Transitions of care for older adults discharged home from the emergency department: an inductive thematic content analysis of patient comments.

OBJECTIVE: Improving care transitions for older adults can reduce emergency department (ED) visits, adverse events, and empower community autonomy. We conducted an inductive qualitative content analysis to identify themes emerging from comments to better understand ED care transitions. METHODS: The LEARNING WISDOM prospective longitudinal observational cohort includes older adults (≥ 65 years) who experienced a care transition after an ED visit from both before and during COVID-19. Their comments on this transition were collected via phone interview and transcribed. We conducted an inductive qualitative content analysis with randomly selected comments until saturation. Themes that arose from comments were coded and organized into frequencies and proportions. We followed the Standards for Reporting Qualitative Research (SRQR). RESULTS: Comments from 690 patients (339 pre-COVID, 351 during COVID) composed of 351 women (50.9%) and 339 men (49.1%) were analyzed. Patients were satisfied with acute emergency care, and the proportion of patients with positive acute care experiences increased with the COVID-19 pandemic. Negative patient comments were most often related to communication between health providers across the care continuum and the professionalism of personnel in the ED. Comments concerning home care became more neutral with the COVID-19 pandemic. CONCLUSION: Patients were satisfied overall with acute care but reported gaps in professionalism and follow-up communication between providers. Comments may have changed in tone from positive to neutral regarding home care over the COVID-19 pandemic due to service slowdowns. Addressing these concerns may improve the quality of care transitions and provide future pandemic mitigation strategies.

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.

Resilience amongst Ontario registered practical nurses in long-term care homes during COVID-19: A grounded theory study.

AIMS: This study aimed to understand how the personal and professional resilience of Registered Practical Nurses working in long-term care (LTC) homes in Ontario were impacted during the Coronavirus 2019 pandemic. BACKGROUND: Registered Practical Nurses are primary regulated healthcare providers that have worked in Ontario LTC homes during the COVID-19 pandemic. As frontline workers, they have experienced increased stress secondary to lockdowns, changing Ministry of Health recommendations, social isolation and limited resources. LTC homes experienced almost a third of all COVID-19-related deaths in Ontario. Understanding registered practical nurses' (RPNs) resilience in this context is vital in developing the programs and supports necessary to help nurses become and stay resilient in LTC and across a range of settings. METHODS: Purposive sampling was used to recruit 40 Registered Practical Nurses working in LTC homes across Ontario for interviews. Charmaz's Grounded theory guided in-depth one-on-one interviews and analyses completed between April to September 2021. RESULTS: Registered Practical Nurse participants represented 15 (37.5%) private, and 25 (62.5%) public LTC homes across Ontario Local Health Integration Networks. Findings informed two distinct perspectives on resilience, one where nurses were able to maintain resilience and another where they were not. Sustaining and fraying resilience, presented as bimodal processes, was observed in four themes: 'Dynamic Role of the Nurse', 'Preserving Self', 'Banding Together' and 'Sense of Leadership Support'. CONCLUSION: Resilience was largely drawn from themselves as individuals. Resources to support self-care and work-life balance are needed. Additionally, workplace supports to build capacity for team-based care practices, collegial support in problem-solving and opportunities for 'connecting' with LTC nursing colleagues would be beneficial. Our findings suggest a role for professional development resources in the workplace that could help rebuild this workforce and support RPNs in providing quality care for older adults living in LTC. PATIENT OR PUBLIC CONTRIBUTION: Our research team included two members of the Registered Practical Nurses Association of Ontario, and these team members contributed to the discussion and design of the study methodology, recruitment, analysis and interpretation. Further, RPNs working in long-term care during the COVID-19 pandemic were the participants in this study and, therefore, contributed to the data. They did not contribute to data analysis or interpretation.

Identifying the areas of low self-reported confidence of internal medicine residents in geriatrics: a descriptive study of findings from a structured geriatrics skills assessment survey.

