Loneliness and social isolation are very common among older adults, both of which have only worsened due to the COVID-19 pandemic. Loneliness and social isolation are also important contributors to depression, anxiety and overall mortality. Unfortunately, there are very few formal and effective programs in place to specifically address loneliness among older adults living with mental health problems. A ‘Community Navigator’ program has been developed in the U.K. that has been shown to have good acceptability, and potential to reduce loneliness and improve mood among adults with depression or anxiety. The 6-month program includes meetings with a Community Navigator and group sessions aimed at offering practical help and supporting goals to increase connectedness and enhance social relationships. Community Navigators help clients develop an action plan to help them support their social connectedness goals using their local knowledge of leisure activities, and social and cultural support groups. The specific objectives of the proposed research study are to (a) adapt and (b) pilot the Community Navigator program in a Canadian setting. Phase 1 (adaptation) will involve meeting with approximately 20 community stakeholders, including older adults with lived experience of mental illness. The developers of the original Community Navigator program will provide crucial guidance in our adaptation of the program. Phase 2 (pilot) will collect mixed-methods data (including questionnaires assessing aspects such as mood, loneliness, and social activity, and qualitative interviews) from 15 older adults (age 60 or above) with depression or anxiety before and after completion of the program, recruited from Humber River Hospital and community-based mental health organizations based in Toronto. Overall, this study will provide crucial evidence about whether the Community Navigator program can successfully be adopted in Canada and if it indeed can reduce loneliness and improve mental health related outcomes among older adults living with depression or anxiety.

L’hospitalisation d’un adulte âgé frêle entraine son lot de conséquences sur la capacité physique et l’autonomie de la personne, affectant passablement sa qualité de vie. Des approches intégratives de réadaptation gériatrique, comme celles offertes dans les unités de courte durée gériatrique (UCDG), ont démontré une tendance vers la réduction des effets de l’hospitalisation sur l’autonomie et des effets positifs sur la satisfaction des soignants et des patients envers les soins. Alors que la réadaptation en physiothérapie fait partie des soins usuels en UCDG, l’ajout d’un programme d’entrainement pourrait contribuer à renverser l’impact de l’hospitalisation sur la perte d’autonomie, améliorant l’expérience et ainsi la qualité de vie des patients. L’objectif principal de cette étude est donc d’évaluer les bénéfices d’un programme d’exercices physiques de groupe sur la qualité de vie des personnes âgées hospitalisées à l’UCDG.

Méthodologie : Cent soixante-quatre patients seront recrutés et randomisés dans un des deux groupes : 1) exercice (EX.: n=82) ou 2) témoin (TEM: n=82). Les patients du groupe EX s’entraineront 5x45-60 min/semaine (exercice aérobie, musculaire et d’équilibre) pendant toute la durée de leur hospitalisation (=25 jours), alors que les patients du groupe TEM recevront les soins usuels. La qualité de vie (questionnaires SF-36 et EQ-5D-5L) et des variables secondaires (indépendance fonctionnelle et capacité physique) seront évaluées avant et après 25 jours d’hospitalisation, ainsi qu’à la sortie de leur séjour (si ˃ 30js). Les caractéristiques de la population seront collectées dans les dossiers médicaux et les variables de contrôle seront évaluées (suppléments alimentaires, risque nutritionnel, durée du séjour, présence de chute et de délirium pendant le séjour). Cette étude permettra d’établir si l’intégration de ce type d’intervention au sein du programme en UCDG est nécessaire pour améliorer la qualité des soins.

The current COVID-19 global pandemic has impacted all of our lives, but the population most at risk are older adults. Canadians over the age of 60 account for 36% of the cases but 95% of the deaths, with 82% of the deaths being linked to supportive living. Older adults with chronic health conditions are especially at risk. Dementia is one of the most common chronic conditions effecting an estimated 1 in every 13 Canadians over the age of 65. In addition to a decline in cognitive function, over 90% of people living with dementia (PLWD) experience responsive behaviours such as apathy, anxiety, aggression and psychosis therefore requiring constant care. Even in “average times” family caregivers (FCGs) for PLWD manage their caregiving duties at the limits of their emotional, physical and financial capacity. As such, it is critical that these FCGs are supported through this unprecedented time to ensure that they are able to continue to care for and protect older adult family members with dementia. Our research team along with our community partners conducted a research study to examine the experiences and outcomes of Calgary area FCGs for PLWD during the COVID-19 pandemic.

