Ken Madden

Does an 'Activity-Permissive' Workplace Change Office Workers' Sitting and Activity Time?

Introduction To describe changes in workplace physical activity, and health-, and work-related outcomes, in workers who transitioned from a conventional to an ‘activity-permissive’ workplace. Methods A natural pre-post experiment conducted in Vancouver, Canada in 2011. A convenience sample of office-based workers (n=24, 75% women, mean [SD] age = 34.5 [8.1] years) were examined four months following relocation from a conventional workplace (pre) to a newly-constructed, purpose-built, movement-oriented physical environment (post). Workplace activity- (activPAL3-derived stepping, standing, and sitting time), health- (body composition and fasting cardio-metabolic blood profile), and work- (performance; job satisfaction) related outcomes were measured pre- and post-move and compared using paired t-tests. Results Pre-move, on average (mean [SD]) the majority of the day was spent sitting (364 [43.0] mins/8-hr workday), followed by standing (78.2 [32.1] mins/8-hr workday) and stepping (37.7 [15.6] mins/8-hr workday). The transition to the ‘activity-permissive’ workplace resulted in a significant increase in standing time (+18.5, 95% CI: 1.8, 35.2 mins/8-hr workday), likely driven by reduced sitting time (-19.7, 95% CI: -42.1, 2.8 mins/8-hr workday) rather than increased stepping time (+1.2, 95% CI: -6.2, 8.5 mins/8-hr workday). There were no statistically significant differences observed in health- or work-related outcomes. Discussion This novel, opportunistic study demonstrated that the broader workplace physical environment can beneficially impact on standing time in office workers. The long-term health and work-related benefits, and the influence of individual, organizational, and social factors on this change, requires further evaluation.

Group Medical Visits (GMVs) in primary care: an RCT of group-based versus individual appointments to reduce HbA1c in older people.

Introduction Type 2 diabetes mellitus (T2DM) affects more than 1.1 million Canadians aged ≥65 years. Group Medical Visits are an emerging health service delivery method. Recent systematic reviews show that they can significantly reduce glycated haemoglobin (HbA1c) levels, but Group Visits have not been evaluated within primary care. We intend to determine the clinical effectiveness, quality of life and economic implications of Group Medical Visits within a primary care setting for older people with T2DM. Methods and analysis A 2-year proof-of-concept, single-blinded (measurement team) randomised control trial to test the efficacy of Group Medical Visits in an urban Canadian primary care setting. Participants ≥65 years old with T2DM (N=128) will be equally randomised to either eight groups of eight patients each (Group Medical Visits; Intervention) or to Individual visits (Standard Care; Controls). Those administering cointerventions are not blinded to group assignment. Our sample size is based on estimates of variance (±1.4% for HbA1c) and effect size (0.9/1.4=0.6) from the literature and from our own preliminary data. Forty participants per group will provide a β likelihood of 0.80, assuming an α of 0.05. A conservative estimation of an effect size of 0.7/1.4 changes the N in the power calculation to 59 per group. Hence, we aim to enrol 64 participants in each study arm. We will use intention-to-treat analysis and compare mean HbA1c (% glycosylated HbA1c) (primary outcome) of Intervention/Control participants at 12 months, 24 months and 1 year postintervention on selected clinical, patient-rated and economic measures. Trial registration number NCT02002143.

