merged, and summarized, then checked against research evidence, creating a list of 41 unanswered questions. Prioritization took place in two stages: first, 146 individuals and groups participated in survey and their responses short-listed 22 questions; and second, an in-person workshop was held on September 26, 2017 in Toronto, Ontario where these 22 questions were discussed and ranked. Conclusion Researchers and research funders can use these results to inform their agendas for research on frailty. Strategies are needed for involving those with lived experience of frailty in research.
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Affiliation(s)
- Jennifer Bethell
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON
| | - Martine T E Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON
| | - Schroder Sattar
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON
| | - Melissa K Andrew
- Department of Medicine (Geriatrics), Dalhousie University, Halifax, NS
| | - Andrew S Choate
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON.,Department of Medicine (Geriatrics), Dalhousie University, Halifax, NS.,Department of Family Medicine, Dalhousie University, Halifax, NS.,James Lind Alliance, Southampton, UK.,Sunnybrook Health Sciences Centre, Toronto, ON.,School of Public Health and Health Systems, University of Waterloo, Waterloo, ON.,Canadian Partnership Against Cancer, Toronto, ON.,Department of Medicine, Queen's University, Kingston, ON.,Providence Care, Kingston, ON.,Seniors' Health, Nova Scotia Health Authority, Halifax, NS.,Health Sciences North Research Institute, Sudbury, ON.,Northern Ontario School of Medicine, Laurentian University, Sudbury, ON.,VHA Home HealthCare, Toronto, ON.,Department of Physical Therapy, University of Toronto, Toronto, ON.,School of Nursing, and Aging, Community and Health Research Unit, McMaster University, Hamilton, ON.,Ryerson University, Toronto, ON
| | - Barry Clarke
- Department of Family Medicine, Dalhousie University, Halifax, NS
| | - Katherine Cowan
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON
| | | | - Jacobi Elliott
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON
| | - Margaret I Fitch
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON.,Canadian Partnership Against Cancer, Toronto, ON
| | - Chris Frank
- Department of Medicine, Queen's University, Kingston, ON.,Providence Care, Kingston, ON
| | | | - Margaret Keatings
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON.,Department of Medicine (Geriatrics), Dalhousie University, Halifax, NS.,Department of Family Medicine, Dalhousie University, Halifax, NS.,James Lind Alliance, Southampton, UK.,Sunnybrook Health Sciences Centre, Toronto, ON.,School of Public Health and Health Systems, University of Waterloo, Waterloo, ON.,Canadian Partnership Against Cancer, Toronto, ON.,Department of Medicine, Queen's University, Kingston, ON.,Providence Care, Kingston, ON.,Seniors' Health, Nova Scotia Health Authority, Halifax, NS.,Health Sciences North Research Institute, Sudbury, ON.,Northern Ontario School of Medicine, Laurentian University, Sudbury, ON.,VHA Home HealthCare, Toronto, ON.,Department of Physical Therapy, University of Toronto, Toronto, ON.,School of Nursing, and Aging, Community and Health Research Unit, McMaster University, Hamilton, ON.,Ryerson University, Toronto, ON
| | - Janet E McElhaney
- Health Sciences North Research Institute, Sudbury, ON.,Northern Ontario School of Medicine, Laurentian University, Sudbury, ON
| | - Sandra M McKay
- VHA Home HealthCare, Toronto, ON.,Department of Physical Therapy, University of Toronto, Toronto, ON
| | - Eric Pitters
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON.,Department of Medicine (Geriatrics), Dalhousie University, Halifax, NS.,Department of Family Medicine, Dalhousie University, Halifax, NS.,James Lind Alliance, Southampton, UK.,Sunnybrook Health Sciences Centre, Toronto, ON.,School of Public Health and Health Systems, University of Waterloo, Waterloo, ON.,Canadian Partnership Against Cancer, Toronto, ON.,Department of Medicine, Queen's University, Kingston, ON.,Providence Care, Kingston, ON.,Seniors' Health, Nova Scotia Health Authority, Halifax, NS.,Health Sciences North Research Institute, Sudbury, ON.,Northern Ontario School of Medicine, Laurentian University, Sudbury, ON.,VHA Home HealthCare, Toronto, ON.,Department of Physical Therapy, University of Toronto, Toronto, ON.,School of Nursing, and Aging, Community and Health Research Unit, McMaster University, Hamilton, ON.,Ryerson University, Toronto, ON