BACKGROUND: Currently, no standardized methods exist to assess the geriatric skills and training needs of internal medicine trainees to enable them to become confident in caring for older patients. This study aimed to describe the self-reported confidence and training requirements in core geriatric skills amongst internal medicine residents in Toronto, Ontario using a standardized assessment tool. METHODS: This study used a novel self-rating instrument, known as the Geriatric Skills Assessment Tool (GSAT), among incoming and current internal medicine residents at the University of Toronto, to describe self-reported confidence in performing, teaching and interest in further training with regard to 15 core geriatric skills previously identified by the American Board of Internal Medicine. RESULTS: 190 (75.1%) out of 253 eligible incoming (Year 0) and current internal medicine residents (Years 1-3) completed the GSAT. Year 1-3 internal medicine residents who had completed a geriatric rotation reported being significantly more confident in performing 13/15 (P < 0.001 to P = 0.04) and in teaching 9/15 GSAT skills (P < 0.001 to P = 0.04). Overall, the residents surveyed identified their highest confidence in administering the Mini-Mental Status Examination and lowest confidence in assessing fall risk using a gait and balance tool, and in evaluating and managing chronic pain. CONCLUSION: A structured needs assessment like the GSAT can be valuable in identifying the geriatric training needs of internal medicine trainees based on their reported levels of self-confidence. Residents in internal medicine could further benefit from completing a mandatory geriatric rotation early in their training, since this may improve their overall confidence in providing care for the mostly older patients they will work with during their residency and beyond.

A systematic review and qualitative analysis of geriatric models of care for rural and remote populations.

INTRODUCTION: Much is known about the healthcare needs of rural and remote communities; however, understanding how to best deliver geriatric models of care in these settings has received less attention. The purpose of this systematic review was to identify necessary key components of existing models of geriatric care serving rural or remote populations. METHODS: A systematic literature review was conducted using MEDLINE, CINAHL and EMBASE databases to identify articles that described models of geriatric care serving rural or remote populations. A qualitative case study and key component analysis approach was used to identify necessary model components. RESULTS: Eight articles were included. We identified eight distinct components that may improve the successful delivery of models of geriatric care serving rural or remote populations. Environmental assessments were done in six of eight models. Model integration with the local healthcare system, local provider leadership, and local provider education in geriatrics were present in five of eight models. Three of eight models used high-risk screening principles and included geriatrician consultation. One model described active community engagement, and one used telemedicine. CONCLUSION: Future geriatric care delivery models designed to serve rural or remote populations are encouraged to use an evidence-based framework based on eight distinct model characteristics found in the literature that aim to support the ideal provision of effective and accessible geriatric medical care.

Reflecting on the Journey to Develop New National Long-Term Care Standards.

Samir K. Sinha - Implementation Science Team lead and chair of the Health Standards Organization's National Long-Term Care Services Standard Technical Committee - sheds light on the development of the long-term care national standards. Sinha also discusses what the standards hope to achieve for improved quality of care and quality of life across the sector.

Risk factors for outbreaks of SARS-CoV-2 infection at retirement homes in Ontario, Canada: a population-level cohort study.

BACKGROUND: The epidemiology of SARS-CoV-2 infection in retirement homes (also known as assisted living facilities) is largely unknown. We examined the association between home-and community-level characteristics and the risk of outbreaks of SARS-CoV-2 infection in retirement homes since the beginning of the first wave of the COVID-19 pandemic. METHODS: We conducted a population-based, retrospective cohort study of licensed retirement homes in Ontario, Canada, from Mar. 1 to Dec. 18, 2020. Our primary outcome was an outbreak of SARS-CoV-2 infection (≥ 1 resident or staff case confirmed by validated nucleic acid amplification assay). We used time-dependent proportional hazards methods to model the associations between retirement home- and community-level characteristics and outbreaks of SARS-CoV-2 infection. RESULTS: Our cohort included all 770 licensed retirement homes in Ontario, which housed 56 491 residents. There were 273 (35.5%) retirement homes with 1 or more outbreaks of SARS-CoV-2 infection, involving 1944 (3.5%) residents and 1101 staff (3.0%). Cases of SARS-CoV-2 infection were distributed unevenly across retirement homes, with 2487 (81.7%) resident and staff cases occurring in 77 (10%) homes. The adjusted hazard of an outbreak of SARS-CoV-2 infection in a retirement home was positively associated with homes that had a large resident capacity, were co-located with a long-term care facility, were part of larger chains, offered many services onsite, saw increases in regional incidence of SARS-CoV-2 infection, and were located in a region with a higher community-level ethnic concentration. INTERPRETATION: Readily identifiable characteristics of retirement homes are independently associated with outbreaks of SARS-CoV-2 infection and can support risk identification and priority for vaccination.

