In Canada, approximately 730,000 people are currently living with dementia. Over 75% will experience behavioural and psychological symptoms of dementia (BPSD). There is a lack of consensus on best practices for the assessment and management of BPSD. In 2024, the Canadian Coalition for Seniors Mental Health (CCSMH) developed a Clinical Practice Guideline (CPG) for assessing and managing BPSD, specifically for agitation, depression, anxiety, psychosis, and sexual expressions of potential risk, and deprescribing antipsychotics and psychotropic medications. Development of the BPSD CPG followed the Guideline International Network (GIN)-McMaster Guideline Development checklist. The guideline is intended for people living with dementia, caregivers of people living with dementia, and health-care providers in community, outpatient, inpatient, long-term care, and other residential care settings. Recommendations were informed by a Canada-wide prioritization exercise to identify CPG topics and preferred terms for describing BPSD. A systematic review of existing dementia CPGs, an overview of systematic reviews on assessing and managing BPSD, and systematic reviews of tools for measuring psychosis, anxiety, and depressive symptoms in people living with dementia was undertaken, along with a rapid review of studies of pharmacologic and nonpharmacologic interventions for reducing sexual expressions of potential risk in people living with dementia. Guideline panel members voted on recommendation strength and quality of evidence, per the Grading of Recommendations, Assessment, Development, and Evaluations approach. This CPG resulted in 11 good practice statements and 63 guideline recommendations that will inform BPSD best practices in a Canadian health-care context.
Reported estimates of frailty prevalence vary considerably. At least partially attributable to differences in the conceptualization of frailty used, a better understanding of the inter-relationships among frailty domains could clarify contributors to the noted heterogeneity. A global frailty index (FI) created from baseline data on 30,097 Canadian Longitudinal Study on Aging comprehensive cohort participants was used to define physical, psychological, cognitive, and social domain-specific FIs. These were divided into quintiles with the highest 20% (Q5) representing the frailest participants. Logistic regression was used to estimate the associations between age group and biological sex with domain-specific FIs in unadjusted and adjusted (income, smoking status, nutritional risk, physical activity, social participation, interaction between sex and age group) models. The association between Q5 membership among the frailty domains was estimated using polychoric correlation coefficients. The prevalence of physical and cognitive frailty increased with age, but psychological frailty decreased, especially in males. Social frailty showed gradual increases with age in females that were only evident in the oldest age group (75-85) among men. The age-groups*sex interaction p value was p<.001 for social. Polychoric correlations were highest between the psychological/physical and psychological/social domains, and decreased with increasing age for all combinations. We found that domain-specific frailty prevalences differed by age group and sex with low associations among frailty domains, particularly at older ages. Understanding the evolution of these findings could be instrumental in developing tailored interventions to prevent frailty or modify its trajectory.
COVID-19 exposed long-standing systemic challenges experienced by congregate settings and created a crisis for long-term care homes (LTCHs) and retirement homes (RHs). This study explored the pandemic-related challenges LTCHs and RHs faced and the strategies they used to mitigate them. Ninety-one key informant interviews were held with LTCH and RH leadership across 47 homes (33 LTCHs, 14 RHs) in Ontario, Canada from February 2021 to July 2022. Data were analyzed following the framework method. Findings confirmed evidence of three main challenges. First, leaders were challenged to implement infection prevention and control (IPAC) protocols and measures. Second, leaders required supports to facilitate COVID-19 vaccine access and to promote vaccine acceptance. Finally, LTCH/RH staff experienced well-being and mental health challenges in the face of COVID-19 pressures. Despite widespread attention and efforts to support these congregate settings, challenges persisted over one year into the pandemic. Our findings reveal a plethora of strategies implemented by homes, with ranging reports of perceived success.
