The Geras virtual frailty rehabilitation program to build resilience in older adults with frailty during COVID-19: a randomized feasibility trial.

BACKGROUND: The Coronavirus (COVID-19) pandemic has exacerbated the risk for poor physical and mental health outcomes among vulnerable older adults. Multicomponent interventions could potentially prevent or reduce the risk of becoming frail; however, there is limited evidence about utilizing alternative modes of delivery where access to in-person care may be challenging. This randomized feasibility trial aimed to understand how a multicomponent rehabilitation program can be delivered remotely to vulnerable older adults with frailty during the pandemic. METHODS: Participants were randomized to either a multimodal or socialization arm. Over a 12-week intervention period, the multimodal group received virtual care at home, which included twice-weekly exercise in small group physiotherapy-led live-streamed sessions, nutrition counselling and protein supplementation, medication consultation via a videoconference app, and once-weekly phone calls from student volunteers, while the socialization group received only once-weekly phone calls from the volunteers. The RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework was used to evaluate the feasibility of the program. The main clinical outcomes were change in the 5-times sit-to-stand test (5 × STS) and Depression, Anxiety and Stress Scale (DASS-21) scores. The feasibility outcomes were analyzed using descriptive statistics and expressed as frequencies and mean percent with corresponding confidence intervals (CI). Analysis of covariance (ANCOVA) was used for the effectiveness component. RESULTS: The program enrolled 33% (n = 72) of referrals to the study (n = 220), of whom 70 were randomized. Adoption rates from different referral sources were community self-referrals (60%), community organizations (33%), and healthcare providers (25%). At the provider level, implementation rates varied from 75 to 100% for different aspects of program delivery. Participant's adherence levels included virtual exercise sessions 81% (95% CI: 75-88%), home-based exercise 50% (95% CI: 38-62%), protein supplements consumption 68% (95% CI: 55-80%), and medication optimization 38% (95% CI: 21-59%). Most participants (85%) were satisfied with the program. There were no significant changes in clinical outcomes between the two arms. CONCLUSION: The GERAS virtual frailty rehabilitation study for community-dwelling older adults living with frailty was feasible in terms of reach of participants, adoption across referral settings, adherence to implementation, and participant's intention to maintain the program. This program could be feasibly delivered to improve access to socially isolated older adults where barriers to in-person participation exist. However, trials with larger samples and longer follow-up are required to demonstrate effectiveness and sustained behavior change. TRIAL REGISTRATION: ClinicalTrials.gov NCT04500366. Registered August 5, 2020, https://clinicaltrials.gov/ct2/show/NCT04500366.

Applicant and Match Trends to Geriatric-Focused Postgraduate Medical Training in Canada: A Descriptive Analysis.

Physicians with postgraduate training in caring for older adults-geriatricians, geriatric psychiatrists, and Care of the Elderly family physicians (FM-COE)-have expertise in managing complex care needs. Deficits in the geriatric-focused physician workforce coupled with the aging demographic necessitate an increase in training and clinical positions. Descriptive analyses of data from established matching systems have not occurred to understand the preferences and outcomes of applicants to geriatric-focused postgraduate training. This study describes applicant and match trends for geriatric-focused postgraduate training in Canada. In this retrospective cohort study, data from the Canadian Resident Matching Service and FM-COE program directors were analysed to examine program quotas, applicants' preferences, and match outcomes by medical school and over time. Based on their first-choice specialty ranking, applicants to geriatric medicine and FM-COE signalled a preference to pursue these programs and tended to match successfully. The proportion of unfilled training positions has increased in recent years, and the number of applicants has not increased consistently over time. There is a disparity between applicants to geriatric-focused training and the health human resources to meet population-level needs. Garnering interest among medical trainees is essential to address access and equity gaps.

Effect of the GERAS DANcing for Cognition and Exercise Program on Physical Function in Older Adults.