Evaluation of the Ottawa 3DY as a screening tool for cognitive impairment in older emergency department patients.

OBJECTIVE: This study sought to evaluate the implementation of the Ottawa 3DY Tool, a simple screening instrument for cognitive impairment, by front-line ED clinicians. METHODS: We conducted a prospective cohort study in an academic ED. Patients ≥75 years underwent cognitive screening with the Ottawa 3DY by front-line nurses and physicians. Descriptive statistics were used to describe level of implementation and acceptability of the tool. Sensitivity and specificity was calculated using an Mini-Mental State Exam <25 as the cut-off for cognitive impairment. A weighted kappa was calculated to establish inter-rater agreement. RESULTS: Cognitive screening was completed in 260/332 eligible patients (78.3%), who were 60% female and had a mean age of 83.7 years. Facilitators to screening: perceived importance and ownership of screening and feasibility of Ottawa 3DY. Barriers to screening were: over confidence in clinical judgement and perceived lack of patient benefit. Ottawa 3DY had a sensitivity of 84.6% (64.3-95.0) and specificity of 54.2% (39.3-68.4) when completed by nurses. When completed by emergency physicians, sensitivity was 78.9% (53.9-93.0) and specificity was 70.0% (45.7-87.2). Inter-rater agreement kappa score was 0.67. DISCUSSION: This study demonstrated that incorporating the Ottawa 3DY tool into the routine evaluation of older ED patients by front-line ED clinicians is both feasible and effective. With its demonstrated good inter-rater reliability and moderate level of sensitivity and specificity when compared with the much longer MMSE, the routine adoption of this tool may help lead to improved recognition of cognitive impairment and ultimately patient and system outcomes.

Aging at Home: A Portrait of Home-Based Primary Care Across Canada.

Older adults and their families often struggle in navigating an increasingly fragmented healthcare system when it becomes increasingly difficult to receive care beyond their homes in the face of advanced illness, frailty and complex care needs. The provision of integrated home-based primary care has demonstrated improved patient and caregiver experiences and reduced healthcare costs when primary care providers collaborate in delivering care as part of larger interprofessional teams. In this trans-Canada portrait of five urban home-based primary care programs, their core features are highlighted to provide a roadmap on how to integrate this form of care into a Patient's Medical Home in partnership with acute and home-care providers.

Frailty and Aging: How the Danish Experience Might Inform Canada.

Scandinavian countries are widely acknowledged as leaders in innovative models of care for their aging populations. To learn what might be potentially applicable to the health system in Canada, the Canadian Frailty Network (CFN) led a contingent of government, administrative, research and patient representatives to Denmark to directly observe Danish approaches for providing healthcare for older adults living with frailty. In this paper and based on what we learned from these observations, we discuss healthcare challenges faced by Canada's aging population for which Danish strategies provide clues as to where and how to improve care and system efficiencies, thereby maximizing the value of Canadian healthcare.

Paramedic-Initiated Home Care Referrals and Use of Home Care and Emergency Medical Services.

OBJECTIVE: We examined the association between paramedic-initiated home care referrals and utilization of home care, 9-1-1, and Emergency Department (ED) services. METHODS: This was a retrospective cohort study of individuals who received a paramedic-initiated home care referral after a 9-1-1 call between January 1, 2011 and December 31, 2012 in Toronto, Ontario, Canada. Home care, 9-1-1, and ED utilization were compared in the 6 months before and after home care referral. Nonparametric longitudinal regression was performed to assess changes in hours of home care service use and zero-inflated Poisson regression was performed to assess changes in the number of 9-1-1 calls and ambulance transports to ED. RESULTS: During the 24-month study period, 2,382 individuals received a paramedic-initiated home care referral. After excluding individuals who died, were hospitalized, or were admitted to a nursing home, the final study cohort was 1,851. The proportion of the study population receiving home care services increased from 18.2% to 42.5% after referral, representing 450 additional people receiving services. In longitudinal regression analysis, there was an increase of 17.4 hours in total services per person in the six months after referral (95% CI: 1.7-33.1, p = 0.03). The mean number of 9-1-1 calls per person was 1.44 (SD 9.58) before home care referral and 1.20 (SD 7.04) after home care referral in the overall study cohort. This represented a 10% reduction in 9-1-1 calls (95% CI: 7-13%, p < 0.001) in Poisson regression analysis. The mean number of ambulance transports to ED per person was 0.91 (SD 8.90) before home care referral and 0.79 (SD 6.27) after home care referral, representing a 7% reduction (95% CI: 3-11%, p < 0.001) in Poisson regression analysis. When only the participants with complete paramedic and home care records were included in the analysis, the reductions in 9-1-1 calls and ambulance transports to ED were attenuated but remained statistically significant. CONCLUSIONS: Paramedic-initiated home care referrals in Toronto were associated with improved access to and use of home care services and may have been associated with reduced 9-1-1 calls and ambulance transports to ED.