Young carers-youth aged 15 to 24 years who provide unpaid care to older adults-represent an essential yet often invisible component of Canada's caregiving landscape. Over one million young Canadians provide unpaid care to family members, with approximately 40% caring for older adults such as grandparents. As Canada's population ages and chronic illness prevalence rises, the number of young people assuming caregiving responsibilities continues to grow. Despite their significant contributions, young carers face unique challenges including impacts on mental health, educational attainment, and social development, often without formal recognition or support. This Perspectives article reviews the current evidence on young carers of older adults in Canada, examines their lived experiences, and identifies systemic gaps in health, education, and social systems. Unlike the United Kingdom, which has enacted legislation formally recognizing and supporting young carers, Canada lacks comprehensive policies and support structures for this population. Innovative programs are emerging, including foundational training for health professionals, online peer support communities, and cross-sector collaborations between health-care providers, educators, and community organizations. The article recommends actionable steps including legislative recognition of young carers, improved data collection and monitoring, expanded professional training, investment in peer support programs, and implementation of family-centered care models. Primary care teams are uniquely positioned to identify young carers, recognize their contributions, and connect families with available supports. Without adequate recognition and intervention, young carers remain at risk of long-term social, academic, and mental health difficulties affecting both themselves and those for whom they care.
Sarcopenia is an age-related skeletal muscle disorder characterized by decreased muscle mass, strength, and physical function, which increases the risk of adverse outcomes in older adults. Recently, ultrasound has emerged as a practical tool for estimating muscle thickness as a proxy for muscle quantity. However, standardized protocols, reference data, and diagnostic cut-off values for ultrasound-based muscle assessment remain lacking. This study pooled participants from three cohorts in which quadriceps muscle thickness was assessed in B-mode with a linear probe using point-of-care ultrasound (POCUS). Of 391 participants, 389 were included in the final analysis. Age was categorized into five-year groups (65-69, 70-74, 75-79, 80-85, and over 85 years old). Means and standard deviations (SD) of quadriceps thickness were calculated by sex and age group. Mean age was 77 ± 7 years. Quadriceps muscle thickness followed a normal distribution with a standard deviation of 0.5 cm. Mean thickness declined with advancing age. Our pooled analysis found a mean quadriceps muscle thickness of 2.0 cm. The decline with advancing age was modest, with the lowest value observed in participants aged 85 years and older (1.8 ± 0.4). On average, muscle thickness decreased by approximately 0.1 cm per decade after age 65. These findings provide age- and sex-specific reference values for quadriceps muscle thickness measured by POCUS, and support its potential utility as a feasible tool for muscle assessment in older adults.
A Comprehensive Geriatric Assessment (CGA) completed by a geriatrician assessing an older person living with frailty and multiple comorbidities involves longer visit durations than standard General Internal Medicine (GIM) consultations, reflecting the need for detailed evaluation. Medical trainees have little formal education about how they will be remunerated as specialists or that there are different methods of clinical payments between provinces of Canada, including Fee for Service (FFS) and Alternative Payment Plans (APP). GIM is a reasonable comparator to Geriatric Medicine because, while not using CGA, GIM residents are also trained to assess medically complex patients who often have comorbidities. The goal of this paper was to provide transparency for medical trainees about differences in the proportion of FFS or APP and the average clinical payments made to geriatricians and general internists between the provinces of Canada. Using data from the Canadian Institute for Health Information (CIHI), we show mean, mean trimmed to $100,000 and median clinical payments to geriatricians across Canada. Average payments were generally lower in provinces with predominantly an APP as the main source of payments compared to provinces with a split model of APP and FFS where payments demonstrated larger variances. The clinical payments to general internists were higher than for geriatricians. In addition to increasing transparency in specialist payments, Provincial Medical Associations and Sections or Divisions of Geriatric Medicine, could use these data to advocate for comparable remuneration between geriatricians and general internists when renegotiating clinical payments funding agreements.