| | - Jenny Ploeg
- School of Nursing, and Aging, Community and Health Research Unit, McMaster University, Hamilton, ON
| | | | - Katherine S McGilton
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON
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Bethell J, Chu CH, Wodchis WP, Walker K, Stewart SC, McGilton KS. Supportive Supervision and Staff Intent to Turn Over in Long-Term Care Homes. Gerontologist 2019; 58:953-959. [PMID: 28329826 DOI: 10.1093/geront/gnx008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Indexed: 01/14/2023] Open
Abstract
Background and Objectives To examine the association between supervisory support and intent to turn over among personal support workers (PSWs) employed in long-term care (LTC) homes in Ontario, Canada, by assessing whether the association is mediated by job satisfaction and the potential confounding effect of happiness. Research Design and Methods Cross-sectional survey data of 5,645 PSWs working within 398 LTC homes in Ontario, Canada, were obtained and analysed through a series of multilevel regression models. Results Overall, analyses support the assertion that the effect of supervisory support on intent to turn over is partially mediated by job satisfaction. However, happiness may act as an effect modifier rather than as a confounder. Discussion and Implications These results reinforce the importance of supportive supervision for PSWs working in LTC homes and highlight the multifaceted role of nurses in LTC, who traditionally provide the majority of PSW supervision. Nurses must be equipped with competencies and skills that reflect the complex organisational environments in which they work. However, these results must also be interpreted in context with the limitations of cross-sectional data; future research should incorporate prospective data collection and clarify the potential role of happiness.
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Affiliation(s)
- Jennifer Bethell
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Charlene H Chu
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Walter P Wodchis
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Kevin Walker
- Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
| | - Steven C Stewart
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Katherine S McGilton
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada
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Rhodes AE, Sinyor M, Boyle MH, Bridge JA, Katz LY, Bethell J, Newton AS, Cheung A, Bennett K, Links PS, Tonmyr L, Skinner R. Emergency Department Presentations and Youth Suicide: A Case-Control Study. Can J Psychiatry 2019; 64:88-97. [PMID: 30282479 PMCID: PMC6405805 DOI: 10.1177/0706743718802799] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We estimate associations between emergency department (ED) diagnoses and suicide among youth to guide ED care. METHOD This ED-based case-control study used data from the Office of the Chief Coroner and all EDs in Ontario, Canada. Cases ( n = 697 males and n = 327 females) were aged 10 to 25 years who died by suicide in Ontario between April 2003 and March 2014, with an ED contact in the year before their death. Same-aged ED-based controls were selected during this time frame. Crude and adjusted odds ratios (aORs) and 95% confidence intervals were calculated. RESULTS Among youth diagnosed with a mental health problem at their most recent ED contact (41.9% cases, 5% controls), suicide was elevated among nonfatal self-inflicted: 'other' injuries, including hanging, strangulation, and suffocation in both sexes (aORs > 14); cut/pierce injuries in males (aOR > 5); poisonings in both sexes (aORs > 2.2); and mood and psychotic disorders in males (aORs > 1.7). Among those remaining, 'undetermined' injuries and poisonings in both sexes (aORs > 5), 'unintentional' poisonings in males (aOR = 2.1), and assault in both sexes (aORs > 1.8) were significant. At least half of cases had ED contact within 106 days. CONCLUSIONS The results highlight the need for timely identification and treatment of mental health problems. Among those with an identified mental health problem, important targets for suicide prevention efforts are youth with self-harm and males with mood and psychotic disorders. Among others, youth with unintentional poisonings, undetermined events, and assaults should raise concern.