Clinical characteristics associated with the onset of delirium among long-term nursing home residents.

BACKGROUND: Nursing home residents are frail, have multiple medical comorbidities, and are at high risk for delirium. Most of the existing evidence base on delirium is derived from studies in the acute in-patient population. We examine the association between clinical characteristics and medication use with the incidence of delirium during the nursing home stay. METHODS: This is a retrospective cohort study of 1571 residents from 12 nursing homes operated by a single care provider in Ontario, Canada. Residents were over the age of 55 and admitted between February 2010 and December 2015 with no baseline delirium and a minimum stay of 180 days. Residents with moderate or worse cognitive impairment at baseline were excluded. The baseline and follow-up characteristics of residents were collected from the Resident Assessment Instrument-Minimal Data Set 2.0 completed at admission and repeated quarterly until death or discharge. Multivariate logistic regression was used to identify characteristics and medication use associated with the onset of delirium. RESULTS: The incidence of delirium was 40.4% over the nursing home stay (mean LOS: 32 months). A diagnosis of dementia (OR: 2.54, p < .001), the presence of pain (OR: 1.64, p < .001), and the use of antipsychotics (OR: 1.87, p < .001) were significantly associated with the onset of delirium. Compared to residents who did not develop delirium, residents who developed a delirium had a greater increase in the use of antipsychotics and antidepressants over the nursing home stay. CONCLUSIONS: Dementia, the presence of pain, and the use of antipsychotics were associated with the onset of delirium. Pain monitoring and treatment may be important to decrease delirium in nursing homes. Future studies are necessary to examine the prescribing patterns in nursing homes and their association with delirium.

Standard set of health outcome measures for older persons.

BACKGROUND: The International Consortium for Health Outcomes Measurement (ICHOM) was founded in 2012 to propose consensus-based measurement tools and documentation for different conditions and populations.This article describes how the ICHOM Older Person Working Group followed a consensus-driven modified Delphi technique to develop multiple global outcome measures in older persons. The standard set of outcome measures developed by this group will support the ability of healthcare systems to improve their care pathways and quality of care. An additional benefit will be the opportunity to compare variations in outcomes which encourages and supports learning between different health care systems that drives quality improvement. These outcome measures were not developed for use in research. They are aimed at non researchers in healthcare provision and those who pay for these services. METHODS: A modified Delphi technique utilising a value based healthcare framework was applied by an international panel to arrive at consensus decisions.To inform the panel meetings, information was sought from literature reviews, longitudinal ageing surveys and a focus group. RESULTS: The outcome measures developed and recommended were participation in decision making, autonomy and control, mood and emotional health, loneliness and isolation, pain, activities of daily living, frailty, time spent in hospital, overall survival, carer burden, polypharmacy, falls and place of death mapped to a three tier value based healthcare framework. CONCLUSIONS: The first global health standard set of outcome measures in older persons has been developed to enable health care systems improve the quality of care provided to older persons.

Deprescribing antipsychotics for behavioural and psychological symptoms of dementia and insomnia: Evidence-based clinical practice guideline.

