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Clinical Research on Older Adults in Canada: Summary of Recent Progress

Published online by Cambridge University Press:  29 November 2010

Kenneth Rockwood ,
Chris MacKnight  and
Colin Powell
Kenneth Rockwood
Affiliation:
Dalhousie University
Chris MacKnight
Affiliation:
Dalhousie University
Colin Powell
Affiliation:
Dalhousie University
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Abstract

Geriatric Medicine is a young specialty in Canada, having been formally recognized in 1981. The early years of research chiefly involved designing and describing programs of care. As the specialty matured, so too did the nature of research into the clinical problems of older adults. This article discusses research published by Canadian geriatricians since 1998, the date of a previous review. Two prominent areas of research are frailty and dementia. Several groups have studied the natural history of frailty, and designed techniques to better measure outcomes. Interventional trials are also gaining prominence, with the Systeme de services intégrés pour personnes agees en perte d'automonie (SIPA) and Mobile Geriatric Assessment Team (MGAT) being good examples. The Canadian Study of Health and Aging (CSHA) is one of the largest studies of dementia epidemiology ever conducted, and the upcoming third wave will provide new data on the outcomes of cognitive impairment not meeting criteria for dementia. Other areas of interest include pharmacoepidemiology, difficult clinical problems, advanced directives and bioethics. Canadian research in geriatrics will continue to develop, with the establishment of the Canadian Institutes of Health Research providing exciting new opportunities.

Résumé

La médecine gériatrique est une toute nouvelle spécialité au Canada formellement reconnue en 1981. Les premières années de la recherche portaient surtout sur la conception et la description des programmes de soins. Au fur et à mesure de la maturation de la discipline, onavuse transformer la nature de la recherche qui s'est penchée sur les problèmes cliniques des aîné(e)s. Cet article traite de la recherche publiée par les gériatres canadien(ne)s depuis 1998, date d'un examen préalable. Deux secteurs importants de cette recherche sont la fragilité et la démence. Plusieurs chercheurs ont examiné le déroulement naturel de la fragilité et ont conçu des techniques pour en mesurer les conséquences. Les interventions s e répandent, notamment le Système de services intégrés pour personnes âgées en perte d'automonie (SIPA) et le Mobile Geriatric Assessment Team (MGAT). L'Étude sur la santé et le vieilhssement au Canada (ESVC) constitue l'une des plus importantes recherches sur l'épidémiologie de la démence dont la troisième phase fournira sous peu des nouvelles données sur les conséquences de problèmes cognitifs qui ne sent pas de la démence. On s'intéresse aussi à la pharmaco-épidémiologie, aux problèmes cliniques difficiles, aux lignes directrices perfectionnées et à la bioéthique. La recherche canadienne en gériatrie se poursuit, grâce à l'établissement des Instituts canadiens de recherche sur la santé qui offrent des perspectives tres intéressantes.

Keywords

Clinical ResearchDementiaFrailtyHealth MeasurementPharmacoepidemiologyRecherche cliniquedémencefragilitémesure de santépharmacoépidemiologie
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 20 , Issue S1: Northern Lights: Reflections on Canadian Gerontological Research , Summer/Été 2001 , pp. 1 - 16
Copyright
Copyright © Canadian Association on Gerontology 2001