The Health of Geriatrics in Canada —More Than Meets the Eye

Much has been written about the “grey tsunami”,(1) an ongoing demographic shift with profound consequences for the Canadian health-care system. Since Geriatric Medicine was accredited by the Royal College in 1977, the field has steadily developed into a dynamic array of clinical, educational, and research activities. By 2051, one in four Canadians is expected to be over the age of 65,(2) providing both opportunities and challenges for the specialty of Geriatric Medicine in Canada. Public awareness of the “greying” Canadian population has increased the receptiveness of all levels of government for the need for geriatric services. In fact, the accelerating need for older adult care and the multidisciplinary skills of geriatricians have allowed geriatric medicine specialists to “punch far above their weight” in terms of leadership in health-care administration.(3) This has allowed a move in Canada towards more elder-friendly hospitals and an increased use of Acute Care of the Elders (ACE) units. Since its first report in the literature, ACE units have been implemented in various jurisdictions across Canada to provide hospitalized elders with patient-centered care, frequent medical review, elder-friendly environment, early rehabilitation, and enhanced discharge planning.(4) Older adults who are served by ACE units represent a particularly vulnerable or frail cohort, as many of them are prone to developing adverse health outcomes even after hospitalization.(5) This has not been an easy endeavour, as comprehensive geriatric care for vulnerable older adults is neither straightforward nor inexpensive. Geriatricians are effective in influencing health-care changes due to their versatility and broad-based multidisciplinary networking. The option of not making specialized geriatric care available to Canadians in an equitable manner is simply not acceptable from a social responsibility and accountability point of view. However, there are challenges that come with administrative success; every geriatrician improving overall senior’s care at the administrative level is one less geriatrician consulting on individual patients. Certainly with an average ratio of 0.50 geriatric medicine specialists per 10,000 older adults, there is ample room for growth and recruitment.(6) In fact, the current and expected employment difficulties in several specialties (including cardiac surgery, neurosurgery, and orthopedic surgery, plus other specialties that have raised concerns) provide new opportunities for recruiting future trainees to our rapidly growing field.(7) The future of aging research in Canada has improved greatly over the last decade. One of the challenges for gerontological researchers was that they were forced to apply to specialized committees that were not always sympathetic to the discipline, or did not appreciate the multidisciplinary quality of aging research. The funding environment has greatly improved since the formation of the Institute of Aging. In 2000–2001, 6% (

Summer Issue 2015.

15.6 million) of CIHR total expenditures were invested in open grants for aging-related research. In 2009–2010, the proportion of CIHR grant expenditures in these areas rose to 13% (

Winter Issue 2015

61 million) of total expenditures for open grants. (8) This increase in direct funding has also indirectly assisted Canada’s gerontological researchers in leveraging funds from other granting agencies. Knowledge translation of Canadian discoveries into practice has also improved, as shown though direct CIHR initiatives(8) and though the formation of a new, open-access National Library of Medicine indexed journal (the Canadian Geriatrics Journal).(9) The future of education in Geriatrics has also improved in recent years, although there is certainly room for further development. Many geriatricians in Canada are well-positioned to help move Geriatrics education forward since they hold important educational leadership positions at their home institutions ranging from course directors to program directors to decanal appointments. There are now national core competencies in Geriatrics identified for undergraduate medical students, and future efforts should focus on increasing exposure to geriatric care across postgraduate residency programs. While the numbers of residency training positions in both Geriatric Medicine programs and Care of the Elderly programs have seen general increases at many Canadian universities, not all residency positions in these programs are being filled.(10) This is likely a multi-factorial issue that warrants further exploration, and trainee selection is a major determinant. The Canadian Geriatrics Society is actively engaged in several strategic programs to improve the image of Geriatrics among medical trainees, including the Resident Geriatrics Interest Group (RGIG) for residents and the National Geriatrics Interest Group (NGIG) for medical students. These programs are centrally facilitated and well-supported by local chapters. In many ways we can describe the overall health of Geriatrics in Canada as reasonably good, and we recognize that there is room for improvement in the clinical, research, and educational arenas. The challenges are real, and yet we believe the future looks promising. We simply cannot afford to think otherwise as we join forces with other stakeholders to meet the health-care needs of the aging population in Canada.