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Affiliation(s)
- Anne E Rhodes
- 1 Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario.,2 Institute for Clinical Evaluative Sciences, Toronto, Ontario.,3 Offord Centre for Child Studies, Hamilton, Ontario.,4 Department of Psychiatry and Behavioural Neuroscience Sciences, McMaster University, Hamilton, Ontario
| | - Mark Sinyor
- 1 Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario.,5 Sunnybrook Health Sciences Centre, Toronto, Ontario.,6 Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Michael H Boyle
- 3 Offord Centre for Child Studies, Hamilton, Ontario.,4 Department of Psychiatry and Behavioural Neuroscience Sciences, McMaster University, Hamilton, Ontario.,7 Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario
| | - Jeffrey A Bridge
- 8 Center for Suicide Prevention and Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,9 Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Laurence Y Katz
- 10 Child and Adolescent Mental Health, Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba
| | - Jennifer Bethell
- 11 The Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
| | - Amanda S Newton
- 12 Department of Pediatrics, University of Alberta, Edmonton, Alberta
| | - Amy Cheung
- 1 Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario.,5 Sunnybrook Health Sciences Centre, Toronto, Ontario.,6 Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Kathryn Bennett
- 3 Offord Centre for Child Studies, Hamilton, Ontario.,4 Department of Psychiatry and Behavioural Neuroscience Sciences, McMaster University, Hamilton, Ontario.,7 Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario
| | - Paul S Links
- 4 Department of Psychiatry and Behavioural Neuroscience Sciences, McMaster University, Hamilton, Ontario
| | - Lil Tonmyr
- 13 Surveillance and Epidemiology Division, Public Health Agency of Canada, Ottawa
| | - Robin Skinner
- 13 Surveillance and Epidemiology Division, Public Health Agency of Canada, Ottawa
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Bethell J, Commisso E, Rostad HM, Puts M, Babineau J, Grinbergs-Saull A, Wighton MB, Hammel J, Doyle E, Nadeau S, McGilton KS. Patient engagement in research related to dementia: A scoping review. Dementia (London) 2018; 17:944-975. [PMID: 30373460 DOI: 10.1177/1471301218789292] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [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: 01/23/2023]
Abstract
Patient 'engagement' or 'involvement' in health research broadly refers to including people with lived experience (i.e. individuals with personal experience of a health issue and their friends, family and caregivers or carers) in the research process. Although previous reviews have systematically summarized approaches to patient engagement in research, it is unclear whether and how engagement activities have been implemented or adapted for research related to dementia. We conducted a scoping review to describe the extent and nature of patient engagement approaches that have been used to involve persons with dementia and their care partners in research. We then summarized the reported barriers, enablers, and impacts of this engagement. Fifty-four research articles were included in the review and almost all were published after 2010. Persons with dementia and their care partners have been engaged in diverse phases of the research process. The majority of engagement involved both persons with dementia and care partners. Barriers and enablers to engagement included those identified for general patient engagement in research, but some more specific to engaging persons with dementia and their care partners were also reported. Very few studies assessed the impact of patient engagement. While the arguments for patient engagement in research are compelling, research to demonstrate the impact - on the research process and outcomes as well as on persons with dementia, care partners, researchers, research institutions and society - is still needed.