This proposed research project is an extension of the phase one pilot work completed this summer. In this second phase of the research, we aim to further examine the impact of the COVID-19 pandemic on FCGs providing care for PLWD across the province of Alberta. We will examine the gaps in essential information and resources that FCGs have experienced during the pandemic and the impact of these gaps on FCGs and the older adults with dementia for whom they provide care. The goal is to generate recommendations for policy makers, public health officials, and caregiving resource agencies that enhance access, efficacy, and supports for FCGs during the COVID-19 pandemic.

In partnership with John R. McConnell Foundation:
Broken bones, or fractures, cause pain, difficulty walking around, loss of independence, and even death. The number of fractures increases dramatically with age and one in three women and one in five men will have a fracture in their lifetime. Diabetes also becomes more common with age, and often co-exists with bone loss and fractures in older adults. Despite this, fragile bones remain an under-recognized complication of diabetes in the older adult population. Exercise can prevent muscle and bone loss, improve metabolic health, and is a promising strategy for fall and fracture prevention. Current diabetes guidelines recommend regular exercise to prevent classical; diabetes complications (high blood sugar, high blood pressure) in at-risk populations. However, considerable knowledge gaps exist regarding the impact of exercise on bone health among older adults with diabetes and diabetes-specific tools, resources, and services focused on exercise for fracture prevention are lacking. We will survey adults over 50 years of age with diabetes to learn more about their bone health and exercise information needs and behaviours. We will work with patients and health care providers in endocrinology, internal medicine, geriatrics, kinesiology, and nutrition to develop a bone health and exercise education program for older adults with diabetes. We will consult on their goals, preferences, and barriers for the education program. We will test how usable it is with older adults with diabetes, and get their feedback. We will then apply for funding to do a large study to evaluate if our education program resources and delivery framework works, and to determine the costs associated with implementing it relative to the benefits. Our work will advance knowledge and practice on fracture prevention and management in diabetes, and create a person-centred education program promoting safe and effective exercise to improve bone health in older adults living with diabetes.

Swallowing impairment (dysphagia) is extremely common in older adults living with dementia due to age-related changes in swallowing and other disease-specific impairments. Dysphagia is commonly managed through modifying diet textures rather than engaging in rehabilitative swallowing therapy. This means that countless people with dementia are left to eat pureed foods and drink thickened liquids, which are unpalatable and lead to malnutrition. As the disease progresses, many are transferred to nursing homes. In Canada, speech-language pathologists, who manage dysphagia, are consultants within nursing homes; therefore, decisions surrounding swallowing difficulties are left to dietitians and nurses, and swallowing therapy is non-existent. However, exercise therapy is more commonly available. Rodent models have demonstrated that physical exercise strengthens tongue and vocal-fold musculature, which are critical components of swallowing. This happens when respiratory rate is increased and muscles of the mouth and throat are engaged to keep the airway open. Therefore, it is possible that whole-body physical exercise, which increases rate of respiration, will help to strengthen swallowing-related musculature in older adults with dementia. In this study, older adults (65+) with early-stage dementia will complete a 12-week physical exercise program. The research objectives are to a) confirm that respiratory muscles can be strengthened through physical exercise in humans and b) establish whether tongue muscles can also be strengthened. We predict that both respiratory and tongue muscles will increase in strength as a result of the intervention. This research will inform the design of future trials to determine the most efficacious treatments for swallowing difficulties in people with dementia and will provide novel insights into the importance of physical activity and multidisciplinary approaches to care. Overall, the goal is to develop effective methods of swallowing rehabilitation to allow older adults with dementia to swallow safely for as long as possible.

