Development and validation of a hospital frailty risk measure using Canadian clinical administrative data.

BACKGROUND: Accessible measures specific to the Canadian context are needed to support health system planning for older adults living with frailty. We sought to develop and validate the Canadian Institute for Health Information (CIHI) Hospital Frailty Risk Measure (HFRM). METHODS: Using CIHI administrative data, we conducted a retrospective cohort study involving patients aged 65 years and older who were discharged from Canadian hospitals from Apr. 1, 2018, to Mar. 31, 2019. We used a 2-phase approach to develop and validate the CIHI HFRM. The first phase, construction of the measure, was based on the deficit accumulation approach (identification of age-related conditions using a 2-year look-back). The second phase involved refinement into 3 formats (continuous risk score, 8 risk groups and binary risk measure), with assessment of their predictive validity for several frailty-related adverse outcomes using data to 2019/20. We assessed convergent validity with the United Kingdom Hospital Frailty Risk Score. RESULTS: The cohort consisted of 788 701 patients. The CIHI HFRM included 36 deficit categories and 595 diagnosis codes that cover morbidity, function, sensory loss, cognition and mood. The median continuous risk score was 0.111 (interquartile range 0.056-0.194, equivalent to 2-7 deficits); 35.1% (n = 277 000) of the cohort were found at risk of frailty (≥ 6 deficits). The CIHI HFRM showed satisfactory predictive validity and reasonable goodness-of-fit. For the continuous risk score format (unit = 0.1), the hazard ratio (HR) for 1-year risk of death was 1.39 (95% confidence interval [CI] 1.38-1.41), with a C-statistic of 0.717 (95% CI 0.715-0.720); the odds ratio for high users of hospital beds was 1.85 (95% CI 1.82-1.88), with a C-statistic of 0.709 (95% CI 0.704-0.714), and the HR of 90-day admission to long-term care was 1.91 (95% CI 1.88-1.93), with a C-statistic of 0.810 (95% CI 0.808-0.813). Compared with the continuous risk score, using a format of 8 risk groups had similar discriminatory ability and the binary risk measure had slightly weaker performance. INTERPRETATION: The CIHI HFRM is a valid tool showing good discriminatory power for several adverse outcomes. The tool can be used by decision-makers and researchers by providing information on hospital-level prevalence of frailty to support system-level capacity planning for Canada's aging population.

The Impact of the COVID-19 Pandemic on Patient Experience in Acute Care Hospitals.

During the COVID-19 pandemic, hospitals and health systems have had to make changes to balance treating patients with COVID-19 and those in the hospital for other reasons. This shift from routine hospital practice and policies affected the delivery of healthcare to patients in hospitals across Canada. Data from the Canadian Institute for Health Information's Canadian Patient Experiences Inpatient Care survey suggest that despite the changes to hospital procedures during the pandemic, most admitted patients - including those with COVID-19 - had a positive experience. Hospital visitor restrictions, however, did likely impact the involvement of a patient's family and friends. Compared to previous years, fewer patients reported that their family and friends were involved in their care as much as they wanted. This type of patient feedback on care experiences can play a valuable role in highlighting areas of best practice and informing decision making to improve patient care.

Patient Experiences in Canadian Hospitals.

With its first release of patient experience data, the Canadian Institute for Health Information provides a high-level summary of results from the Canadian Patient Experiences Survey - Inpatient Care captured in the Canadian Patient Experiences Reporting System. It examines how Canadian patients feel about how information was communicated and shared at different stages of their hospital stay.

Lifelong learning in active ageing discourse: its conserving effect on wellbeing, health and vulnerability.

The Active Ageing Framework has been adapted as a global strategy in ageing policies, practices and research over the last decade. Lifelong learning, however, has not been fully integrated into this discourse. Using survey data provided by 416 adults (aged 60 years and above) enrolled in non-formal general-interest courses in a public continuing education programme in Canada, this study examined the association between older adults' duration of participation in the courses and their level of psychological wellbeing, while taking their age, gender, self-rated health and vulnerability level into consideration. An analytical framework was developed based on the literature of old-age vulnerabilities and the benefits of lifelong learning. Two logistic regression and trend analyses were conducted. The results indicate that older adults' participation is independently and positively associated with their psychological wellbeing, even among those typically classified as 'vulnerable'. This result provides additional evidence that suggests the continuous participation in non-formal lifelong learning may help sustain older adults' psychological wellbeing. It provides older learners, even those who are most vulnerable, with a compensatory strategy to strengthen their reserve capacities, allowing them to be autonomous and fulfilled in their everyday life. The result of this study highlights the value of the strategic and unequivocal promotion of community-based non-formal lifelong learning opportunities for developing inclusive, equitable and caring active ageing societies.

I Learn, Therefore I am: A Phenomenological Analysis of Meanings of Lifelong Learning for Vulnerable Older Adults.

Background and Objectives: This study explores the lifelong learning experience of vulnerable older adults to find out (a) what is involved in their activities, (b) what meanings they take from their learning, and (c) how participation in a learning program helps to maintain their well-being and independent living despite their daily challenges. Research Design and Methods: This study employed a hermeneutic phenomenological approach. As part of a larger study, we conducted semi-structured interviews with older learners enrolled in general interest courses at a public continuing education program. In this study, we particularly focused on 10 vulnerable participants (8 women and 2 men, aged from 70 to 90), and analyzed their accounts following van Manen's (2014) guided existential inquiry method. After the inductive thematic analysis, we clustered the overarching themes into five existentials (lived-body, lived-relation, lived-space, lived-time, and lived-material) to explicate the meanings of their lived experience of learning. Results: The meanings of learning found in the five existential aspects included: (a) assurance for the dissonant body and mind; (b) a circle of camaraderie; (c) a balance between physical and mental spaces; (d) integration of past, present, and future; and (e) beyond knowledge and skills. Participants' continuous practice of learning works as a therapeutic self-help mechanism to counterbalance changes in their lifeworlds. Discussion and Implications: The findings contribute to the growing body of evidence of the wider benefits of lifelong learning and its crucial role in well-being and health among aging populations. Governments at all levels should take full advantage of these benefits.