Publications by authors named "Hirdes J"

Unlabelled: Decline in the ability to perform activities of daily living (ADL) or 'functional decline' is a major health concern among aging populations. With intervention, ADL decline may be delayed, prevented or reversed. The capacity to anticipate the trajectory of future functional change can enhance care planning and improve outcome for residents.

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  • * Researchers compared data from residents admitted during the pandemic (2020/2021) with those from two pre-pandemic years (2018/2019 and 2019/2020) using complex statistical models to account for various resident characteristics.
  • * The findings revealed that antipsychotic medication use rose during the pandemic, with new residents more likely to start these medications and less likely to stop them, indicating that pandemic-related factors influenced treatment patterns.
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Falls and hip fractures are a major health concern among older adults in long term care (LTC) with almost 50% of residents experiencing a fall annually. Hip fractures are one of the most important and frequent fall-related injuries in LTC. There is moderate to strong certainty evidence that multifactorial interventions may reduce the risk of falls and fractures; however, there is little evidence to support its implementation.

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Objectives: To describe delirium incidence before and during the COVID-19 pandemic and examine factors associated with delirium incidence in the long-term care setting.

Methods: We conducted a retrospective cohort study of Ontario long-term care residents without severe cognitive impairment or baseline delirium with an assessment between February 1, 2019, and March 31, 2021. Data were collected from the interRAI Minimum Data Set (MDS) 2.

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  • Geriatric Emergency Department Guidelines aim to improve care transitions for older patients, highlighting the need for coordinated interprofessional services such as occupational therapy and social work.
  • The study involved assessing older adults in 10 EDs across Canada to determine their referral patterns, focusing on those with high-risk characteristics, and utilized rigorous assessment tools to identify complex needs.
  • Results showed that while a majority of high-needs patients received referrals to various services, factors like hospital location and the extent of their healthcare needs influenced referral decisions, indicating that risk-based referrals may not be consistently applied.
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  • Older adults, who are 65 and older, now make up half of the patients in hospitals, so it's important to understand their unique needs.
  • Many of these older adults have multiple health problems and are at risk for being harmed in the hospital or being stuck there longer than needed.
  • The article talks about creating better care for older adults to help them recover well and emphasizes the need for teamwork among healthcare professionals to make sure they get the right support before, during, and after their hospital stay.
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Objective: The proportion of long-term care (LTC) residents being treated with antipsychotic medication is high, and these medications may exacerbate behavioral symptoms. We used propensity scores to investigate the effect of antipsychotic use on the worsening of behavioral symptoms among residents in LTC facilities.

Design: A retrospective study.

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Introduction: We used clinical assessment records to provide pan-Canadian estimates of the prevalence and risks associated with recent (within the last 3 days) critical wandering among home care clients, with and without dementia.

Methods: The data source is interRAI Home Care (interRAI HC) assessments. The population was all long-stay home care clients assessed between 2004 and 2021 in seven Canadian provinces and territories (N = 1,598,191).

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Navigating the evaluation and management of pain in long-term care homes is a complex task. Despite an extensive body of literature advocating for a paradigm shift in pain assessment and management within long-term care homes, much more remains to be done. The assessment of pain in long-term care is particularly challenging, given that a substantial proportion of residents live with some degree of cognitive impairment.

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The COVID-19 pandemic had profound effects on the long-term care (LTC) setting worldwide, including changes in admission practices. We aimed to describe the characteristics and medical complexity of newly admitted LTC residents before (March 1, 2019 to February 29, 2020) and during (March 1, 2020 to March 31, 2021) the COVID-19 pandemic via a population-based serial cross-sectional study in Ontario, Alberta, and British Columbia, Canada. With data from the Minimum Data Set 2.

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Introduction: Improving quality of life has become a priority in the long-term care (LTC) sector internationally. With development and implementation guidance, standardised quality-of-life monitoring tools based on valid, self-report surveys could be used more effectively to benefit LTC residents, families and organisations. This research will explore the potential for subjective quality-of-life indicators in the interRAI Self-Reported Quality of Life Survey for Long-Term Care Facilities (QoL-LTCF).

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The population of people in federal custody in Canada is aging. Those in custody report experiencing poorer health and high rates of chronic health conditions. Two health concerns that are disproportionately higher among those in custody are mood disorders and pain.