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Affiliation(s)
- Jennifer Bethell
- Toronto Rehabilitation Institute - University Health Network, Toronto, Canada
| | - Elana Commisso
- Toronto Rehabilitation Institute - University Health Network, Toronto, Canada
| | | | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Jessica Babineau
- Toronto Rehabilitation Institute - University Health Network, Toronto, Canada
| | - Anna Grinbergs-Saull
- Alzheimer's Society, UK; NIHR Clinical Research Network South London, Guy's Hospital, London, UK
| | | | - John Hammel
- Ontario Dementia Advisory Group, London, Canada
| | - Elizabeth Doyle
- Geriatric Medicine, Nova Scotia Health Authority / Dalhousie University, Halifax, Canada; Canadian Consortium on Neurodegeneration in Aging
| | - Sacha Nadeau
- Geriatric Medicine, Nova Scotia Health Authority / Dalhousie University, Halifax, Canada; Canadian Consortium on Neurodegeneration in Aging
| | - Katherine S McGilton
- Toronto Rehabilitation Institute - University Health Network, Toronto, Canada; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada; Canadian Consortium on Neurodegeneration in Aging
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Bethell J, Pringle D, Chambers LW, Cohen C, Commisso E, Cowan K, Fehr P, Laupacis A, Szeto P, McGilton KS. Patient and Public Involvement in Identifying Dementia Research Priorities. J Am Geriatr Soc 2018; 66:1608-1612. [PMID: 30084194 DOI: 10.1111/jgs.15453] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [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: 02/13/2018] [Revised: 04/18/2018] [Accepted: 04/18/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To engage persons with dementia, friends, family, caregivers, and health and social care providers to identify and prioritize their questions for research related to living with dementia and prevention, diagnosis, and treatment of dementia. DESIGN The Canadian Dementia Priority Setting Partnership (PSP) followed James Lind Alliance PSP methods. Results were compared with the World Health Organization research prioritization exercise and the United Kingdom Dementia PSP. SETTING Canada. PARTICIPANTS In the first survey, 1,217 individuals and groups from across Canada submitted their questions about dementia. 249 participated in the interim prioritization. For the final prioritization workshop, the 28 participants included persons with dementia, friends, family, caregivers, health and social care providers, Alzheimer Society representatives, and members of an organization representing long-term care home residents. RESULTS The Canadian Dementia PSP top 10 priorities relate to health, quality of life, societal issues, and dementia care. Five priorities overlap with one or both of the other two prioritization initiatives. CONCLUSION These results provide researchers and research funding agencies with topics that individuals with personal or professional experience of dementia prioritize, but they are not intended to preclude research into other aspects of dementia.
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Affiliation(s)
- Jennifer Bethell
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Dorothy Pringle
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Larry W Chambers
- Alzheimer Society of Canada, Toronto, Ontario, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada.,Health, Nursing and Environmental Studies, Faculty of Health, York University, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Carole Cohen
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Elana Commisso
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Katherine Cowan
- James Lind Alliance, National Institute for Health Research Evaluation, Trials and Studies Coordinating Centre, University of Southampton, Southampton, United Kingdom
| | - Phyllis Fehr
- Ontario Dementia Advisory Group, Ontario, Canada.,Dementia Alliance International, Ankeny, Iowa
| | - Andreas Laupacis
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Paula Szeto
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Katherine S McGilton
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Rhodes AE, Boyle MH, Bridge JA, Sinyor M, Katz LY, Bennett K, Newton AS, Links PS, Tonmyr L, Skinner R, Cheung A, Bethell J, Carlisle C. Les soins médicaux de jeunes hommes et de jeunes femmes qui décèdent par suicide. Can J Psychiatry 2018; 63:161-169. [PMID: 29121806 PMCID: PMC5846965 DOI: 10.1177/0706743717741060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Prior year medical care was compared among youth dying by suicide to their peers. Effect modification of these associations by age or place of residency (rural versus larger community sizes) was examined in a large, medically insured population. METHOD This population-based case control study used data from the Office of the Chief Coroner in Ontario, Canada, linked to health care administrative data to examine associations between medical care for mental health or other reasons (versus no medical care) and suicide. Decedents ( n = 1203 males and n = 454 females) were youth (aged 10 to 25 years) who died by suicide in Ontario between April 2003 and March 2014, inclusive. Peers of the same ages were frequency matched to decedents on sex and place of residency. Logistic regression was used to calculate odds ratios and 95% confidence intervals and to test effect modification. RESULTS Associations with mental health care were stronger in decedents than peers with a gradation of care (i.e., outpatient only, emergency department [ED], inpatient care) in both sexes. However, these associations were weaker among youth living in rural communities. Furthermore, older males (aged 18 to 25 years) were less likely than younger males (aged 10 to 17 years) to access the ED (ambulatory care only). This decrease was observed in rural and larger communities alongside no increase in medical care for other reasons. CONCLUSIONS Geographical and age-related barriers to mental health care exist for youth who die by suicide. Preventive efforts can address these barriers, intervening early and integrating services, including the ED.