Falls are a leading cause of injury and loss of independence in older adults. Impaired balance is a modifiable risk factor yet traditional rehabilitation approaches may not fully address balance control. Augmented reality (AR) provides an interactive method to support balance training and fall prevention. This scoping review summarizes key characteristics of AR interventions for balance rehabilitation in older adults, as well as associated outcome measures. Literature searches were performed across CENTRAL, CINAHL, EMBASE, Medline, PubMed, ScienceDirect, SCOPUS, and Web of Science from inception to July 2024. Using Arksey and O'Malley's framework, we included studies meeting the following criteria: (i) older adults (65+), (ii) AR-based balance rehabilitation, (iii) randomized control trials (RCTs) or observational studies, and (iv) outcomes related to balance, balance confidence, or fear of falling, categorized using the Balance Evaluation Systems Test (BESTest) framework. Two reviewers independently screened and extracted data. Ten studies (six RCTs, four observational) involving 235 participants (ages 64.70-75.8 yrs) met inclusion. AR interventions were delivered 1-5 times/week over 4 to 12 weeks (4-36 total hr), with adherence rates of 83.3% to 100%. The most frequently assessed balance systems were stability in gait (100%) and anticipatory postural adjustments (90%), which improved with AR. Only one study evaluated all balance systems. RCTs showed statistically significant improvements in balance, while observational studies mainly reported associations and trends. This review highlights AR as a complementary tool for fall prevention, supporting tailored interventions across balance domains. Clinicians may find AR useful for engaging older adults in targeted, functional rehabilitation.
SYNchronizing Exercises, Remedies in GaIt and Cognition @Home (SYNERGIC@Home/SYNERGIE~Chez soi) is a home-based, double-blind, randomized controlled trial. Sixty community dwelling older adults (aged 60-90 years), living in New Brunswick, Canada, who were at risk of dementia participated remotely using secure videoconferencing. Participants underwent 16 weeks (three sessions/week) of cognitive and physical interventions. This research aimed to determine the frequency, severity, and relationship of adverse events (AEs) that occurred during the physical and cognitive intervention phase of the SYNERGIC@Home study. This study addressed a critical question: Whether AEs occurring during a remote exercise and cognitive intervention for older adults at risk of dementia can be managed safely and effectively to optimize participation. All AEs were recorded, including type, severity, and their relatedness to the intervention. Intervention modifications due to AEs were also recorded. Participant's mean age was 69.5 years (SD=6.47), 76.7% were female, and 58.4% were living in suburban or urban communities. A total of 88 AEs affected 42 (70.0%) participants. Most AEs (71.6%) were unrelated to the intervention, and 69.3% were classified as mild, with musculoskeletal issues being the most common AE (39.8%). One unrelated serious AE was recorded. Modifications to the physical intervention were made for 31 participants, and two discontinued due to unrelated medical issues. When delivered remotely, physical and cognitive interventions resulted in no serious related AEs and the few related, mostly mild AEs, were safely managed through modifications to the physical interventions.
暂无摘要（点击查看详情）
Combining power training (PT) with endurance training (ET) offers health benefits for older adults. However, little is known about the effects of PT plus ET on arterial stiffness and hemodynamic parameters in previously trained hypertensive older adults. Additionally, the effects of exercise order-PT followed by ET versus ET followed by PT-on arterial stiffness and hemodynamic parameters remain unclear in older adults. This study aimed to a) examine the effects of concurrent training (CT) on arterial stiffness and hemodynamic parameters in previously trained hypertensive older adults; and b) to investigate the effects of concurrent PT and ET exercise order on arterial stiffness and hemodynamic parameters in previously trained hypertensive adults. Older adults with grade 1 hypertension were randomized into two groups: PT then ET group (DPTETG) and ET then PT group (ETDPTG). Both groups trained twice weekly for 16 weeks. Arterial stiffness and hemodynamic parameters were measured at baseline and after 16 weeks. No significant changes in arterial stiffness or hemodynamic parameters emerged after 16 weeks in either group (p > .05). This study demonstrates that 16 weeks of different exercise orders of concurrent power and ET do not change arterial stiffness and hemodynamic parameters in older adults with hypertension.