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References

1. Rockwood, K, Bergman, H, DB, Hogan, McCracken, P. Age-related clinical and health services research in Canada. J Am Geriatr Soc 1998;46:1469–72.Google Scholar
2. DB, Hogan. Research in geriatric medicine: review of the published abstracts of the Canadian Society of Geriatric Medicine (1981-1998). Ann Roy Coll Phys Surg Can 1999;32:152-6.Google Scholar
3. Canadian Study ofHealth and Aging Working Group. Canadian Study of Health and Aging: study methods and prevalence of dementia. Can Med Assoc J 1994;150:899–913.Google Scholar
4. The Canadian Study of Health and Aging. The Canadian Study of Health and Aging: risk factors for Alzheimer's disease in Canada. Neurology 1994;44:2073 80.CrossRefGoogle Scholar
5. The Canadian Study of Health and Aging Working Group. Patterns of caring for people with dementia in Canada. Can J Aging 1994;13:470–87.Google Scholar
6. The Canadian Study of Health and Aging Working Group. The incidence of dementia in Canada. Neurology 2000;55:66-73.CrossRefGoogle Scholar
7. Rockwood, K, RA, Fox, Stolee, P, Robertson, D, Beattie BL. Frailty in elderly people: an evolving concept. Can Med Assoc J 1994;150:489–95.Google Scholar
8. Rockwood, K, Stolee, P, McDowell, I. Factors associated with institutionalization of older people in Canada: testing a multifactorial definition of frailty. J Am Geriatr Soc 1996;44:578–82.Google Scholar
9. Rockwood, K, Stadnyk, K, MacKnight, C, McDowell, I, Hebert, R, DB, Hogan. A brief clinical instrument to classify frailty in elderly people. Lancet 999;353:205-6.CrossRefGoogle Scholar
10. Frailty, Powell C.: help or hindrance? J R Soc Med 1997;90(suppl 32):23-6.CrossRefGoogle Scholar
11. Hogan, Rockwood K DB, MacKnight C. Conceptualisation and measurement of frailty in elderly people. Drugs Aging 2000;17;295-302.CrossRefGoogle Scholar
12. AJ, Campell, DM, Buchner. Unstable disability and the fluctuations of frailty. Age Ageing 1997; 26:315-8.CrossRefGoogle Scholar
13. Pinning, Gillick M.down frailty. J Gerontol Med Sci 2001;56A:M134–5.Google Scholar
14. LP, Fried, CM, Tangen, J, Walston et al. Frailty in older adults: evidence for a phenotype. J Gerontol Med Sci 2001;56A:M146–56.Google Scholar
15. Hebert, R, Brayne, C, Spiegelhalter D. Factors associated with functional decline and improvement in a very elderly community-dwelling population. Am J Epidemiol 1999;150:501–10.Google Scholar
16. Bergman, H, Béland, F, Lebel, P, Contandriopolous AP, Tousignant P, Brunelle Y, Kaufman T, Leibovich E, Rodriguez R, Clarfield M. Care for Canada's frail elderly population: fragmentation or integration? Can Med Assoc J 1997;157:1116–21.Google Scholar
17. Gold, S, Bergman H. A geriatric consultation team in the emergency room. J Am Geriatr Soc 1997;45:764–7.Google Scholar
18. Sinoff, G, AM, Clarfield, Bergman, H, Beaudet M. A two-year follow-up of geriatric consults in the emergency department. J Am Geriatr Soc. 1998;46(6):716–20Google Scholar
19. AJ, Gagnon, Schein, C, McVey, L, Bergman H. Randomized controlled trial of nurse case management of frail older people. J Am Geriatr Soc 1999;47:1118–24.Google Scholar
20. Stadnyk, K, Calder, J, Rockwood, K. Testing the measurement properties of the Short Form-36 Health Survey in a frail elderly population. J Clin Epidemiol 1998;51:827–35.Google Scholar
21. Rockwood, K, Stadnyk, K, Carver, D, MacPherson KM, Beanlands HE, Powell C, Stolee P, Thomas VS, Tonks RS. A clinimetric evaluation of specialized geriatric care for rural dwelling, frail older people. J Am Geriatr Soc 2000;48:1080–5.Google Scholar