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Affiliation(s)
- Anne E Rhodes
- 1 Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario.,2 The Institute for Clinical Evaluative Sciences, Toronto, Ontario.,3 The Offord Centre for Child Studies, Hamilton, Ontario.,4 Department of Psychiatry and Behavioural Neuroscience Sciences, McMaster University, Hamilton, Ontario
| | - Michael H Boyle
- 3 The Offord Centre for Child Studies, Hamilton, Ontario.,4 Department of Psychiatry and Behavioural Neuroscience Sciences, McMaster University, Hamilton, Ontario.,5 Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario
| | - Jeffrey A Bridge
- 6 Center for Suicide Prevention and Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,7 The Ohio State University College of Medicine, Columbus, OH, USA
| | - Mark Sinyor
- 1 Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario.,8 Sunnybrook Health Sciences Centre, Toronto, Ontario.,9 Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Laurence Y Katz
- 10 Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba.,11 Child and Adolescent Mental Health, Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba
| | - Kathryn Bennett
- 3 The Offord Centre for Child Studies, Hamilton, Ontario.,4 Department of Psychiatry and Behavioural Neuroscience Sciences, McMaster University, Hamilton, Ontario.,5 Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario
| | - Amanda S Newton
- 12 Department of Pediatrics, University of Alberta, Edmonton, Alberta
| | - Paul S Links
- 4 Department of Psychiatry and Behavioural Neuroscience Sciences, McMaster University, Hamilton, Ontario
| | - Lil Tonmyr
- 13 Surveillance and Epidemiology Division, Public Health Agency of Canada, Ottawa
| | - Robin Skinner
- 13 Surveillance and Epidemiology Division, Public Health Agency of Canada, Ottawa
| | - Amy Cheung
- 1 Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario.,8 Sunnybrook Health Sciences Centre, Toronto, Ontario.,9 Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Jennifer Bethell
- 14 The Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
| | - Corine Carlisle
- 15 Department of Psychiatry, University of Toronto, Toronto, Ontario.,16 Department of Psychiatry, Hospital for Sick Children (SickKids), Toronto, Ontario
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Bethell J, Pringle D, McGilton KS, Chambers L, Commisso E. [P3–503]: CANADIANS’ PRIORITIES FOR DEMENTIA RESEARCH: OUTCOMES OF THE CANADIAN DEMENTIA PRIORITY SETTING PARTNERSHIP. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.1722] [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: 10/18/2022]
Affiliation(s)
- Jennifer Bethell
- Toronto Rehabilitation Institute‐University Health NetworkTorontoONCanada
| | | | | | | | - Elana Commisso
- Toronto Rehabilitation Institute‐University Health NetworkTorontoONCanada
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Bethell J, Pringle D, Chambers L, McGilton KS. P2‐392: Eliciting Dementia Research Priorities from Canadians. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.06.1603] [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: 11/27/2022]
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Abstract
OBJECTIVE To examine the incidence and nature of emergency department (ED) presentations for nonfatal suicide-related behaviours (SRBs) over time, in boys and girls living in Ontario. We hypothesize declining rates (fiscal years [FYs] 2002/03 to 2006/07) ceased thereafter owing to renewed regulatory warnings against prescribing antidepressants and the economic recession. METHOD We graphed and tested differences in ED SRB incidence rates for FYs 2002/03 to 2010/11. We estimated rate ratios and 95% confidence intervals using negative binomial regression controlling for changes in the underlying population (age, community size, and neighbourhood income quintile). We examined the nature of the incident (index) presentations over time in terms of the method(s) used and events occurring before and after the index event. RESULTS ED SRB incidence rates decreased by 30% in boys and girls from FYs 2002/03 to 2006/07, but not thereafter. This trend was most evident in girls who self-poisoned and in girls' presentations to hospital with mental illness in the preceding year. Within a year of the index event, the proportion of girls with a repeat ED SRB presentation also declined by about one-third, but beyond FYs 2005/06 to 2009/10. However, the proportion admitted subsequent to the index event increased by about one-third. In boys, their patterns of presentations to hospital with mental illness and SRB repetition over time were similar to girls, but estimated with greater variability. CONCLUSIONS While the decline in ED SRB rates to FY 2006/07 is encouraging, the lack of decline thereafter and an increase in subsequent admissions merits ongoing monitoring and evaluation.
