The role of navigation services in supporting mental health and addictions care transitions: A qualitative exploration of perspectives from transitional-aged youth, family, and service providers (part 2).

Introduction: Transitional-aged youth (TAY) are at a vulnerable stage of their development in which mental health and/or addiction (MHA) issues tend to manifest and/or increase in severity. These youth also tend to find themselves caught in the gap between child and adult MHA services, often resulting in sub-optimal access to and transition through MHA services. Navigation services may be one way to close this and other system gaps and improve service utilization and supports for TAY.

Experiences of barriers and facilitators in mental health care transitions: A qualitative exploration of perspectives from transitional-aged youth, family, and service providers (part 1).

Introduction: Transitional-aged youth (TAY) are at a vulnerable stage of their development in which mental health and/or addiction (MHA) issues tend to manifest and/or increase in severity. TAY also tend to find themselves subject to multiple care transitions, often resulting in sub-optimal access to MHA services. The objective of this study was to explore the perspectives of TAY, family members, and system providers regarding the supports needed by TAY and their families during transitions through MHA care.

Integration of hospital with congregate care homes in response to the COVID-19 pandemic.

Background: The coronavirus disease 2019 (COVID-19) pandemic has highlighted the need to improve the safety of the environments where we care for older adults in Canada. After providing assistance during the first wave, many Ontario hospitals formally partnered with local congregate care homes in a "hub and spoke" model during second pandemic wave onward. The objective of this article is to describe the implementation and longitudinal outcomes of residents in one hub and spoke model composed of a hospital partnered with 18 congregate care homes including four long-term care and 14 retirement or other congregate care homes.

Transitions in mental health and addiction care for youth and their families: a scoping review of needs, barriers, and facilitators.

Introduction: Transitional-aged youth (TAY) with mental health and/or addictions (MHA) concerns and their families experience significant challenges finding, accessing, and transitioning through needed MHA care. To develop appropriate supports that assist TAY and their families in navigating MHA care, their experiences of transitions in the MHA care system must be better understood. This scoping review identifies and explores the needs, barriers, and facilitators for TAY and their families when transitioning through MHA care.

Access to Community Support Services among Older Adults in Social Housing in Ontario.

Community support services are an integral enabler of aging in place. In social housing, older adult tenants struggle to access these services because of the siloed nature of housing and health services. This study examined the provision of government-funded community support services to 83 seniors' social housing buildings in Toronto, Ontario.

Exercise priming with transcranial direct current stimulation: a study protocol for a randomized, parallel-design, sham-controlled trial in mild cognitive impairment and Alzheimer's disease.

Background: Transcranial direct current stimulation (tDCS) is a non-invasive type of brain stimulation that uses electrical currents to modulate neuronal activity. A small number of studies have investigated the effects of tDCS on cognition in patients with Mild Cognitive Impairment (MCI) and Alzheimer's disease (AD), and have demonstrated variable effects. Emerging evidence suggests that tDCS is most effective when applied to active brain circuits.

Patient-centred innovation for multimorbidity care: a mixed-methods, randomised trial and qualitative study of the patients' experience.

Background: Patient-centred interventions to help patients with multimorbidity have had mixed results.

Aim: To assess the effectiveness of a provider-created, patient-centred, multi-provider case conference with follow-up, and understand under what circumstances it worked, and did not work.

Design And Setting: Mixed-methods design with a pragmatic randomised trial and qualitative study, involving nine urban primary care sites in Ontario, Canada.

Connecting People With Multimorbidity to Interprofessional Teams Using Telemedicine.

Purpose: Most models for managing chronic disease focus on single diseases. Managing patients with multimorbidity is an increasing challenge in family medicine. We evaluated the feasibility of a novel approach to caring for patients with multimorbidity, performing a case study of TIP-Telemedicine IMPACT (Interprofessional Model of Practice for Aging and Complex Treatments) Plus-a 1-time interprofessional consultation with primary care physicians (PCPs) and their patients in Toronto, Canada.

Computerized Cognitive Testing in Primary Care: A Qualitative Study.

Computerized cognitive assessment tools may facilitate early identification of dementia in the primary care setting. We investigated primary care physicians' (PCPs') views on advantages and disadvantages of computerized testing based on their experience with the Computer Assessment of Mild Cognitive Impairment (CAMCI). Over a 2-month period, 259 patients, 65 years and older, from the family practice of 13 PCPs completed the CAMCI.

Communication technology adoption among older adult veterans: the interplay of social and cognitive factors.

Objectives: InTouch is an electronic communication platform designed to be accessible by computer-naive seniors. The present study explored the process of adoption and use of the application by seniors with and without mild cognitive impairment (MCI) through the lens of Social Cognitive Theory (SCT).

Method: We studied adoption and use of InTouch for social communication over a 12-week period in a 475-bed Veteran's care facility at Sunnybrook Health Sciences Centre in Toronto, Canada.

The Effects of Computerized Cognitive Testing of Older Patients on Primary Care Physicians' Approaches to Care: A Canadian Study.