The motivations and attitudes of caregivers strongly influence the care they provide. Motivation is also a central component in staff retention and care consistency, whereas attitude shapes delivery and degree of person-centeredness in care. Although caregiver attitudes and motivations have been examined separately in dementia care research, these constructs have not been comprehensively mapped together within residential memory care settings or explicitly linked to care quality. This review aims to assess literature pertaining to attitudes and motivations of formal caregivers in residential dementia care facilities and to examine how these constructs are associated with care quality. This review seeks to generate practical insights to inform workforce training and recruitment strategies to support high-quality, person-centered dementia care. Literature focused on the attitudes and motivations of formally employed caregivers providing care to residents in a residential memory care setting. Studies published of any design, from any year, country, or language will be considered. This scoping review will follow the Joanna Briggs Institute (JBI) method. A comprehensive search will be conducted across major health, social science, and interdisciplinary databases, along with grey literature sources. Data will be extracted according to a JBI template informed by three theoretical frameworks: the Tripartite Model of Attitudes, the Empathy-Altruism Hypothesis, and Person-Centered Care. Results will be reported in accordance with the PRISMA-ScR guidelines. Open Science Framework https://osf.io/8yrge.
Social isolation and loneliness are associated with many adverse health outcomes. The COVID-19 pandemic increased its prevalence and disproportionately affected older adults. Since telephone befriending was a potentially feasible and safe intervention during the pandemic, the McMaster Phone-a-Friend Program (PFP) was developed using this strategy to try to reduce social isolation and loneliness among older adults. Thus, this study aimed to evaluate the effectiveness and long-term feasibility of PFP. Community-dwelling older adults in Ontario, Canada were matched to trained university student volunteers, who provided social engagement and pandemic-related education through weekly telephone calls. Two main referral sources were used: 1) older adults identified by their primary care provider as at risk for social isolation; and 2) older adults referred for multi-modal frailty rehabilitation, where telephone befriending was a desired component intervention. Older adults completing ≥4 calls were contacted to participate in a telephone survey to provide program feedback. Of the 220 active participants in August 2021, 60 participated in our survey. At the time of survey completion, the mean number of calls completed was 8.3. The mean age of participants was 75.6 years and 71.7% (n=43) identified as female. Furthermore, 58.3% (n=35) of the participants agreed or strongly agreed that they felt less lonely after participating in the program and 68.3% (n=41) stated they would participate in the program after the pandemic resolves. The intergenerational PFP telephone befriending program is a safe and effective method of reducing or possibly preventing social isolation and loneliness among at-risk community-dwelling older adults.
Comprehensive geriatric assessment (CGA) is the reference standard for diagnosing and managing frailty. By evaluating a broad range of health, functional, cognitive, and social problems, the CGA enables the construction of a deficit accumulation Frailty Index (FI-CGA). Recent advances have integrated the electronic CGA (eCGA) into electronic health/medical records and other digital platforms, allowing automated coding and summarization of CGA data to generate an electronic Frailty Index (eFI-CGA). We reviewed over two decades of research on the development, validation, and application of the FI-CGA, eCGA, and eFI-CGA in health-care contexts, conducted following the PRISMA-ScR guidelines. A comprehensive search was performed in MEADLINE and CINAHL databases, including English language publications from 2004 to July 1, 2025. The 38 studies that met all criteria are included in the final review. Data were synthesized descriptively and analyzed thematically. The evidence suggests that the FI-CGA is a robust, adaptable predictor of adverse outcomes including mortality, hospitalization, and functional decline. Digital adaptations improve feasibility, accuracy, and workflow, supporting wider application in acute, long-term, primary, and community care. The transition from manual to eCGA-based frailty measurements marks a significant advance toward scalable, integrated frailty care. Emerging implementations are targeting earlier detection, risk stratification, and personalized interventions. The digital eCGA and eFI-CGA tools hold potential to enhance ("geriatrize") capacity to identify and manage frailty across care settings. Further research is needed to validate them across populations, and leverage innovative technologies to advance frailty care, in these ways promoting healthy aging.