Variability in the selection of outcome measures in randomized controlled trials (RCTs) contributes to bias and makes it difficult to compare, contrast, and combine results across trials. These issues make it challenging to identify effective, ineffective, and unproven interventions and thereby impede health care decision making, policy making, and public health programming. Core outcome sets (COS) address these problems; they represent a minimum and standard set of outcomes to measure and report in all trials in a clinical area. Outcomes must be meaningful to key stakeholders, including patients and health-care professionals. Development and implementation of COS leads to higher-quality evidence about interventions. In turn, interventions that work are available more quickly to those who need them.

Physical activity (PA) is a strongly recommended intervention for older adults. RCTS of PA interventions for older adults demonstrate positive effects on a variety of outcomes (e.g. falls, cognition, mobility), but there is no standard COS that captures these diverse outcomes. Our long-term goal is to develop and implement COS for RCTs of PA for older adults. In support, the proposed project aims to identify outcome domains (‘what’ to measure) and measurement instruments (‘how’ to measure) that (1) have been used in RCTs of PA for older adults (via rapid review knowledge synthesis) and (2) are deemed important by older adults and their health care professionals (via community consultation). Outputs will be used directly in future consensus generating activities with international stakeholder panels to develop COS.

Guided by international frameworks for COS development, integrated knowledge translation, and patient-oriented research approaches, the proposed project is an essential step toward developing COS for RCTs of PA in older adults. This work will ultimately improve the quality of evidence we have available to support physical, social and mental wellbeing of older adults.

Background: Previous research shows that good oral health is key for general health. Some studies suggest that people with gum disease or missing many teeth are at higher risk of neurological diseases, including early dementia and Alzheimer’s. Claimed reasons include:

(a) Inflammation caused by bacteria around the gums;

(b) Lower stimulus and blood flow in the brain when chewing without teeth.

However, poor mental health seems to align with oral diseases during the aging process. Therefore, we believe that another factor linked to aging may better explain this association. Nerves that secrete a substance called acetylcholine are notably prone to degenerate with aging. Curiously, these same neurons also control the production of saliva, and their death is involved in the development and progression of dementia.

Research Plan: We will determine whether middle-aged and old adults who have dry mouth and other oral health problems also have poorer memory/mental performance. In addition, we will study whether the action of acetylcholine-producing neurons can explain this association. Data will come from 30,000 people examined during the Canadian Longitudinal Study on Aging (CLSA).

Impact: Our study may show that certain oral health problems point towards a higher risk for cognitive impairment. This information will help dentists to understand their roles in helping to prevent dementia. The study may also identify new ways to prevent or to slow the progress of dementia.

The End-of-life Respiratory distress protocol (RDP) is an “in case” prescription made for every patient at the end-of-life in the event of sudden and severe breathlessness (inability to breathe), while being “conscious”. It is the simultaneous administration of three drugs (sedative, opioid, antimucosal) by nurses for inducing deep sedation and decreasing breathlessness. However, the RDP is not supported by scientific evidence and not used outside the Province of Quebec. Its prevalence, the conditions and the consequences of its use are unknown. However, it may be more frequently used with older adults, in long-term and intensive care. It may also be used for other reasons than breathlessness and for unconscious patients. Given the increased risks of toxicity and overdose among frail older people and that the administration of the RDP is not as rigorously controlled as palliative sedation and medical aid in dying, its use raises serious questions. AIM: To describe the prevalence and the factors contributing to the use of the RDP among older patients and to compare patients across settings who received RDP and other dyspnea-related treatments. A retrospective chart review of n=1000 older patients (65 years +) who died in three different types of settings (hospital, hospice and long-term care) in Quebec City will be conducted. Sociodemographic, medical characteristics, dyspnea treatments, including the RDP, reasons for their use, and survival across settings and groups will be extracted and analyzed. This project directly addresses the Drummond Foundation’s mission of protecting physically and mentally vulnerable older patients and their relatives.