End-of-Life Acute Care use and Pain-Related Outcomes in Chinese-speaking Residents in Canadian Long-Term Care Homes.

Objectives: Patients from ethnically minoritized communities often face disparities in health care due to language and cultural barriers. This study aimed to compare health care use and end-of-life outcomes between Chinese-speaking residents living in language-concordant and language-discordant long-term care (LTC) homes.

Design: Retrospective cohort study.

Variations in caregiving patterns of spouses/partners and adult children of long-term care home residents in Ontario, Canada.

Family involvement in care often continues after an individual moves into a long-term care (LTC) home. This cross-sectional study delves into the dynamics of family caregiving for LTC residents. Spouses/partners (n = 32, mean age 76) primarily focused on tasks such as mealtimes (53 %) and direct care like feeding, whereas adult children (n = 159, mean age 62) showed a preference for non-mealtime visits (64 %) and managing indirect care activities such as finances.

Transitions to Nursing Homes among Residents of Assisted Living and Community-Dwelling Home Care Recipients.

Objectives: To examine transitions to a nursing home among residents of assisted living relative to community-dwelling home care recipients.

Design: Population-based retrospective cohort study emulating a target trial.

Setting And Participants: Linked, individual-level health system data were obtained from older adults (aged ≥65 years) who made an incident application for a bed in a nursing home in Ontario, Canada, between April 1, 2014, and March 31, 2019, and were followed until December 31, 2019.

Effectiveness of the Sub-Acute Care for Frail Elderly (SAFE) Transitional Care Unit on Short-Term Functional Independence in Frail Older Patients Discharged from Hospital.

Background: Transitional care programs help improve continuity of care and post-discharge outcomes for frail older adults who are hospitalized. In this study, we examined the effectiveness of a transitional care model, based in a long-term care (LTC) home, on the functional independence of older hospitalized patients post-discharge.

Methods: We used a propensity-score matched cohort, whereby cases comprised patients who were admitted to a transitional care program-called the Sub-Acute Care for Frail Elderly (SAFE) Unit-following a hospitalization between March 1, 2018 and June 30, 2019.

Derivation and validation of an algorithm to predict transitions from community to residential long-term care among persons with dementia-A retrospective cohort study.

Objectives: To develop and validate a model to predict time-to-LTC admissions among individuals with dementia.

Design: Population-based retrospective cohort study using health administrative data.

Setting And Participants: Community-dwelling older adults (65+) in Ontario living with dementia and assessed with the Resident Assessment Instrument for Home Care (RAI-HC) between April 1, 2010 and March 31, 2017.

Exploring perceptions of online calculators for identifying community-dwelling older people at risk of dying: A qualitative study.

Objectives: This study aimed to assess the acceptability, value, and perceived barriers of using electronic risk calculators for predicting and communicating the risk of death in community-dwelling older adults.

Methods: One focus group and eight interviews were conducted with 16 participants with experience caring for patients or family members at end of life. A prototype mortality risk tool was used to anchor discussions.

Activated eosinophils in early life impair lung development and promote long-term lung damage.

Exaggeration of type 2 immune responses promotes lung inflammation and altered lung development; however, eosinophils, despite expansion in the postnatal lung, have not been specifically assessed in the context of neonatal lung disease. Furthermore, early life factors including prematurity and respiratory infection predispose infants to chronic obstructive pulmonary disease later in life. To assess eosinophils in the developing lung and how they may contribute to chronic lung disease, we generated mice harboring eosinophil-specific deletion of the negative regulatory enzyme SH2 domain-containing inositol 5' phosphatase-1.

Ascertaining the Francophone population in Ontario: validating the language variable in health data.

Background: Language barriers can impact health care and outcomes. Valid and reliable language data is central to studying health inequalities in linguistic minorities. In Canada, language variables are available in administrative health databases; however, the validity of these variables has not been studied.

Building evidence to advance health equity: a systematic review on care-related outcomes for older, minoritised populations in long-term care homes.

Background: Advancing health equity requires more contextualised evidence.

Objectives: To synthesise published evidence using an existing framework on the origins of health disparities and determine care-related outcome disparities for residents of long-term care, comparing minoritised populations to the context-specific dominant population.

Design: Systematic review.

Estimated mortality risk and use of palliative care services among home care clients during the last 6 months of life: a retrospective cohort study.

Background: In Canada, only 15% of patients requiring palliative care receive such services in the year before death. We describe health care utilization patterns among home care users in their last 6 months of life to inform care planning for older people with varying mortality risks and evolving care needs as they decline.

Methods: Using population health administrative data from Ontario, we performed a retrospective cohort study involving home care clients aged 50 years and older who received at least 1 interRAI (Resident Assessment Instrument) Home Care assessment between April 2018 and September 2019.

Nurse practitioner and physician end-of-life home visits and end-of-life outcomes.

Objectives: Physicians and nurse practitioners (NPs) play critical roles in supporting palliative and end-of-life care in the community. We examined healthcare outcomes among patients who received home visits from physicians and NPs in the 90 days before death.

Methods: We conducted a retrospective cohort study using linked data of adult home care users in Ontario, Canada, who died between 1 January 2018 and 31 December 2019.

Exploring COVID-19 education to support vaccine confidence amongst the general adult population with special considerations for healthcare and long-term care staff: A scoping review.