Letter from the Editorial Board

Hello! The editorial board of the Canadian Geriatrics Journal would like to introduce our second issue of 2015. In this issue we present the abstracts from the recent Technology Evaluation in the Elderly Network meeting in Toronto. This group is part of the Canadian Networks of Centres of Excellence (NCE) program, whose mandate is to develop, rigorously evaluate, and ethically disseminate information about the use of technologies for the care of seriously ill elderly patients and their families. In addition to the abstracts of the TEEN meeting, we also have a number of original research articles. Dr. Soham Rej and colleagues(1) attempt to examine, with an observational study, the various psychosocial risk factors that are associated with cognitive decline in patients with late life depression. Dr. Laura Middleton(2) examines through a survey methodology barriers to referring patients with minimal cognitive impairment for cardiac rehabilitation. In a similar vein, Dr. Saad Shakeel(3) presents a meta-analysis identifying the feasibility of physical activity programs for patients admitted to long-term care, and Dr. Jeannette Prorok et al.(4) evaluate the effectiveness of a dementia education program for family medicine residents. Dr. Sanjeev Khanagar and colleagues(5) performed a cross-sectional examination of the oral hygiene status of older adults in long-term care in India. We also would like to present an invited commentary on a structured approach to managing disagreements in a health-care setting, by Dr. Kenneth Rockwood.(6) Have a great summer!

Last Issue, 2016

Hi! The editorial board of the Canadian Geriatrics Journal is delighted to present our winter issue containing a wide variety of original research. Xu et al.(1) examines the ability of a pre-clerkship observership program to improve positive attitudes towards the practice of geriatric medicine. Another article examines the effectiveness of the DEAR (Delirium Elderly at Risk) tool at identifying hip fracture patients at risk for delirium.(2) Forbes et al.(3) presents a meta-analysis of the effect of various supplements on cognition. As well, we are excited to showcase geriatric research occurring nationally by providing the abstracts presented at both the Canadian Consensus Conference4,5 on Dementia and the Canadian Association of Geriatric Psychiatry5 meetings this year. See you in 2016!

Fall Issue, 2015

CANADIAN GERIATRICS JOURNAL, VOLUME 20, ISSUE 1, MARCH 2017 In our current issue, Hogan et al.(1) present a comprehensive review of the current state of knowledge surrounding frailty in the acute care setting. In a similar acute care setting, Marcel Emond et al.(2) present a retrospective examination of the prevalence of emergency department-induced delirium. McGuire et al.(3) provide us with a retrospective exploration of both the characteristics and incidence of traumatic brain injury in older adults using homecare services in the province of Ontario. Boscart et al.(4) examine the conceptual framework behind the Living Classroom, a collaboration between a nursing home group and a community college where students, college faculty, care teams, residents, and families engage in a culture of learning. We are also pleased to present the abstracts from the 25th Annual Scientific Meeting of the Canadian Academy of Geriatric Psychiatry, held recently in Quebec City.(5)

Assisted Living or Facility

CANADIAN GERIATRICS JOURNAL, VOLUME 19, ISSUE 4, DECEMBER 2016 The editorial board of the Canadian Geriatrics Journal would like to present the last issue of 2016, addressing a wide variety of geriatric and gerontological topics. Dr. David Hogan and Dr. Montero-Odasso(1) call on the Canadian Geriatrics Society to develop a Falls and Fractures Special Interest Group, which is an attempt to systematically improve fall prevention in vulnerable seniors on a national level. Hategan et al.(2) examine the associations between emergency department use and homelessness in the geriatric population. Clinical gaps in the in-patient care of geriatric in-patients with heart failure, as perceived by the patient’s caregivers, are systematically examined by Azad et al.(3) A careful methodological examination of the Team Standardized Assessment of Clinical Encounter Report (Team StACER) is performed by Dr. Camilla Wong et al.,(4) and Heckman et al.(5) examine the key quality assurance components involved in providing good community dementia care. We would like to thank the membership of the Canadian Geriatrics Society for their continuing support for the Canadian Geriatrics Journal, especially all the members who volunteered their time to review and improve the papers.

Your Fireplace Reading

Hello! Our fall issue contains a wide range of geriatrics research ranging from improving dental health in older adults,(1) to an examination of the association of cognitive test scores and level of function in older adults.(2) Other papers examine the risk factors for developing dementia in older indigenous persons,(3) and provide an overview of outcomes and results of a pre-conference workshop held prior to the Scientific Meeting of the Canadian Association on Gerontology.(4) Finally we are pleased to present the abstracts presented at the 35th Annual Scientific Meeting of the Canadian Geriatrics Society, which was in Montreal this year.(5) Thanks again for your interest!