Retrospective Analysis of the Integration of Palliative Care Into the Care of Stroke Patients Admitted to a Regional Stroke Center.

Palliative care (PC) aims to enhance the quality of life for patients when confronted with serious illness. As stroke inflicts high morbidity and mortality, the integration of PC within acute stroke care remains an important aspect of quality inpatient care. However, there is a tendency to offer PC to stroke patients only when death appears imminent.

Skin Tear Management: A Multidisciplinary Education Project.

Objective: To identify the number of skin tears present at the authors' facility and evaluate a multidisciplinary educational intervention to support treatment of skin tears.

Methods: The authors determined the prevalence of skin tears from an analysis of a wound audit dataset at Baycrest Health Sciences and compared it with the literature to inform the aims of the educational intervention. They developed an educational module and presented it to physicians and students at separate in-person sessions and to clinical care staff at a virtual session.

A Novel Approach to Measurement-Based Care: Integrating Palliative Care Tools Into Geriatric Mental Health.

Older adults cared for in a geriatric mental health program often have medical co-morbidities causing physical symptoms which may be under-recognized. We explore the utility of palliative care tools in this patient population to identify the burden of symptoms and impact on patient dignity. Participants were recruited from a geriatric mental health inpatient unit and outpatient day hospital.

A Novel Instrument for Caregivers in Managing Neuropsychiatric Symptoms of Dementia: Baycrest Quick-Response Caregiver Tool.

Background: Family caregivers can experience significant stress related to behaviour changes in persons with dementia (PWD). Approaches to support caregivers with stress management when responding to changes in behaviours are needed. The Baycrest Quick-Response Caregiver Tool (BQRCT) was developed to provide caregivers with an online tool that can be used in real time to recognize and manage their emotions when managing neuropsychiatric symptoms of dementia.

Characteristics, treatment and delirium incidence of older adults hospitalized with COVID-19: a multicentre retrospective cohort study.

Background: The COVID-19 pandemic has affected older adults disproportionately, and delirium is a concerning consequence; however, the relationship between delirium and corticosteroid use is uncertain. The objective of the present study was to describe patient characteristics, treatments and outcomes among older adults hospitalized with COVID-19, with a focus on dexamethasone use and delirium incidence.

Methods: We completed this retrospective cohort study at 7 sites (including acute care, rehabilitation and long-term care settings) in Toronto, Ontario, Canada.

MedSafer to Support Deprescribing for Residents of Long-Term Care: a Mixed-Methods Study.

Background: Polypharmacy is prevalent in long-term care homes (LTCH) and increases the risk of adverse drug events. Feasible and effective deprescribing interventions applicable in the LTCH environment are needed.

Methods: We performed a mixed methods study to evaluate the feasibility, applicability, and effectiveness of an electronic deprescribing tool, MedSafer, to facilitate quarterly medication reviews (QMRs) on two pilot units in an academic long-term care home (LTCH).

Development of an Advance Care Planning Policy within an Evidenced-Based Evaluation Framework.

As the population is aging and medical advancements enable people to live longer, advance care planning (ACP) becomes increasingly important in guiding future care decisions; however, they are often incomplete or absent from the patient chart. This study describes the development and implementation of an ACP policy in a post-acute care and long-term care setting using a systematic implementation framework. A process evaluation that parallels the Replicating Effective Programs (REP) framework was used to understand stakeholder experiences with ACP and identify gaps in practice.

Therapeutic Touch in the Management of Responsive Behaviors in Patients with Dementia.

Introduction: This study aimed to investigate the use of therapeutic touch (TT) in the management of responsive behaviors in patients with dementia.

Methods: A randomized, double-blinded control trial was used to compare response to TT in a population with responsive behaviors in dementia, in 3 phases, pretreatment, treatment, and posttreatment each lasting 5 days. The participants were divided into three groups: experimental, placebo, and control.

Benzodiazepine Use and Morbidity-Mortality Outcomes in a Geriatric Palliative Care Unit: A Retrospective Review.

Introduction: Patients often experience delirium at the end of life. Benzodiazepine use may be associated with an increased risk of developing delirium. Alternate medications used in conjunction with benzodiazepines may serve as an independent precipitant of delirium.

Integrating Palliative Care Assessment Tools to Enhance Understanding of Illness Trajectory in Post-Acute Care and Long-Term Care.

Objectives: To determine whether education and integration of the Gold Standard Framework Proactive Identification Guidance (GSF-PIG) and the Palliative Performance Scale (PPS) into care rounds, in post-acute care settings, can facilitate communication between the interprofessional care team to enhance understanding of illness trajectories, identifying those who would benefit from a palliative approach to care.

Methods: Interprofessional care teams received training on the GSF-PIG and PPS which were integrated into weekly care rounds and completed a post-evaluation survey. A chart review was conducted for the 40 patients and residents reviewed with the GSF-PIG and PPS.

Cholinesterase Inhibitor Use in Patients With Dementia Admitted to a Palliative Care Unit.

Objectives: Current guidelines suggest that patients with severe dementia on cholinesterase inhibitors (CHEIs) should discontinue their CHEIs by taper. This study aims to define the prevalence of patients admitted to a palliative care unit (PCU) with dementia on a CHEI and to determine whether these patients were tapered off their CHEIs according to current deprescribing guidelines.