Background: Despite the demonstrated efficacy of approved COVID-19 vaccines, high levels of hesitancy were observed in the first few months of the COVID-19 vaccines' rollout. Factors contributing to vaccine hesitancy are well-described in the literature. Among the various strategies for promoting vaccine confidence, educational interventions provide a foundationally and widely implemented set of approaches for supporting individuals in their vaccine decisions.

Physician continuity of care in the last year of life in community-dwelling adults: retrospective population-based study.

Objective: To describe the timing of involvement of various physician specialties over the last year of life across different levels of primary care physician continuity for differing causes of death.

Methods: We conducted a retrospective cohort study of adults who died in Ontario, Canada, between 1 January 2013 and 31 December 2018, using linked population level health administrative data. Outcomes were median days between death and first and last outpatient palliative care specialist encounter, last outpatient encounter with other specialists and with the usual primary care physician.

End-of-life interventions in patients with cancer.

Objectives: To describe variations in the receipt of potentially inappropriate interventions in the last 100 days of life of patients with cancer according to patient characteristics and cancer site.

Methods: We conducted a population-based retrospective cohort study of cancer decedents in Ontario, Canada who died between 1 January 2013 and 31 December 2018. Potentially inappropriate interventions, including chemotherapy, major surgery, intensive care unit admission, cardiopulmonary resuscitation, defibrillation, dialysis, percutaneous coronary intervention, mechanical ventilation, feeding tube placement, blood transfusion and bronchoscopy, were captured via hospital discharge records.

Perceptions of Palliative and End-Of-Life Care Capacity Among Frontline Staff and Administrators in Long-Term Care Homes During the COVID-19 Pandemic in Ontario, Canada: A Mixed-Methods Evaluation.

Objectives: The COVID-19 pandemic has greatly affected the morbidity and mortality of residents in long-term care (LTC) homes. However, not much is known about its impact on staff's perception of their capacity to provide palliative and end-of-life (EOL) care for LTC residents over the course of the pandemic. We investigated changes in self-reported confidence among LTC workers and their experience in providing palliative and EOL care to residents before and during the COVID-19 pandemic.

Physician home visits to rostered patients during their last year of life: a retrospective cohort study.

Background: Physician home visits are associated with better health outcomes, yet most patients near the end of life never receive such a visit. Our objectives were to describe the receipt of physician home visits during the last year of life after a referral to home care - an indication that the patient can no longer live independently - and to measure associations between patient characteristics and receipt of a home visit.

Methods: We conducted a retrospective cohort study using linked population-based health administrative databases housed at ICES.

Digital Immunization Tracking in Long-Term Care and Assisted Living Facilities.

A disproportionate share of the health impacts of COVID-19 has been borne by older adults, particularly those in long-term care facilities (LTCs). Vaccination has been critical to efforts to combat this issue, but as we begin to emerge from this pandemic, questions remain about how to protect the health of residents of LTC and assisted living facilities proactively in order to prevent such a disaster from occurring again. Vaccination, not just against COVID-19, but also against other vaccine-preventable illness, will be a key component of this effort.

PROTOCOL: Exploring education to support vaccine confidence amongst healthcare and long-term care staff amidst the COVID-19 pandemic: A protocol for a living scoping review.

Despite the demonstrated effectiveness of vaccines, varying levels of hesitancy were observed among healthcare and long-term care workers, who were prioritized in the roll out of COVID-19 vaccines due to their high risk of exposure to SARS-CoV-2 transmission. However, the evidence around the measurable impact of various educational interventions to improve vaccine confidence is limited. The proposed scoping review is intended to explore any emerging research and experiences of delivering educational interventions to improve COVID-19 vaccine confidence among health and long-term care workforces.

Decline in Other Instrumental Activities of Daily Living as Indicators of Driving Risk in Older Adults at an Academic Memory Clinic.

Background: Decisions around driving retirement are difficult for older persons living with cognitive decline and their caregivers. In many jurisdictions, physicians are responsible for notifying authorities of driving risks. However, there are no standardized guidelines for this assessment.

Pandemic Preparedness and Beyond: Person-Centred Care for Older Adults Living in Long-Term Care during the COVID-19 Pandemic.

The increasing complexity of residents' needs, emphasis on social distancing and limited access to high-quality support presented challenges to patient-centred care during the pandemic. Yet the pandemic created an opportunity to explore novel approaches to achieving person-centred care within long-term care (LTC). We share three projects designed to enhance care delivery in the context of the pandemic: to address personhood needs during outbreaks, to improve the quality of medical care and to deliver personalized palliative and end-of-life care using a prediction algorithm.

Initial treatment is associated with improved survival and end-of-life outcomes for patients with pancreatic cancer: a cohort study.

Background: We describe the association between initial treatment and end-of-life (EOL) outcomes among patients with pancreatic ductal adenocarcinoma (PDAC).

Methods: This population-based cohort study included patients with PDAC who died from April 2010-December 2017 in Ontario, Canada using administrative databases. We used multivariable models to explore the association between index cancer treatment (no cancer-directed therapy, radiation, chemotherapy, surgery alone, and surgery and chemotherapy), and primary (mortality, healthcare encounters and palliative care) and secondary outcomes (location of death, hospitalizations, and receipt of chemotherapy within the last 30 days of life).