Behavioural and psychological symptoms of dementia (BPSD) are complex to assess and manage, and a lack of updated clinical practice guidelines (CPGs) leads to variation in clinical practice. When generating CPGs, involvement of end-users in developing and prioritizing topics is key to creating effective recommendations. To inform the creation of a CPG for the management of BPSD, we completed a Canada-wide online BPSD topic prioritization survey using Qualtrics. In January-March 2023 the survey was disseminated widely to identify preferred terminology to use in the guideline and to prioritize topics to be included. Two hundred fifty-four persons responded to the survey. Participants were mostly female (88.2%), identified as women (87.0%), were aged 50-64 (37.0%), from Ontario (69.7%), and from nursing roles (n=83). BPSD was the most preferred terminology (32.1%) followed by responsive behaviours (26.2%). Seven topics were reviewed for guideline inclusion, with priority placed on prevention, non-drug management, and prodromal symptoms. Comments from participants identified concerns around validity of detection tools, possible lack of available evidence, and conflict between standardized approaches versus the need for individualized care. Involvement of end-users in the determination of terminology and prioritization of topics was an effectual way to ensure CPGs represent the needs of the user.
Emotion-focused model of care delivery creates a supportive environment for persons with dementia. There is a lack of certainty regarding one such emotion-focused model's effectiveness (Butterfly) in an acute care environment, primarily because prior research has been confined to long-term care (LTC) facilities. Studies have demonstrated reduced neuropsychiatric symptoms (NPS) when person-centred dementia care models are deployed for persons living with dementia (PLWD). A multi-site cross-sectional design assessed NPS in PLWD using the NPI-Q scale in hospitalized patients on a Emotion-focused unit for 7-21 days. We identified 177 PLWD (88 from an acute care for elderly unit, 89 from general medicine units). The two cohorts had 40 female and 48 male patients in the ACE unit and 35 female and 54 male patients in the general medicine unit. The average age between the two groups was 83 and 84 yrs, respectively. NPI-Q symptom severity was lower on the ACE unit in comparison to the general medicine unit. Mean improvement for motor behaviours and sleep were significant. Caregiver distress scores were significantly lower for delusions, agitation, anxiety, irritability, motor behaviour and sleep. Emotion-focused care made a statistically significant change in NPS severity and caregiver distress when compared to care provided in general medicine units.
Specialized training is necessary for health-care providers such as physicians, nurses, and social workers, to be able to accurately perform decision-making capacity assessments (DMCAs). With an increasing demand for flexible, accessible education, there is growing interest in utilizing online training modules to keep health-care providers up to date on current best practices in DMCAs. This study evaluates the effectiveness of online training modules in enhancing clinicians' self-reported knowledge, confidence, and comfort with the core concepts necessary to conduct DMCAs. This was a pretest/posttest study on an online DMCA training. Participants from a regional health authority (Alberta, Canada) took 13 online modules on 15 core DMCA concepts, from March to December 2021. A pretest and a posttest were completed before and after completion of the modules. Agreement to Likert-like items were collected and compared at a group level. Additionally, the ratings were compared with historical data from face-to-face DMCA workshops. A total of 683 pretests and 241 posttests were completed. All 15 posttest ratings were higher (p < .001) than pretest ratings. Compared to the historical face-to-face workshops, the self-reported ratings in the online modules tended to be higher both on pretest and posttest. However, the changes in self-reported ratings from pretest to posttest were similar between the online modules and the historical workshops. Online learning of DMCA concepts can lead to higher self-reported learning posttest to pretest. Furthermore, the changes in self-reported ratings are similar to those observed in face-to-face workshops.
Herpes zoster (HZ) and its complications, postherpetic neuralgia (PHN), are common in adults, particularly the frail. Frailty may affect infection outcomes and vaccine efficacy. This study evaluated the association between frailty and HZ/PHN risk, and examined vaccine uptake, immunogenicity, and efficacy in frail versus non-frail individuals. We systematically reviewed PubMed/MEDLINE, the Cochrane Library, Embase, and grey literature for studies published from January 2015 to January 2025. Eligible studies included observational and randomized controlled trials evaluating frailty in adults aged ≥50 years and reporting HZ incidence, severity, PHN, or vaccination. Two reviewers independently selected studies, extracted data using a standardized form, and assessed quality using JBI tools. Due to heterogeneity, data were synthesized narratively. Eight studies met the inclusion criteria, with a sample size exceeding 15,000 participants. Two studies identified an association between frailty and an increased incidence of HZ, while two others indicated an elevated risk of PHN among frail individuals. One study highlighted low vaccine uptake in a frail Italian cohort. Three studies assessed the immunogenicity of the zoster vaccine, suggesting that although absolute immune responses may be diminished in frail individuals, relative responses are often maintained. A pooled analysis of recombinant zoster vaccine trials demonstrated consistently high efficacy (exceeding 90%) across all frailty levels. Frailty may increase vulnerability to HZ and PHN. Routine frailty assessment may improve vaccine uptake and prevention. Further longitudinal studies using standardized frailty measures are needed to understand the causal pathways and optimize care.