OBJECTIVE: To develop an evidence-based guideline to help clinicians make decisions about when and how to safely taper and stop antipsychotics; to focus on the highest level of evidence available and seek input from primary care professionals in the guideline development, review, and endorsement processes. METHODS: The overall team comprised 9 clinicians (1 family physician, 1 family physician specializing in long-term care, 1 geriatric psychiatrist, 2 geriatricians, 4 pharmacists) and a methodologist; members disclosed conflicts of interest. For guideline development, a systematic process was used, including the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Evidence was generated from a Cochrane systematic review of antipsychotic deprescribing trials for the behavioural and psychological symptoms of dementia, and a systematic review was conducted to assess the evidence behind the benefits of using antipsychotics for insomnia. A review of reviews of the harms of continued antipsychotic use was performed, as well as narrative syntheses of patient preferences and resource implications. This evidence and GRADE quality-of-evidence ratings were used to generate recommendations. The team refined guideline content and recommendation wording through consensus and synthesized clinical considerations to address common front-line clinician questions. The draft guideline was distributed to clinicians and stakeholders for review and revisions were made at each stage. RECOMMENDATIONS: We recommend deprescribing antipsychotics for adults with behavioural and psychological symptoms of dementia treated for at least 3 months (symptoms stabilized or no response to an adequate trial) and for adults with primary insomnia treated for any duration or secondary insomnia in which underlying comorbidities are managed. A decision-support algorithm was developed to accompany the guideline. CONCLUSION: Antipsychotics are associated with harms and can be safely tapered. Patients and caregivers might be more amenable to deprescribing if they understand the rationale (potential for harm), are involved in developing the tapering plan, and are offered behavioural advice or management. This guideline provides recommendations for making decisions about when and how to reduce the dose of or stop antipsychotics. Recommendations are meant to assist with, not dictate, decision making in conjunction with patients and families.

Delivering improved patient and system outcomes for hospitalized older adults through an Acute Care for Elders Strategy.

Acute care hospitals are widely recognized as potentially high-risk environments for older adults. In 2010, Mount Sinai Hospital conceived its Acute Care for Elders (ACE) Strategy as a multi-component intervention to improve the care of hospitalized older adults. In order to determine its effectiveness, we conducted a quasi-experimental time series analysis of 12,008 older patients admitted non-electively for acute medical issues over a 6-year period. Despite a 53% increase in annual admissions of older patients between 2009/2010 and 2014/2015, Mount Sinai decreased total lengths of stay and readmissions and reduced the direct cost of care per patient, leading to net savings of CDN$4.2 million in 2014/2015. This article presents Mount Sinai's ACE Strategy and discusses the benefits of implementing integrated evidence-based models across the continuum of care and how it is supporting the implementation of ACE Strategy models of care and care practices across Canada and beyond.

Detecting Delirium in Hospitalized Elderly Patients: A Review of Practice Compliance.

Background: The Ontario Senior Friendly Hospital Strategy recognizes delirium prevention and management as a top priority and recommends implementation of delirium screening as well as management protocols. This strategy proposes that hospitals monitor 2 specific indicators: (1) rate of baseline delirium screening and (2) rate of hospital-acquired delirium. Objective: To (1) determine compliance with the Ontario Senior Friendly Hospital Strategy indicators; (2) describe the use of pharmacological and nonpharmacological interventions for management of delirious patients; and (3) identify predictors of screening compliance. Methods: We conducted a retrospective review of patients aged ≥65 years admitted to 4 different inpatient units for ≥48 hours. Data were extracted for 7 two-month time blocks chosen between September 2010 and October 2013, following the implementation of various geriatric and delirium related initiatives at the hospital. Results: A total of 786 patients met study inclusion criteria. Overall, 68.2% had baseline delirium screening (indicator 1), with screening rates increasing over time (P < .001). Inpatient unit and year of study were both statistically significant predictors of delirium screening. Among those screened, the overall rate of hospital-acquired delirium was 17.2% (indicator 2). Early mobilization and device removal were the most common nonpharmacological interventions, while initiation of an antipsychotic and discontinuation of benzodiazepines were the most common pharmacological interventions. Conclusions: Although the rates of baseline delirium screening have significantly increased over the sampled time period, rates are still below the averages referenced in other literature. Our study suggests we need additional efforts to improve compliance with delirium screening in our institution.

Healthcare for the Aging Citizen and the Aging Citizen for Healthcare: Involving Patient Advisors in Elder-Friendly Care Improvement.

With an aging population and a healthcare system that is overly reliant on providing expensive and sometimes problematic hospital-based care for older Canadians, driving improvements that promote elder-friendly care has never been more critical. The Acute Care for Elders (ACE) Strategy at Toronto's Mount Sinai Hospital is the focus of a pan-Canadian collaborative delivered by the Canadian Foundation for Healthcare Improvement in partnership with the Canadian Frailty Network. The intent is to spread the ACE Strategy's elder-friendly models of care and practices to 18 participating healthcare delivery organizations. A key element of the ACE Collaborative is the inclusion of patient advisors as members of the 18 teams. This article considers the development of elder-friendly care models and practices, with lessons for patient advisors and organizations on the necessary skill-mix, as well as lessons for providers and managers on ways to more effectively engage patient advisors in health system improvement to better serve an aging population.