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Affiliation(s)
- Anne E Rhodes
- Research Scientist, Suicide Studies Research Unit and the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario; Associate Professor, Department of Psychiatry, Faculty of Medicine, University of Toronto and the Dalla Lana School of Public Health, Faculty of Medicine, University of Toronto, Toronto, Ontario; Adjunct Scientist, Institute for Clinical Evaluative Sciences, Toronto, Ontario
| | - Jennifer Bethell
- Research Coordinator, Suicide Studies Research Unit, St Michael's Hospital, Toronto, Ontario; Doctoral Student, Dalla Lana School of Public Health, Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Corine Carlisle
- Assistant Professor, Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario; Clinical Head, Youth Concurrent Disorders Service, Centre for Addictions and Mental Health, Toronto, Ontario
| | - Rhonda J Rosychuk
- Professor, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta
| | - Hong Lu
- Analyst, Institute for Clinical Evaluative Sciences, Toronto, Ontario
| | - Amanda Newton
- Assistant Professor, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta
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Rhodes AE, Khan S, Boyle MH, Tonmyr L, Wekerle C, Goodman D, Bethell J, Leslie B, Lu H, Manion I. Sex differences in suicides among children and youth: the potential impact of help-seeking behaviour. Can J Psychiatry 2013; 58:274-82. [PMID: 23756287 DOI: 10.1177/070674371305800504] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe sex differences in health service use among children and youth who died by suicide. METHOD This is a retrospective study of children and youth (aged 10 to 25 years) living in Ontario who died by suicide between April 1, 2003, and December 31, 2007. Coroner records were individually linked to outpatient physician visit, emergency department (ED) presentation, and inpatient stay administrative health care records for 724 people (192 girls and 532 boys). Only 77 (10.6%) were aged 10 to 15 years. The health services types used, number of contacts made, and the last contact were compared in boys and girls. RESULTS About 80% of subjects had contact with the health care system in the year before their death, typically to an outpatient physician and (or) the ED. However, not all were seen for mental health reasons. Girls had more outpatient physician and ED contact than boys and closer in time to their death. Further, girls were more likely than boys to have contact in more than one setting. Still, boys and girls did not differ in their use of an outpatient psychiatrist, some ED presentations, and in the nature and number of inpatient stays. CONCLUSIONS While most people were seen by an outpatient physician and (or) in the ED in the year before their death, not all received mental health care. Further research is needed to determine whether boys and girls who died by suicide differ from their peers in their health service use to guide preventive interventions.
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Abstract
OBJECTIVES Self-harm is an important public health issue among youth, including as a major risk factor for suicide (a leading cause of death in this age group). This study used population-based emergency department data to describe clinical and demographic characteristics of emergency department presentations for self-harm among youth (12-17 year-olds) in the province of Ontario, Canada. METHODS Administrative data capturing every emergency department visit in Ontario between April 1, 2002 and March 31, 2009 were used to identify and describe self-harm presentations. RESULTS Over the 7-year period between 2002/03 and 2008/09, there were 16,835 self-harm presentations by 12,907 youth. Two thirds of self-harm presentations were self-poisonings (almost always with medicinal agents), followed by self-cutting, which accounted for about one quarter. Incidence rates were higher in girls than boys, increased with age, were inversely related to neighbourhood income and were highest in rural areas. Self-harm accounted for about 1 in 100 emergency department presentations by youth, but also a disproportionate number of presentations triaged as high acuity or admitted to hospital (about 1 in 20). CONCLUSION Self-harm is an important public health issue, requiring a comprehensive approach to prevention. Ontario has useful data with which to study emergency department presentations for self-harm, and the similarities between self-harm presentations among Ontario youth and those reported from the United States and Europe suggest generalizability of results between populations. Further research is needed to address the reasons for the geographic differences in frequency of self-harm.
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Affiliation(s)
- Jennifer Bethell
- Suicide Studies Research Unit, St. Michael's Hospital, Toronto, ON.