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Calls to leverage routinely collected data to inform health system improvements have been made. Misalignment between home care services and client needs can result in poor client, caregiver, and system outcomes. To inform development of an integrated model of community-based home care, grounded in a holistic definition of health, comprehensive clinical profiles were created using Ontario, Canada home care assessment data.

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Background: Trauma is commonly overlooked or undiagnosed in clinical care settings. Undetected trauma has been associated with elevated substance use highlighting the need to prioritize identifying individuals with undetected trauma through common characteristics.

Objective: The purpose of this study is to identify classifications of traumatic life experiences and substance use among persons admitted to inpatient psychiatry in Ontario and to identify covariates associated with classification membership.

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  • The study investigates how resident frailty and home-level characteristics impact COVID-19 mortality among long-term care (LTC) residents in Ontario, Canada, both before and after COVID-19 vaccinations became available.
  • It analyzes data from over 14,000 confirmed COVID-19 cases in LTC homes, revealing a higher mortality rate during the pre-vaccine period and that frailty is a strong predictor of mortality regardless of vaccination status.
  • The findings suggest that while frailty significantly correlates with COVID-19 mortality, factors related to the LTC homes themselves do not account for considerable variations in mortality rates.
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Objective: The demand for long-term care in community and facilitybased settings in Canada is expected to increase with population growth. The Toronto Grace Health Center piloted an intervention program that aims to support return to the community of acute hospital patients designated for LTC placement. We investigated whether this program was effective in transitioning the program patients back to their homes in the community and the factors associated with transitioning patients to different destinations.

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Objective: We aimed to examine whether functional decline accelerated during the first wave of the COVID-19 pandemic (March to June 2020) for persons in long-term care facilities (LTCs) in Canada compared with the pre-pandemic period.

Design: We conducted a population-based longitudinal study of persons receiving care in LTC homes in 5 Canadian provinces before and during the COVID-19 pandemic.

Setting And Participants: Residents in 1326 LTC homes within the Canadian provinces of Alberta, British Columbia, Manitoba, Newfoundland & Labrador, and Ontario between January 31, 2019, and June 30, 2020, with activities of daily living Hierarchy scale less than 6 and so, who still have potential for decline (6 being the worst of the 0-6 scale).

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  • The increasing number of older adults with complex chronic conditions (CCCs) poses challenges for care providers, as existing decision support systems are inadequate for addressing the complexities involved in their treatments.
  • This EU-funded project aims to develop advanced decision support systems using a vast pool of real-world data from over 51 million older adults across eight countries to improve health outcome predictions and evaluate treatment impacts.
  • Ethical guidelines have been followed for the study, which will disseminate findings through publications in peer-reviewed journals and share them with relevant stakeholders to enhance the quality of care for older persons with CCCs.
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Objectives: The interRAI Community Rehabilitation Assessment (CRA) is a comprehensive health assessment designed to collect essential health and function information for rehabilitation care planning, benchmarking, and evaluation of clinic and home-based programs. A portion of the CRA is completed through patient self-report. The objective of this study was to demonstrate how the CRA can be used to describe the baseline clinical characteristics of patients participating in ambulatory rehabilitation programs and measure change across numerous domains of function, health, and wellbeing over time.

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Objective: Long-term care (LTC) homes ("nursing homes") were challenged during the first year of the COVID-19 pandemic in Canada. The objective of this study was to measure the impact of the COVID-19 pandemic on resident admission and discharge rates, resident health attributes, treatments, and quality of care.

Design: Synthesis analysis of "Quick Stats" standardized data table reports published yearly by the Canadian Institute for Health Information.

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During the pandemic, the interRAI COVID-19 Vulnerability Screener (CVS) was used to identify community-dwelling older adults or adults with disabilities at risk of negative outcomes and facilitate triage for follow-up with health/social services. The interRAI CVS, a standardized self-report instrument administered virtually by a lay-person, includes COVID-19-related items and psychosocial and physical vulnerability. Our objective was to describe those assessed and identify sub-groups at highest risk of adverse outcomes.

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Background: Frailty, social isolation, loneliness, and poverty may render older adults vulnerable to social or health stressors. It is imperative to identify effective interventions to address them especially in the context of COVID-19 pandemic.

Objective: To identify effective community-based interventions to address frailty, social isolation, loneliness, and poverty among community-dwelling older adults.

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