Jenny Basran

Improving access to dementia care: Development and evaluation of a rural and remote memory clinic

The availability, accessibility and acceptability of services are critical factors in rural health service delivery. In Canada, the aging population and the consequent increase in prevalence of dementia challenge the ability of many rural communities to provide specialized dementia care. This paper describes the development, operation and evaluation of an interdisciplinary memory clinic designed to improve access to diagnosis and management of early stage dementia for older persons living in rural and remote areas in the Canadian province of Saskatchewan. We describe the clinic structure, processes and clinical assessment, as well as the evaluation research design and instruments. Finally, we report the demographic characteristics and geographic distribution of individuals referred during the first three years.

Supplemental Use of Antioxidant Vitamins and Subsequent Risk of Cognitive Decline and Dementia

There are conflicting reports about the potential role of vitamin antioxidants in preventing and/or slowing the progression of various forms of cognitive impairment including Alzheimer’s disease (AD). We examined longitudinal data from the Canadian Study of Health and Aging, a population-based, prospective 5-year investigation of the epidemiology of dementia among Canadians aged 65+ years. Our primary objective was to examine the association between supplemental use of antioxidant vitamins and subsequent risk of significant cognitive decline (decrease in 3MS score of 10 points or more) among subjects with no evidence of dementia at baseline (n = 894). We also explored the relationship between vitamin supplement use and incident vascular cognitive impairment (VCI; including a diagnosis of vascular dementia, possible AD with vascular components and VCI but not dementia), dementia (all cases) and AD. After adjusting for potential confounding factors assessed at baseline, subjects reporting a combined use of vitamin E and C supplements and/or multivitamin consumption at baseline were significantly less likely (adjusted OR 0.51; 95% CI 0.29–0.90) to experience significant cognitive decline during a 5-year follow-up period. Subjects reporting any antioxidant vitamin use at baseline also showed a significantly lower risk for incident VCI (adjusted OR 0.34, 95% CI 0.13–0.89). A reduced risk for incident dementia or AD was not observed. Our findings suggest a possible protective effect for antioxidant vitamins in relation to cognitive decline but randomized controlled trials are required for confirmation.

Rationalizing prescribing for older patients with multimorbidity: Considering time to benefit

Given the growing number of older adults with multimorbidity who are prescribed multiple medications, clinicians need to prioritize which medications are most likely to benefit and least likely to harm an individual patient. The concept of time to benefit (TTB) is increasingly discussed in addition to other measures of drug effectiveness in order to understand and contextualize the benefits and harms of a therapy to an individual patient. However, how to glean this information from available evidence is not well established. The lack of such information for clinicians highlights a critical need in the design and reporting of clinical trials to provide information most relevant to decision making for older adults with multimorbidity. We define TTB as the time until a statistically significant benefit is observed in trials of people taking a therapy compared to a control group not taking the therapy. Similarly, time to harm (TTH) is the time until a statistically significant adverse effect is seen in a trial for the treatment group compared to the control group. To determine both TTB and TTH, it is critical that we also clearly define the benefit or harm under consideration. Well-defined benefits or harms are clinically meaningful, measurable outcomes that are desired (or shunned) by patients. In this conceptual review, we illustrate concepts of TTB in randomized controlled trials (RCTs) of statins for the primary prevention of cardiovascular disease. Using published results, we estimate probable TTB for statins with the future goal of using such information to improve prescribing decisions for individual patients. Knowing the relative TTBs and TTHs associated with a patient’s medications could be immensely useful to a clinician in decision making for their older patients with multimorbidity. We describe the challenges in defining and determining TTB and TTH, and discuss possible ways of analyzing and reporting trial results that would add more information about this aspect of drug effectiveness to the clinician’s evidence base.

Evaluation of Telehealth for Preclinic Assessment and Follow-Up in an Interprofessional Rural and Remote Memory Clinic.

Using data from a sample of 169 patients, this study evaluates the acceptability and feasibility of telehealth videoconferencing for preclinic assessment and follow-up in an interprofessional memory clinic for rural and remote seniors. Patients and caregivers are seen via telehealth prior to the in-person clinic and followed up at 6 weeks, 12 weeks, 6 months, 1 year, and yearly. Patients are randomly assigned to in-person (standard care) or telehealth for the first follow-up, then alternating between the two modes of treatment, prior to 1-year follow-up. On average, telehealth appointments reduce participants’ travel by 426 km per round trip. Findings show that telehealth coordinators rated 85% of patients and 92% of caregivers as comfortable or very comfortable during telehealth. Satisfaction scales completed by patient–caregiver dyads show high satisfaction with telehealth. Follow-up questionnaires reveal similar satisfaction with telehealth and in-person appointments, but telehealth is rated as significantly more convenient. Predictors of discontinuing follow-up are greater distance to telehealth, old-age patient, lower telehealth satisfaction, and lower caregiver burden.