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46
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Rhodes AE, Boyle MH, Bethell J, Wekerle C, Tonmyr L, Goodman D, Leslie B, Lam K, Manion I. Child maltreatment and repeat presentations to the emergency department for suicide-related behaviors. Child Abuse Negl 2013; 37:139-149. [PMID: 23260122 DOI: 10.1016/j.chiabu.2012.07.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 07/24/2012] [Accepted: 07/26/2012] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To identify factors associated with repeat emergency department (ED) presentations for suicide-related behaviors (SRB) - hereafter referred to as repetition - among children/youth to aid secondary prevention initiatives. To compare rates of repetition in children/youth with substantiated maltreatment requiring removal from their parental home with their peers in the general population. METHODS A population-based (retrospective) cohort study was established for children/youth with a first ED SRB presentation at risk for repetition in the Province of Ontario, Canada between 1 January 2004 and 31 December 2008. Children/youth legally removed from their parental home because of substantiated maltreatment (n=179) and their population-based peers (n=6,305) were individually linked to administrative health care records over time to ascertain social, demographic, and clinical information and subsequent ED presentations for SRB during follow-up. These children/youth were described and their repetition-free probabilities over time compared. To identify factors associated with repetition we fit multivariable, recurrent event survival analysis models stratified by repetition and present unadjusted and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS Children/youth with substantiated maltreatment (as noted) were two times more likely to have repetition than their peers after adjustments for social, demographic, and clinical factors (conditional on prior ED SRB presentations). A number of these factors were independently associated with repetition. No one factor distinguished between having a first and second repetition nor was more strongly associated with repetition than another. CONCLUSIONS The risk of repetition is higher in children with substantiated maltreatment (as noted) than their peers. No one factor stood out as predictive of repetition. Implications for secondary prevention initiatives include a non-selective approach, sensitive to family difficulties and the need to better contextualize repetition and harness data linkages.
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Affiliation(s)
- Anne E Rhodes
- The Suicide Studies Research Unit, The Keenan Research Centre at the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Ontario, Canada
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Rhodes AE, Khan S, Boyle MH, Wekerle C, Goodman D, Tonmyr L, Bethell J, Leslie B, Manion I. Sex differences in suicides among children and youth: the potential impact of misclassification. Can J Public Health 2012. [PMID: 22905641 DOI: 10.1007/bf03403815] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES We examined whether established sex differences in suicide rates persist when adjustments are made for potential misclassification of deaths in children and youth. METHODS This is a retrospective, descriptive study of 1294 suicides, 961 accidental and 254 undetermined deaths occurring between January 1, 2000 and December 31, 2007, among persons aged 10 to 25 years in Ontario, Canada. Using data from Coroner's records, causes of death were reclassified based on two different misclassification criteria. Actual and reclassified suicide rates were calculated by sex and age group (with 95% confidence intervals) and by year of death. RESULTS Males aged 16-25 years accounted for the majority of suicides (68.9%). Asphyxia was the most common cause of suicide in both sexes. While suicides by shooting were almost exclusive to males, suicides due to alcohol/drug toxicity were significantly higher in females. Both before and after reclassification of suicide deaths, sex differences in suicide rates emerged in the 16-25 years age group. In each study year, both actual and reclassified suicide rates were higher in males than females. CONCLUSIONS Sex differences in suicide rates emerging in adolescence are unlikely to be due to misclassification. Other proposed explanations for sex differences in youth suicide rates should be investigated further.
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Affiliation(s)
- Anne E Rhodes
- The Suicide Studies Research Unit, Keenan Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON.