Deciding whether to continue driving or transition to alternative means of transportation is a challenging issue for older adults in preventive care settings. This study aimed to identify potential associations between the Japanese version of the Montreal Cognitive Assessment (MoCA-J) and driving as the primary mode of transport among older adults. The participants of this cross-sectional study were community-dwelling older adults participating in a long-term preventive care program. Participants were divided into two groups (DRIVING or OTHER) based on their questionnaire response regarding the main mode of transport used when going out, where the OTHER group included all participants who selected any other mode than a car driven by themselves. Cognitive function was measured using 13 MoCA-J tasks. Binary logistic regression analysis was used to identify associations between MoCA-J results and inclusion in the DRIVING group. Among the 199 participants, 156 were categorized into DRIVING group and 43 into OTHER group. The DRIVING group showed significantly higher task achievement rates than the OTHER group in trail-making, digit span, and phonemic verbal fluency tests. Of these, only the trail-making test results were associated with inclusion in the DRIVING group (odds ratio, 2.82; 95% confidence interval, 1.22-6.51; p =.016). The trail-making task of MoCA-J may assist health-care professionals in providing driving guidance to older adults.
Psychosocial interventions targeting cognition improve objective cognitive test performance, strategy use, emotional well-being, and quality of life in individuals with mild cognitive impairment and early dementia. These interventions have been labeled as cognitive training, cognitive remediation, cognitive rehabilitation, cognitive stimulation, and overlap with cognitive (psycho)therapy. The inconsistent labeling of the interventions has resulted in ambiguity of what a cognitive intervention entails and limits the translation of interventions into clinical practice. To address this, we propose a new framework, "PICC-M", that classifies cognitive interventions based on five active ingredients or the mechanisms resulting in clinically significant change. These ingredients are psychotherapeutic support (P), individualized patient goals (I), cognitive exercises (C), compensatory strategies (C), and metacognitive strategies (M). We examine three intervention programs to illustrate how this framework clarifies each intervention's active ingredients and their relation to cognitive, psychological, and functional outcomes. The PICC-M framework lays the foundation for dismantling studies to isolate and test the effectiveness of specific active ingredients and ultimately support clinical delivery of evidence-based interventions for older individuals with neurocognitive deficits.
The Frailty Index (FI) is a measure of frailty with recent guidance on its calculation. Objectives were: 1) To determine the prevalence of frailty and its component domains at different ages in older men; and 2) To determine if the FI, and/or its component scores predict death or long-term care (LTC) admission. Design: A cohort study. Setting: Most of the participants lived in Canada. Subjects: 3,983 men who qualified for air crew training during the Second World War. We included 1,711 men (mean age 76) free of dementia, living in the community, who had data to construct a FI in 1996. Medical conditions have been measured from 1948. Functional status, health status, and social well-being have been measured by survey since 1996. We constructed a FI from these data and calculated the prevalence of frailty from the age of 75+. We considered three domains of frailty: medical, functional, and psychosocial. We calculated the mortality risk and the risk of LTC care admission using proportional hazards models. Frailty, dementia, and LTC use are all strongly related to age. The FI is associated with mortality and LTC admission at all ages. This effect was a spectrum of risk. The effect of functional domains was seen at all ages, while the effect of medical conditions on these outcomes declined with advancing age. Psychosocial domains were less strongly correlated with these outcomes. The FI is associated with adverse outcomes, and should be considered in clinical and policy decisions.