Implementation of a Physical Activity Monitoring System for the Elderly People with Built-in Vital Sign and Fall Detection

Physical activity monitoring of the elderly people provides valuable information for health aware services. This paper presents the implementation of a system to sense, send, display and store physiology activity. The system includes a wearable device to be worn by the individual to collect physical activity data, a wireless communication link between the patient and the monitoring network. A fall detection and heart beat measurement are also included to provide better monitoring. Testing results show the system function properly and provide accurate fall detection and data for monitoring purpose.

Specialist Physicians in Geriatrics— Report of the Canadian Geriatrics Society Physician Resource Work Group

Background At the 2011 Annual Business Meeting of the Canadian Geriatrics Society (CGS), an ad hoc Work Group was struck to submit a report providing an estimate of the number of physicians and full-time equivalents (FTEs) currently working in the field of geriatrics, an estimate of the number required (if possible), and a clearer understanding of what has to be done to move physician resource planning in geriatrics forward in Canada. Methods It was decided to focus on specialist physicians in geriatrics (defined as those who have completed advanced clinical training or have equivalent work experience in geriatrics and who limit a significant portion of their work-related activities to the duties of a consultant). Results In 2012, there are 230–242 certified specialists in geriatric medicine and approximately 326.15 FTE functional specialists in geriatrics. While this is less than the number required, no precise estimate of present and future need could be provided, as no attempts at a national physician resource plan in geriatrics based on utilization and demand forecasting, needs-based planning, and/or benchmarking have taken place. Conclusions This would be an opportune time for the CGS to become more involved in physician resource planning. In addition to this being critical for the future health of our field of practice, there is increasing interest in aligning specialty training with societal needs (n = 216).

A Fall and Near-Fall Assessment and Evaluation System

The FANFARE (Falls And Near Falls Assessment Research and Evaluation) project has developed a system to fulfill the need for a wearable device to collect data for fall and near-falls analysis. The system consists of a computer and a wireless sensor network to measure, display, and store fall related parameters such as postural activities and heart rate variability. Ease of use and low power are considered in the design. The system was built and tested successfully. Different machine learning algorithms were applied to the stored data for fall and near-fall evaluation. Results indicate that the Naïve Bayes algorithm is the best choice, due to its fast model building and high accuracy in fall detection.

The Longitudinal Elderly Person Shadowing Program: Outcomes From an Interprofessional Senior Partner Mentoring Program

The University of Saskatchewans Longitudinal Elderly Person Shadowing (LEPS) is an interprofessional senior mentors program (SMP) where teams of undergraduate students in their first year of medicine, pharmacy, and physiotherapy; 2nd year of nutrition; 3rd year nursing; and 4th year social work partner with community-dwelling older adults. Existing literature on SMPs provides little information on the sustainability of attitudinal changes toward older adults or changes in interprofessional attitudes. LEPS students completed Polizzis Aging Semantic Differential and the Interdisciplinary Education Perception Scale. Perceptions of older men and women improved significantly and changes were sustained after one year. However, few changes were seen in interprofessional attitudes.

Pulse transit time-based blood pressure estimation using hilbert-huang transform

The pulse transit time (PTT) based method has been suggested as a continuous, cuffless and non-invasive approach to estimate blood pressure. It is of paramount importance to accurately determine the pulse transit time from the measured electrocardiogram (ECG) and photoplethysmo-gram (PPG) signals. We apply the celebrated Hilbert-Huang Transform (HHT) to process both the ECG and PPG signals, and improve the accuracy of the PTT estimation. Further, the blood pressure variation is obtained by using a well-established formula reflecting the relationship between the blood pressure and the estimated PTT. Simulation results are provided to illustrate the effectiveness of the proposed method.

Data acquisition system using six degree-of-freedom inertia sensor and Zigbee wireless link for fall detection and prevention

Fall detection and prevention require logged physiological activity data of a patient for a long period of time. This work develops a data acquisition system to collect motion data from multiple patients and store in a data base. A wireless sensor network is built using high precision inertia sensors and low power Zigbee wireless transceivers. Testing results prove the system function properly. Researchers and physicians can now retrieve and analyze the accurate data of the patient movement with ease.