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Rhodes AE, Boyle MH, Bethell J, Wekerle C, Goodman D, Tonmyr L, Leslie B, Lam K, Manion I. Child maltreatment and onset of emergency department presentations for suicide-related behaviors. Child Abuse Negl 2012; 36:542-51. [PMID: 22749614 DOI: 10.1016/j.chiabu.2012.04.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 04/11/2012] [Accepted: 04/30/2012] [Indexed: 05/24/2023]
Abstract
OBJECTIVES To determine whether the rates of a first presentation to the emergency department (ED) for suicide-related behavior (SRB) are higher among children/youth permanently removed from their parental home because of substantiated maltreatment than their peers. To describe the health care settings accessed by these children/youth before a first SRB presentation to help design preventive interventions. METHODS A population-based (retrospective) cohort of 12-17-year-olds in Ontario, Canada was established. Children/youth removed from their parental home because of the above noted maltreatment (n=4683) and their population-based peers (n=1,034,546) were individually linked to administrative health care records over time to ascertain health service use and subsequent ED presentations for SRB during follow-up. Person-time incidence rates were calculated and Cox regression models used to estimate adjusted hazard ratios (HR) and corresponding 95% confidence intervals (CI). RESULTS After controlling for demographic characteristics and prior health service use, maltreated children/youth were about five times more likely to have a first ED presentation for SRB compared to their peers, in both boys (HR: 5.13, 95% CI: 3.94, 6.68) and girls (HR: 5.36, 95% CI: 4.40, 6.54). CONCLUSIONS Children/youth permanently removed from their parental home because of substantiated child maltreatment are at an increased risk of a first presentation to the ED for SRB. The prevention of child maltreatment and its recurrence and the promotion of resilience after maltreatment has occurred are important avenues to study toward preventing ED SRB presentations in children/youth. Provider and system level linkages between care sectors may prevent the need for such presentations by providing ongoing environmental support.
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Affiliation(s)
- Anne E Rhodes
- The Suicide Studies Research Unit and Keenan Research Centre at tLi Ka Shing Knowledge Institute of St. Michael's Hospital, Canada
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Kromm SK, Bethell J, Kraglund F, Edwards SA, Laporte A, Coyte PC, Ungar WJ. Characteristics and quality of pediatric cost-utility analyses. Qual Life Res 2011; 21:1315-25. [PMID: 22038397 DOI: 10.1007/s11136-011-0049-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2011] [Indexed: 11/28/2022]
Abstract
PURPOSE Measuring utility for cost-utility analysis (CUA) is challenging in children. The objectives were to characterize pediatric CUAs, appraise their quality, and identify determinants of higher quality. METHODS Descriptive data were imported from the PEDE database for 305 pediatric CUAs published from 1997 to 2009, and quality was rated using the Pediatric Quality Appraisal Questionnaire (PQAQ) in 213 studies. The impact on quality of publication year, journal type, and whether utility was measured was analyzed using multiple regression. RESULTS CUAs increased over time and the largest proportion was from North America (38%). Children aged 1-12 years (39%) and preventative interventions (51%) were studied most frequently. Whereas a societal perspective was most common in papers published before 2007 (49%), a third-party payer perspective was subsequently most frequent (63%). Utility was measured prospectively in 8% of studies. Domains that demonstrated the poorest quality were Perspective, Costs and resource use, Outcomes, Analysis, Incremental analysis and Conflict of interest. Quality increased significantly over time for most domains and was greater in studies published in methods/health economic journals. CONCLUSIONS The quality of pediatric CUAs is increasing. Few studies ascertain utility prospectively, suggesting the need for better instruments for pediatric health state valuation and measurement.
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Affiliation(s)
- Seija K Kromm
- Department of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
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Rhodes AE, Boyle MH, Tonmyr L, Wekerle C, Goodman D, Leslie B, Mironova P, Bethell J, Manion I. Sex differences in childhood sexual abuse and suicide-related behaviors. Suicide Life Threat Behav 2011; 41:235-54. [PMID: 21477094 DOI: 10.1111/j.1943-278x.2011.00025.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [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] [Indexed: 12/11/2022]
Abstract
Child sexual abuse and suicide-related behaviors are associated, but it remains unclear if the strength of this association differs in boys and girls. In a systematic review of this association in children and youth, we identified 16 relevant studies, all cross-sectional surveys of students. The association is stronger in boys specific to suicide attempt(s). Adjustments for potential confounding variables explained some, but not all of this sex difference. While additional research would strengthen causal inferences, this sex difference may be influenced by the nature and timing of child sexual abuse as well as the sex of the perpetrator, which in turn shapes the disclosure of these events.
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Affiliation(s)
- Anne E Rhodes
- The Suicide Studies Research Unit and the Keenan Research Centre at the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Canada
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