Design: This is a descriptive retrospective chart review that examined patients admitted to a PCU with dementia on a CHEI from January 2015 to June 2019.

Using Standardized Tools to Characterize Adult Day Program Populations: Implications for Future Research and Clinical Practice.

Objectives: To demonstrate the usefulness of primary data collection using clinician-rated and self-rated standardized measures to describe adult day program (ADP) populations and address programming issues such as identifying members at risk of dropping out.

Setting And Participants: One ADP in London, Ontario, and 2 ADPs in Toronto, Ontario, Canada. A total of 223 community-dwelling older adults were recruited across the 3 different programs.

A Retrospective Chart Review of Transfusion Practices in the Palliative Care Unit Setting.

Background: There remains limited data in the literature on the frequency, clinical utility and effectiveness of transfusions in palliative care, with no randomized controlled trials or clinical practice guidelines on this topic. There are no routinely accepted practices in place for the appropriate transfusion of blood products in this setting.

Aim: The aim of this study was to retrospectively review all transfusions in the palliative care units of 2, tertiary care hospitals in Canada.

Characteristics and Outcomes of Patients in Rehabilitation with Hip Fracture: A Retrospective Chart Review.

ABSTRACTHip fracture rehabilitation has two streams: high tolerance short duration (HTSD) and low tolerance long duration (LTLD). This study examined patient characteristics and outcomes in HTSD and LTLD associated with length of stay (LOS) and discharge destination. We retrospectively examined patients' medical charts following hip fracture surgery and collected demographic, functional, and health characteristics.

Primary Thromboprophylaxis in Individuals without Cancer Admitted to a Geriatric Palliative Care Unit.

Background/objectives: The prevalence of individuals with advanced noncancer disease is increasing on palliative care units (PCUs), but there are no current guidelines to direct venous thromboembolism (VTE) prophylaxis decisions in these individuals. The aim of this study was to compare primary VTE prophylaxis in elderly adults with advanced noncancer diagnoses with that of those with advanced cancer on a dedicated geriatric PCU.

Design: Single-center retrospective chart review.

Prevalence of Dementia in a Geriatric Palliative Care Unit.

Objectives: To determine the prevalence of dementia in a palliative care unit (PCU) and to determine whether there is a difference between length of stay (LOS) and Palliative Performance Scale (PPS) score in individuals admitted with a primary diagnosis of dementia compared to individuals admitted with other noncancer and cancer diagnoses.

Design: Descriptive retrospective chart review.

Setting: Geriatric PCU in an academic community geriatric hospital.

Knowledge translation: An interprofessional approach to integrating a pain consult team within an acute care unit.

Management of pain in the frail elderly presents many challenges in both assessment and treatment, due to the presence of multiple co-morbidities, polypharmacy, and cognitive impairment. At Baycrest Health Sciences, a geriatric care centre, pain in its acute care unit had been managed through consultations with the pain team on a case-by-case basis. In an intervention informed by knowledge translation (KT), the pain specialists integrated within the social network of the acute care team for 6 months to disseminate their expertise.

Therapeutic Touch(®) in a geriatric Palliative Care Unit - A retrospective review.

Unlabelled: Complementary therapies are increasingly used in palliative care as an adjunct to the standard management of symptoms to achieve an overall well-being for patients with malignant and non-malignant terminal illnesses. A Therapeutic Touch Program was introduced to a geriatric Palliative Care Unit (PCU) in October 2010 with two volunteer Therapeutic Touch Practitioners providing treatment.

Objective: To conduct a retrospective review of Therapeutic Touch services provided to patients in an in-patient geriatric palliative care unit in order to understand their responses to Therapeutic Touch.

Attributes and outcomes of end stage liver disease as compared with other noncancer patients admitted to a geriatric palliative care unit.

Background: End stage liver disease (ESLD) is increasingly more prevalent as a noncancer disease to manage in palliative care. Because of the clear lack of a "terminal phase" in ESLD, palliative care is often initiated only when death is perceived as being imminent. Palliative care units (PCUs) serve as an option for continued care for patients living with ESLD and are a limited resource, often not able to accommodate longer patient admissions.

A Survey of Knowledge and Attitudes of Nurses About Pain Management in End-Stage Liver Disease in a Geriatric Palliative Care Unit.

Background: Palliative care is often initiated late for patients with end stage liver disease (ESLD) with pain being a common morbidity that is under-treated throughout the disease trajectory. When admitted to a palliative care unit (PCU), nurses play a pivotal role and must be highly informed to ensure effective pain management. The aim of this study is to determine the baseline level of knowledge and attitudes of PCU nurses regarding pain management in patients with ESLD.

Slow Stream Rehabilitation: A New Model of Post-Acute Care.

Objectives: To identify characteristics and outcomes of elderly patients admitted to a slow stream, low-intensity, and long-duration inpatient rehabilitation (SSR) program after an acute hospitalization because they were unable to tolerate traditional inpatient rehabilitation.

Design: Single group pre-post study with assessments conducted on admission and discharge.

Setting: Baycrest's 30-bed SSR Unit in Toronto, Ontario, Canada.