Background: We evaluated effects of providing primary care physicians (PCPs) with reports of their patients' results on the Computer Assessment of Mild Cognitive Impairment (CAMCI) by examining their documented care approaches after receipt of the report.

Methods: Patients were 65 years and above, without a diagnosis or previous workup for dementia, seen consecutively over 2 months by one of 13 PCPs. PCPs indicated whether they, patients, or families had concerns about patients' cognition.

Self-report measures of well-being predict incident harm due to self-neglect in cognitively impaired seniors who live alone.

Background: Primary care physicians (PCPs) increasingly must identify which of their cognitively impaired patients who live alone are at greatest risk of harm due to self-neglect.

Objectives: To determine whether brief patient self-report measures could accurately do this.

Methods: Participants were ≥65 years, lived alone, and recruited from PCPs' practices, community agencies, a hospital emergency department, and acute care medical units.

Factors associated with primary care physicians' recognition of cognitive impairment in their older patients.

Although there are accurate screens for cognitive impairment, there is as yet no evidence that screening improves outcomes including primary care physicians' (PCP) medical decision making. PCPs' recognition of cognitive impairment being suboptimal, we investigated factors associated with improved recognition. Eligible patients were aged 65 years and above, without documented dementia or previous work-up for dementia, seen consecutively over 2 months by one of 13 PCPs.

Feasibility and validity of the self-administered computerized assessment of mild cognitive impairment with older primary care patients.

We investigated whether a validated computerized cognitive test, the Computerized Assessment of Mild Cognitive Impairment (CAMCI), could be independently completed by older primary care patients. We also determined the optimal cut-off for the CAMCI global risk score for mild cognitive impairment against an independent neuropsychological reference standard. All eligible patients aged 65 years and older, seen consecutively over 2 months by 1 family practice of 13 primary care physicians, were invited to participate.

The IMPACT clinic: innovative model of interprofessional primary care for elderly patients with complex health care needs.

Problem Addressed: The growing number of elderly patients with multiple chronic conditions presents an urgent challenge in primary care. Current practice models are not well suited to addressing the complex health care needs of this patient population.

Objective Of Program: The primary objective of the IMPACT (Interprofessional Model of Practice for Aging and Complex Treatments) clinic was to design and evaluate a new interprofessional model of care for community-dwelling seniors with complex health care needs.

Risk factors for medication nonadherence in older adults with cognitive impairment who live alone.

Objective: The aim of this study was to prospectively examine the influence of cognitive, medical, behavioral, and social risk factors on medication nonadherence in community-dwelling older adults with cognitive impairment.

Methods: A sample of 339 elderly participants with cognitive impairment, who lived alone and took at least one medication, underwent baseline assessment which included the five subscales of the Dementia Rating Scale (DRS), number of medications, retrospective medication nonadherence, amount of formal and informal assistance, functional impairment, depression, perception of social resources, comorbidity, and alcohol consumption. The outcome was medication nonadherence during the 12-month prospective period as reported by the participants' primary care physicians and caregivers at three-month intervals.

Perceptions of family and staff on the role of the environment in long-term care homes for people with dementia.

Background: Disruptive behaviors are frequent and often the first predictor of institutionalization. The goal of this multi-center study was to explore the perceptions of family and staff members on the potential contribution of environmental factors that influence disruptive behaviors and quality of life of residents with dementia living in long-term care homes.

Methods: Data were collected using 15 nominal focus groups with 45 family and 59 staff members from eight care units.

Neuropsychological predictors of self-neglect in cognitively impaired older people who live alone.

Objective: The authors examined the accuracy of certain neuropsychological tests in the prediction of harm resulting from self-neglect in cognitively impaired seniors who lived alone.

Methods: The study included 130 participants, aged 65 and older, who scored less than 131 on the Dementia Rating Scale. Neuropsychological tests were administered at baseline, resulting in eight predictive scores.

Enteral feeding in end-stage dementia: a comparison of religious, ethnic, and national differences in Canada and Israel.

Background: Although enteral feeding in end-stage dementia is thought by many clinicians to be "futile," it is still widely used. We examined rates of tube feeding (gastrostomy or nasogastric) in end-stage dementia in hospitals in both Canada and Israel, and hypothesized that Canadian non-Jewish affiliated hospitals would have the lowest (and Israeli institutions the highest), with Canadian Jewish hospitals exhibiting intermediate rates.

Methods: We conducted a cross-sectional survey of six geriatric long-term hospitals: two in Israel and four in Canada (two Jewish affiliated, two not; two in Ontario, two in Quebec province).

Risk factors for harm in cognitively impaired seniors who live alone: a prospective study.

Objectives: To identify risk factors for harm due to self-neglect or behaviors related to disorientation in cognitively impaired seniors who live alone that can be used in primary care.

Design: Inception cohort followed prospectively for 18 months.

Setting: Participants were referred by their primary care physicians and community service agencies or were patients of several medical units of a large teaching hospital.