22. TJ, Kiresuk, Smith, A, Cardillo JE. Goal attainment scaling: applications, theory, and measurement. Hillsdale, NJ: Lawrence Erlbaum Associates, Publishers, 1994.Google Scholar
23. Hartman, D, MJ, Borrie, Davison, E, Stolee P. Use of goal attainment scaling in a dementia special care unit. Am J Alz Dis 1997;12:111–16.Google Scholar
24. DJ, Evans, S, Oakey, Almdahl, S et al. Goal attainment scaling in a geriatric day hospital. Can Fam Physician 1999;45:954-960.Google Scholar
25. JE, Gordon, Powell, C, Rockwood K Goal attainment scaling as a measure of clinically important change in nursing-home patients. Age Ageing 1999:28:275-281.CrossRefGoogle Scholar
26. Stolee, P, Stadnyk, K, AM, Myers, Rockwood K. An Individualized Approach to Outcome Measures in Geriatric Rehabilitation. J Geron Med Sci 1999;54A(12):M641–M647.Google Scholar
27. Hebert, R, Lindsay, J, Verreault, R, Rockwood, K, Hill, G, Dubois M-F. Vascular dementia: incidence and risk factors in the Canadian Study of Health and Aging. Stroke 2000;31:1487-93.CrossRefGoogle Scholar
28. Laurin, D, Verreault, R, Lindsay, J, MacPherson, K, Rockwood K. Physical activity and the risk of cognitive impairment and dementia in elderly persons. Arch Neurol 2001;58:498-504.CrossRefGoogle Scholar
29. JE, Graham, Rockwood, K, BL, Beattie, Eastwood, R, Gauthier, S, Tuokko, H, McDowell I. Prevalence and severity of cognitive impairment with and without dementia in an elderly population. Lancet 1997;349:1793-1796.CrossRefGoogle Scholar
30. Rockwood, K, Wentzel, C, Hachinski, V, DB, Hogan, MacKnight, C, McDowell I for the Vascular Cognitive Impairment Investigators of the Canadian Study of Health and Aging. Prevalence and outcomes of vascular cognitive impairment. Neurology 2000;54:447-51.CrossRefGoogle Scholar
31. DB, Hogan, Ebly EM. Predicting who will develop dementia in a cohort of Canadian seniors. Can J Neurol Sci 2000;27:18–24.Google Scholar
32. CJ, Patterson, Gauthier, S, Bergman, H, CA, Cohen, JW, Feightner, Feldman, H, Hogan DB. The recognition, assessment and management of dementing disorders: conclusions from the Canadian Consensus Conference on Dementia. CanMed Assoc J 1999;160 (suppl 12):S1-15.Google Scholar
33. DB, Hogan, Jennet, P, Freter, S, Bergman, H, Chertkow, H, Gold, S, Clarfield AM. Recommendations of the Canadian Consensus Conference on Dementia: dissemination, implementation, and evaluation of impact. Can J Neurol Sci 2001;28(suppl l):Sl 15–21.Google Scholar
34. Tamblyn, R, Laprise, R, JA, Hanley, Abrahamowicz, M, Scott, S, Mayo, N, Hurley, J, Grad, R, Latimer, E, Perreault, R, McLeod, P, Huang, A, Larochelle, P, Mallet L. Adverse events associated with prescription drug cost-sharing among poor and elderly persons. JAMA 2001;285:421-9.CrossRefGoogle Scholar
35. RM, Tamblyn, PJ, McLeod, Abrahamowicz, M, Laprise R. Do too many cooks spoil the broth? Multiple physician involvement in medical management of elderly patients and potentially inappropriate drug combinations. Can Med Assoc J 1996;154:1177–84.Google Scholar
36. PA, Rochon, JV, Tu, GM, Anderson, JH, Gurwitz, JP, Clark, Lau, P, JP, Szalai, Sykora, K, Naylor CD. Rate of heart failure and 1-year survival for older people receiving low-dose beta-blocker therapy after myocardial infarction. Lancet 2000;356:639-44.CrossRefGoogle Scholar
37. PA, Rochon, GM, Anderson, JV, Tu, JH, Gurwitz, JP, Clark, NH, Shear, Lau P. Age- and gender-related use of low-dose drug therapy: the need to manufacture low-dose therapy and evaluate the minimum effective dose. J Am Geriatr Soc 1999;47:954–9.Google Scholar