Facteurs de risque d'éclosion de SRAS-CoV-2 dans les résidences pour aînés en Ontario, au Canada: étude de cohorte à l'échelle de la population.

CONTEXTE: L'épidémiologie de l'infection au SRAS-CoV-2 dans les résidences pour aînés (offrant une aide à la vie autonome), est pour une bonne part inconnue. Nous avons étudié le lien entre les caractéristiques des résidences et des communautés avoisinantes et le risque d'éclosion de SRAS-CoV-2 dans les résidences pour aînés depuis le début de la première vague de la pandémie de COVID-19. MÉTHODES: Nous avons procédé à une étude de cohorte rétrospective dans la population des résidences pour aînés certifiées en Ontario, au Canada, entre le 1er mars et le 18 décembre 2020. Notre paramètre principal était toute éclosion de SRAS-CoV-2 (≥ 1 cas confirmé parmi les résidents ou le personnel au moyen d'un test d'amplification des acides nucléiques). Nous avons utilisé la méthode des risques proportionnels avec prédicteurs chronologiques pour modéliser les liens entre les caractéristiques des résidences et des communautés avoisinantes et les éclosions de SRAS-CoV-2. RÉSULTATS: Notre cohorte a inclus l'ensemble des 770 résidences privées pour aînés (RPA) certifiées en Ontario qui hébergeaient 56 491 résidents. On a dénombré 273 (35,5 %) résidences pour aînés qui ont connu 1 éclosion de SRAS-CoV-2 ou plus; 1944 résidents (3,5 %) et 1101 employés (3,0 %) ont contracté l'infection. Ces cas étaient inégalement distribués entre les résidences. En effet, 2487 cas parmi les résidents et le personnel (81,7 %) sont survenus dans 77 résidences (10 %). Le rapport de risque ajusté d'une éclosion de SRAS-CoV-2 dans une résidence a été clairement associé aux établissements qui avaient une grande capacité d'accueil, qui comportaient des unités de soins de longue durée, qui appartenaient à de plus grandes bannières et offraient plusieurs services sur place, qui se trouvaient dans des régions marquées par une hausse de l'incidence régionale de SRAS-CoV-2 et où la concentration ethnique à l'échelle de la communauté était supérieure. INTERPRÉTATION: Certaines caractéristiques facilement identifiables des résidences pour aînés sont associées de manière indépendante aux éclosions de SRAS-CoV-2 et peuvent faciliter l'évaluation des risques et orienter la priorisation de la vaccination.

Without Empowered Patients, Caregivers and Providers, a Community-Based Dementia Care Strategy Will Remain Just That.

In trying to cope with the needs of the growing number of people living with dementia (PLWD), jurisdictions around the world have been implementing a variety of strategies, policies and programs to enable better access to the supports they and those who care for them require. Despite considerable efforts that have been undertaken, PLWD and their caregivers still face considerable challenges in pursuing care pathways and community-based supports that can help them avoid premature institutionalization. Morton-Chang et al. (2016) have comprehensively reviewed jurisdictional approaches towards the development of dementia strategies, policies and programs; there is a growing understanding and consensus around the things we need to do as societies to better meet the needs of PLWD and their caregivers; however, progress to date could be best characterized as top-down, patchy and fragmented. This paper builds on Morton-Chang et al.'s (2016) assertion that the development of a comprehensive person and caregiver-centred community-based dementia strategy in Ontario and other parts of Canada is likely achievable, particularly if implemented using a "ground-up" approach that is well-aligned with other government-related initiatives.

"A More Rounded Full Care Model": Interprofessional Team Members' Perceptions of Home-Based Primary Care in Ontario, Canada.

This study explores interprofessional team members' perspectives and experiences providing home-based primary care (HBPC) in Ontario, Canada. Employing an inductive qualitative methodology using procedures informed by grounded theory, themes emerged in the data in relation to the benefits of the HBPC model, and the barriers associated with its provision, as well as the key components that enable or hinder interprofessional collaboration in the HBPC environment. This research deepens our understanding of the key features and processes of interprofessional teams providing high-quality care in the home.