GERAS DANcing for Cognition and Exercise is a therapeutic dance program for older adults with cognitive or mobility impairments. Using a pre-/posttest study design, we investigated the effect of 12 weeks of dance on the short performance physical battery (SPPB). In 107 participants aged 61-93 (mean 76.1, SD = 7.0; 20% men), over 90% had multifrailty and/or cognitive impairment. The mean attendance rate was 18/24 classes (75%). A substantial minimal clinically important difference (>0.4) occurred for SPPB total (+0.53, SD = 2.04, p = .002) and chair stands (+0.45, SD = 0.92, p < .001). Individuals with baseline SPPB ≤8 points (n = 38)-indicative of sarcopenia and physical frailty-had the most marked improvement (SPPB total: +1.45, SD = 1.97, p < .001; balance: +0.65, SD = 1.27, p = .006; chair stands: +0.68, SD = 0.97, p < .001). GERAS DANcing for Cognition and Exercise may be a promising rehabilitation intervention to improve daily physical function.

Online Educational Tools for Caregivers of People with Dementia: A Scoping Literature Review.

BACKGROUND: Informal caregivers of people with dementia provide the majority of health-based care to people with dementia. Providing this care requires knowledge and access to resources, which caregivers often do not receive. We set out to evaluate the effect of online educational tools on informal caregiver self-efficacy, quality of life, burden/stress, depression, and anxiety, and to identify effective processes for online educational tool development. METHODS: We conducted a scoping review of articles on online educational interventions for informal caregivers of people with dementia searching CINAHL, MEDLINE, EMBASE, and PubMed from 1990 to March 2018, with an updated search conducted in 2020. The identified articles were screened and the data were charted. RESULTS: 33 articles that reported on 24 interventions were included. There is some evidence that online interventions improve caregiver-related outcomes such as self-efficacy, depression, dementia knowledge, and quality of life; and decrease caregiver burden. Common findings across the studies included the need for tailored, stage-specific information applicable to the caregiver's situation and the use of psychosocial techniques to develop the knowledge components of the interventions. CONCLUSION: We demonstrate the importance of having caregivers and health-care professionals involved at all stages of tool conceptualization and development. Online tools should be evaluated with robust trials that focus on how increased knowledge and development approaches affect caregiver-related outcomes.

Do Interest Groups Cultivate Interest? Trajectories of Geriatric Interest Group Members.

BACKGROUND: Minimal exposure, misconceptions, and lack of interest have historically driven the shortage of health-care providers for older adults. This study aimed to determine how medical students' participation in the National Geriatrics Interest Group (NGIG) and local Geriatrics Interest Groups (GIGs) shapes their career development in the care of older adults. METHODS: An electronic survey consisting of quantitative and qualitative metrics to assess the influence of Interest Groups was distributed to all current and past members of local GIGs at Canadian universities since 2017, as well as current and past executives of the NGIG since 2011. Descriptive statistics and thematic analysis were performed. RESULTS: Thirty-one responses (27.7% response rate) were collected from medical students (13), residents (16), and physicians (2). 79% of resident respondents indicated they will likely have a geriatrics-focused medical practice. 45% of respondents indicated GIG/NGIG involvement facilitated the establishment of strong mentorship. Several themes emerged on how GIG/NGIG promoted interest in geriatrics: faculty mentorship, networking, dispelling stigma, and career advancement. CONCLUSION: The positive associations with the development of geriatrics-focused careers and mentorship compel ongoing support for these organizations as a strategy to increase the number of physicians in geriatrics-related practices.

Early Clinical Exposure to Geriatric Psychiatry and Medical Students' Interest in Caring for Older Adults: A Randomized Controlled Trial.

OBJECTIVE: In the next 25 years, the population aged 65 and older will nearly double in many countries, with few new doctors wishing to care for older adults. The authors hypothesize that early clinical exposure to elderly patient care could increase student interest in caring for older adults during their future career. METHODS: The authors conducted a pragmatic medical education randomized controlled trial (RCT) at the Jewish General Hospital and the Douglas Mental Health Institute, McGill University, in Montreal, Canada. Third-year medical students undergoing their mandatory 16-week half-time clerkship rotation in psychiatry were randomly assigned to the equivalent of 2-4 weeks of full-time exposure to clinical geriatric psychiatry (n = 84). RESULTS: Being randomly assigned to geriatric psychiatry exposure (n = 44 of 84) was associated with increased "comfort in working with geriatric patients and their families" at 16-week follow-up (59.1% versus 37.5%, χ2 (1) = 3.9; p = 0.05). However, there was no significant association found between geriatric psychiatry exposure and change "in interest in caring for older adults," or change in "interest in becoming a geriatric psychiatrist." CONCLUSION: The results of this pragmatic education RCT suggest that exposing third-year medical students to 2-4 weeks of geriatric psychiatry did not increase their interest to care for older adults or become a geriatric psychiatrist. However, it did increase their comfort level in working with older adults and their families. However, more research is necessary to identify potential interventions that could inspire and increase medical student interest in caring for older adults as part of their future careers.

