Publications by authors named "Nathan Stall"
Background And Aims: The expanded use of virtual care may worsen pre-existing disparities in use and delivery of end-of-life care among certain groups of people. We measured the use of virtual care in the last three months of life before and after the introduction of virtual care fee codes that funded care delivery at the start of COVID-19 on March 14, 2020, and identified changes in the characteristics of people using it.
Methods: We used linked clinical and administrative datasets to study use of virtual care in the last three months of life among 411,564 adults who died between January 25, 2018, and November 30, 2022.
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 (≥65 years of age) 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.
Article Synopsis
- * 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.
Objective: To measure the association between types of serious illness and the use of different physician-delivered care models near the EOL during the COVID-19 pandemic.
Design, Setting And Participants: Population-based cohort study using health administrative datasets in Ontario, Canada, for adults aged ≥18 years in their last 90 days of life who died of cancer or terminal noncancer illness and received physician-delivered care models near the end-of-life between March 14, 2020 and January 24, 2022.
Exposure: The type of serious illness (cancer or terminal noncancer illness).
Importance: Patients with a non-English language preference served within English-dominant health care settings are at increased risk of adverse events that may be associated with communication barriers and inequitable access to care.
Objective: To investigate the association of non-English language preference with surgical wait time and postoperative outcomes in older patients undergoing hip fracture repair.
Design, Setting, And Participants: This population-based, retrospective cohort study was conducted using linked databases to measure surgical wait time and postoperative outcomes among older adults (aged ≥66 years) in Ontario, Canada, who underwent hip fracture surgery between January 1, 2017, and December 31, 2022.
Introduction: A clinical prediction tool to estimate life expectancy in community-dwelling individuals living with dementia could inform healthcare decision-making and prompt future planning. An existing Ontario-based tool for community-dwelling elderly individuals does not perform well in people living with dementia specifically. This study seeks to develop and validate a clinical prediction tool to estimate survival in community-dwelling individuals living with dementia receiving home care in Ontario, Canada.
View Article and Find Full Text PDFArticle Synopsis
- Late identification of SARS-CoV-2 outbreaks in long-term care homes is linked to higher rates of secondary infections and mortality among residents.
- A study of outbreaks in Ontario from March to November 2020 showed that 36.4% were identified late, leading to significantly increased infection (10.3%) and mortality rates (3.2%) compared to early identified outbreaks (3.3% and 0.9% respectively).
- The findings suggest timely outbreak identification is crucial for better management and response to respiratory infections in LTC homes, helping to reduce adverse effects on residents.
Objective: To examine transitions to an assisted living facility among community-dwelling older adults who received publicly funded home care services.
Design: Nested case-control study.
Setting And Participants: Linked, population-level health system administrative data were obtained from adults aged 65 years and older who received home care services in Ontario, Canada, from April 1, 2018, to December 31, 2019.
Background: It is unclear whether antibiotics impact delirium outcomes in older adults with pyuria or bacteriuria in the absence of systemic signs of infection or genitourinary symptoms.
Methods: We registered our systematic review protocol with PROSPERO (CRD42023418091). We searched the Medline and Embase databases from inception until April 2023 for studies investigating the impact of antimicrobial treatment on the duration and severity of delirium in older adults (≥60 years) with pyuria (white blood cells detected on urinalysis or dipstick) or bacteriuria (bacteria growing on urine culture) and without systemic signs of infection (temperature > 37.
The use of virtual care for people at the end-of-life significantly increased during the COVID-19 pandemic, but its association with acute healthcare use and location of death is unknown. The objective of this study was to measure the association between the use of virtual end-of-life care with acute healthcare use and an out-of-hospital death before vs. after the introduction of specialized fee codes that enabled broader delivery of virtual care during the COVID-19 pandemic.
View Article and Find Full Text PDFBackground: There is growing interest in understanding the care needs of lonely people but studies are limited and examine healthcare settings separately. We estimated and compared healthcare trajectories in lonely and not lonely older female and male respondents to a national health survey.
Methods: We conducted a retrospective cohort study of community-dwelling, Ontario respondents (65+ years) to the 2008/2009 Canadian Community Health Survey-Healthy Aging.
Objectives: In Canada, patients whose acute medical issues have been resolved but are awaiting discharge from hospital are designated as alternate level of care (ALC). We investigated short-term mortality and palliative care use following ALC designation in Ontario, Canada.
Methods: We conducted a population-based retrospective cohort study of adult, acute care hospital admissions in Ontario with an ALC designation between January and December 2021.
Article Synopsis
- 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.
Background: It is unclear whether there are sex-based differences in use of palliative care near the end of life. The objective of this study was to measure the association between sex and palliative care use.
Methods: We performed a population-based retrospective cohort study of all patients aged 18 years or older in the last year of life who died in Ontario, Canada, between 2010 and 2018.