38. Liu, B, Anderson, G, Mittman, N, To, T, Axcell, T, Shear N. Use of selective serotonin reuptake inhibitors or tricyclic antidepressants and risk of hip fractures in elderly people. Lancet 1998;351:1303-7.CrossRefGoogle Scholar
39. Tamblyn, R, Perreault R. Prescription drug use and seniors. Can J Aging 2000;19(suppl 1):143–175.Google Scholar
40. EM, Ebly, DB, Hogan, Fung TS. Potential adverse outcomes of psychotropic and narcotic drug use in Canadian seniors. J Clin Epidemiol 1997;50:857–63.Google Scholar
41. Man-Son-Hing, M, Nichol, G, Lau, A, Laupacis A. Choosing antithrombotic therapy for elderly patients with atrial fibrillation who are at risk for falls. Arch Intern Med 1999;159:677-85.CrossRefGoogle Scholar
42. SJ, Connolly. Preventing stroke in atrial fibrillation: why are so many eligible patients not receiving anticoagulant therapy? Can Med Assoc J 1999;161:533–4.Google Scholar
43. Man-Son-Hing, M.Why aren't we falling for anticoagulant therapy? Can Med Assoc J 2000;162:191–2.Google Scholar
44. PG, Jarrett, Rockwood, K, Carver, D, Stolee, P, Cosway S. Illness presentation in elderly patients. Arch Intern Med 1995;155:1060-4.CrossRefGoogle Scholar
45. MacKnight, C, Rockwood, K. A hierarchical assessment of balance and mobility. Age & Ageing 1995;24:126-130.CrossRefGoogle Scholar
46. MacKnight, C, Rockwood, K.Rasch analysis of the Hierarchical Assessment of Balance and Mobility (HABAM). J Clin Epidemiol 2000;53:1242–7.Google Scholar
47. Walker, S, McGeer, A, AE, Simor, Armstrong-Evans, M, Loeb M. Why are antibiotics prescribed for asymptomatic bacteriuria in institutionalized elderly people? Can Med Assoc J 2000;163:273–7.Google Scholar
48. LE., NicolleUrinary tract infections in the elderly. Symptomatic or asymptomatic? Int J Antimicrob Agents 1999;11:265–8.Google Scholar
49. LE., NicolleAsymptomatic bacteriuria in institutionalized elderly people: evidence and practice. Can Med Assoc J 2000; 163:285–6.Google Scholar
50. Rockwood, K, Await, E, MacKnight, C, McDowell I. Incidence and outcomes of diabetes mellitus in elderly people: report from the Canadian Study of Health and Aging. Can Med Assoc J 2000;162:769–72.Google Scholar
51. GS, Meneilly, Elliot, T. Metabolic alterations in middle-aged and elderly obese patients with type 2 diabetes. Diabetes Care 1999;22:112-8.CrossRefGoogle Scholar
52. GS, Meneilly, Tessier, D.Diabetes in elderly adults. J Gerontol Med Sci 2001;56A:M5-13.Google Scholar
53. GS, Meneilly, EA, Ryan, Radziuk, J, DC, Lau, JF, Yale, Morais, J, JL, Chiasson, Rabasa-Lhoret, R, Maheux, P, Tessier, D, Wolever, T, RG, Josse, Elahi D. Effect of acarbose on insulin sensitivity in elderly patients with diabetes. Diabetes Care 2000;23:l 162-7.CrossRefGoogle Scholar
54. Tessier, D, Menard, J, Fulop, T, Ardilouze, J, Roy, M, Dubuc, N, Dubois, M, Gauthier P. Effects of aerobic physical exercise in the elderly with type 2 diabetes mellitus. Arch Gerontol Geriatr 2000;31:121-32.CrossRefGoogle Scholar
55. DB, Rolfson, JE, McElhaney, Rockwood, K, BA, Finnegan, LM, Entwistle, JF, Wong, Suarez-Almazor ME. Incidence and risk factors for delirium and other adverse outcomes after coronary artery bypass graft surgery. Can J Cardiol 1999;15:771–6.Google Scholar
56. MacDonald, P, Stadnyk, K, Cossett, J, Klassen, G, Johnstone, D, Rockwood K. Outcomes of coronary artery bypass surgery in elderly people. Can J Cardiol 1998;14:1215–22.Google Scholar