The Short Performance Physical Battery Is Associated with One-Year Emergency Department Visits and Hospitalization.

Les outils cliniques employés dans les établissements de soins peuvent fournir des informations pronostiques importantes aux professionnels de la santé. Dans cette étude observationnelle prospective d'un an, nous avons examiné l'association entre les scores au Short Performance Physical Battery (SPPB), d'une part, et les consultations à l'urgence et les hospitalisations au cours de l'étude, d'autre part. Au total, 191 patients ayant été nouvellement référés à une clinique gériatrique externe de Hamilton (Ontario) ont été contactés, et parmi eux, 120 pris part à l'étude. Le SPPB et d'autres évaluations ont été réalisés dans le cadre de consultations de routine. Les dossiers médicaux électroniques ont été examinés pour déterminer le nombre de consultations à l'urgence et d'hospitalisations dans l'année qui a suivi l'évaluation de base. Des analyses de régression logistique ont été utilisées pour identifier des prédicteurs des consultations à l'urgence et des hospitalisations. Le score moyen au SPPB dans la cohorte étudiée (moyenne d'âge = 80,6 ans, écart-type = 6,3 ans ; 53 % de femmes) était de 6,3 (écart-type = 3,2). Au cours de cette période d'un an, le score au SPPB était associé au nombre de consultations à l'urgence [RR = 0,90 (0,78-1,03)] et d'hospitalisations [RR = 0,84 (0,72-0,97)], après ajustement pour l'âge, le sexe et les comorbidités.Tools applied at the point of care can provide valuable prognostic information for practitioners. In this one-year, prospective observational study, we examined the association of the short performance physical battery (SPPB) and one-year emergency department (ED) visits and hospitalizations. Overall, 191 new referrals attending an outpatient geriatric clinic in Hamilton, Ontario, were approached, and 120 were enrolled. SPPB and other assessments were completed during the routine clinical visit. ED visits and hospitalizations within one year of the baseline assessment were abstracted from electronic medical records. Logistic regression analyses were used to determine ED visits and hospitalization predictors. The mean SPPB score in the study cohort (mean age 80.6, SD 6.3 years; 53% female) was 6.3 (SD 3.2). SPPB score was associated with a one-year ED visit (OR = 0.90 [0.78­1.03]) and hospitalization (OR = 0.84 [0.72­0.97]) after adjusting for age, sex, and co-morbidities.

Care recipients' physical frailty is independently associated with subjective burden in informal caregivers in the community setting: a cross-sectional study.

BACKGROUND: Physical frailty is associated with significant morbidity and mortality in community-dwelling older adults. Burden in informal caregivers of older adults causes significant physical and psychological distress. However, the relationship between these two clinical phenomena has not been extensively studied. This cross-sectional study evaluated the relationship between physical frailty of community-dwelling older adults attending an outpatient geriatric clinic and the subjective burden reported by their informal caregivers. METHODS: We measured the following characteristics of 45 patient-caregiver dyads attending an outpatient geriatric assessment clinic: Physical frailty using the Fried Frail Scale (FFS); self-reported independence in activities of daily living (ADL) using the Katz Index; clinical diagnosis of dementia; and subjective caregiver burden using the short 12-item version of the Zarit Burden Interview (ZBI). Multivariable linear regression was performed with FFS, Katz Index score, gender, age, and diagnosis of dementia as independent variables, and ZBI score as the dependent variable. RESULTS: Only physical frailty significantly predicted caregiver burden (ß = 8.98 95% confidence interval [CI]: 2.15, 15.82). CONCLUSIONS: Physical frailty is independently associated with caregiver burden in a population of community-dwelling older adults. Despite limitations related to sample size and lack of data about caregiver characteristics, this study suggests that the relationship between physical frailty and caregiver burden merits further study.