57. DB, Rolfson, JE, McElhaney, GS, Jhangri, Rockwood K. Validity of the confusion assessment method in detecting postoperative delirium in the elderly. Int Psychogeriatr 1999;11:431-8.CrossRefGoogle Scholar
58. Monette, J, Galbaud du Fort, G, SH, Fung, Massoud, F, Moride, Y, Arsenault, L, Afilalo M. Evaluation of the confusion assessment method (CAM) as a screening tool for delirium in the emergency room. Gen Hosp Psychiatr 2001;23:20-5.CrossRefGoogle Scholar
59. Rockwood, K, Cosway, S, Carver, D, Jarret, P, Stadnyk, K, Fisk J. The risk of dementia and death after delirium. Age Ageing 1999;28:551-6.CrossRefGoogle Scholar
60. E, Alemayehu, Molloy D, W, GH, Guyatt et al. Variability in physicians' decisions on caring for chronically ill elderly patients: an international study. Can Med Assoc J 1991;144:1133–8.Google Scholar
61. DW, Molloy, Urbanyi, M, JR, Horsman, GH, Guyatt, Bedard M. Two years' experience with a comprehensive health care directive in a home for the aged. Ann Roy Coll Phys Surg Can 1992;7:433-436.Google Scholar
62. DW, Molloy, Harrison, C, MC, Farrugia, Cunje A. The Canadian experience with advance treatment directives. Humane Med 1993;l:70-77.Google Scholar
63. GH, Guyatt, Mitchell, A, DW, Molloy, Capretta, R, Horsman, J, Griffith L. Measuring patient and relative satisfaction with level or aggressiveness of care and involvement in care decisions in the context of life threatening illness. J Clin Epidemiol 1995;48:1215–24.Google Scholar
64. Harrison, C, DW, Molloy, PJ, Darzins, Bedard M. Should people do unto others as they would not want done unto themselves? J Clin Ethics 1995;6:14–19.Google ScholarPubMed
65. DW, James J. Molloy, Urbanyi M. Rapelje DH. The right to die with dignity. Can Health Care Manage 1996;78-82.Google Scholar
66. DW, Molloy, Mepham V. Let Me Decide. 3rd ed. Toronto, Ontario: Penguin Books; 1996.Google Scholar
67. DW, Molloy, P, Silberfeld M. Darzins et al. Measuring capacity to complete an advance directive. J Am Geriatr Soc 1996;44:660–4.Google Scholar
68. C, Patterson, DW, Molloy, GH, Guyatt et al. Systematic implementation of an advance health care directive in the community. Can J Nurse Adm 1997;10:96–108.Google Scholar
69. Patterson, C, Molloy, W, Jubelius, R, GH, Guyatt, Bedard M. Provisional educational needs of health care providers in palliative care in three nursing homes in Ontario. J Palliat Care 1997;13:13–17.Google Scholar
70. DW, Molloy, GH, Guyatt, R, Goeree et al. A comprehensive health-care directive for competent and incompetent residents of a home for the aged. Ann Roy Coll Phys Surg Can 1997;30:339-345.Google Scholar
71. DW, Molloy, Russo, R, Pedlar, D, Bedard M. Implementation of advance directives among community-dwelling veterans. Gerontologist 2000;40:213-7.CrossRefGoogle Scholar
72. DW, Molloy, GH, Guyatt, R, Russo et al. Systematic implementation of an advanced directive program in nursing homes: a randomised controlled trial JAMA 2000;283:1437-44.Google Scholar
73. Goldsand, G, RS, Zahava, Gordon M. Bioethics for clinicians: 22. Jewish bioethics. Can Med Assoc J 2001;164:219–22.Google Scholar
74. Gordon, M, Turner T. Healing medicare: options to save the single payer system. Ann Roy Coll Phys Surg Can 1997;30:275-8.Google Scholar
75. Gordon, M, Mintz, J, Chen D. A tax-based alternative to privatization. Can Med Assoc J 1998;159;493–6.Google Scholar
76. Gordon, M, SA, Sternberg, Turner L. The ethics of health-care systems: contrasting Canada and the United States. Ann Roy Coll Phys Surg Can 1999;32:267-71.Google Scholar