Skip header and navigation

Refine By

12 records – page 1 of 2.

Determinants of adult day center attendance among older adults with functional limitations.

https://arctichealth.org/en/permalink/ahliterature148391
Source
J Aging Health. 2009 Oct;21(7):985-1015
Publication Type
Article
Date
Oct-2009
Author
Jacinthe Savard
Nicole Leduc
Paule Lebel
François Béland
Howard Bergman
Author Affiliation
SOLIDAGE Reseach Group, Université de Montréal and McGill University, Montreal, Quebec, and Occupational Therapy Program, University of Ottawa, 451 Smyth Road, Ottawa, Ontario K1H 8M5, Canada. jacinthe.savard@uottawa.ca
Source
J Aging Health. 2009 Oct;21(7):985-1015
Date
Oct-2009
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Aged, 80 and over
Caregivers
Cognition Disorders
Cost of Illness
Day Care - utilization
Female
Frail Elderly
Health services needs and demand
Health Services for the Aged - utilization
Health status
Humans
Length of Stay
Male
Quebec
Questionnaires
Abstract
To examine factors related to regularity of adult day center (ADC) attendance among seniors with functional limitations.
Using data collected as part of a larger study, we identified the proportion of scheduled days attended among 101 ADC users in Montréal and identified determinants of this attendance.
More regular attendance was associated with previous profession of ADC participant or spouse in a sector other than health care, receiving formal help for activities of daily living or instrumental activities of daily living on days of expected ADC participation, participating for the whole day rather than half a day, lower participation in prevention and health-promotion activities, and lower caregiver burden among persons with cognitive impairments and higher caregiver burden among persons without cognitive impairments.
To enhance ADC intervention effects, levels of participation should be maximized. Study findings suggest ways to promote more regular attendance.
PubMed ID
19773597 View in PubMed
Less detail

Fostering participation of general practitioners in integrated health services networks: incentives, barriers, and guidelines.

https://arctichealth.org/en/permalink/ahliterature152019
Source
BMC Health Serv Res. 2009;9:48
Publication Type
Article
Date
2009
Author
Matthieu de Stampa
Isabelle Vedel
Howard Bergman
Jean-Luc Novella
Liette Lapointe
Author Affiliation
University of Versailles St-Quentin, Santé Vieillissement Laboratory, AP-HP, Sainte Perine Hospital, Paris, France. matthieu.destampa@spr.aphp.fr
Source
BMC Health Serv Res. 2009;9:48
Date
2009
Language
English
Publication Type
Article
Keywords
Aged
Attitude of Health Personnel
Cooperative Behavior
Delivery of Health Care, Integrated - manpower
Female
Frail Elderly
Health Services Research
Health Services for the Aged - manpower
Humans
Interprofessional Relations
Interviews as Topic
Longitudinal Studies
Male
Physicians, Family - psychology - statistics & numerical data
Quebec
Questionnaires
Retrospective Studies
Abstract
While the active participation of general practitioners (GPs) in integrated health services networks (IHSNs) plays a critical role in their success, little is known about the incentives and barriers to their actual participation.
Data were gathered through semi-structured interviews and a mail survey with GPs enrolled in SIPA (system of integrated care for older persons) at 2 sites in Montreal. A total of 61 GPs completed the questionnaire, from which 22 were randomly selected for the qualitative study, with active and non-active participation in the IHSN.
The key themes associated with GP participation were clinician characteristics, consequences perceived at the outset, the SIPA implementation process, relationships with the SIPA team and professional consequences. The incentive factors reported were collaborative practices, high rates of elderly and SIPA patients in their clienteles, concerns about SIPA, the selection of frail elderly patients, close relationships with the case manager, the perceived efficacy of SIPA, and improved professional practices. Barriers to GP participation included high expectations, GP recruitment, lack of information on SIPA, difficult relationships with SIPA geriatricians and deterioration of physician-patient relationships. Four profiles of participation were identified: 2 groups of participants active in SIPA and 2 groups of participants not active in SIPA. The active GPs were familiar with collaborative practices, had higher IHSN patient rates, expressed more concerns than expectations, reported satisfactory relationships with case managers and perceived the efficacy of SIPA. Both active and non-active GPs reported quality care in the IHSN and improved professional practice.
Throughout the implementation process, the participation of GPs in an IHSN depends on numerous professional (clinician characteristics) and organizational factors (GP recruitment, relationships with case managers). Our study provides guiding principles for establishing future integrated models of care. It suggests practical guidelines to support the active participation of GPs in these networks such as physicians with collaborative practices, recruitment of significant number of patients per physicians, the information provided and the accompaniment by geriatricians.
Notes
Cites: Gerontologist. 2002 Jun;42(3):314-2012040133
Cites: J Gerontol A Biol Sci Med Sci. 2002 Apr;57(4):M250-811909892
Cites: Gerontologist. 2002 Dec;42(6):835-4212451165
Cites: JAMA. 2003 Jan 22-29;289(4):434-4112533122
Cites: Ann Intern Med. 2003 Feb 4;138(3):256-6112558376
Cites: Int J Geriatr Psychiatry. 2003 Mar;18(3):222-3512642892
Cites: Age Ageing. 1988 Sep;17(5):293-3022976575
Cites: Gerontologist. 1992 Dec;32(6):771-801478496
Cites: JAMA. 1995 Jan 25;273(4):323-97815662
Cites: Gerontologist. 1995 Jun;35(3):349-597622088
Cites: J Am Geriatr Soc. 1995 Sep;43(9):1016-207657917
Cites: J Am Geriatr Soc. 1997 Jan;45(1):101-78994497
Cites: BMJ. 1997 Aug 23;315(7106):441-29284652
Cites: CMAJ. 1997 Oct 15;157(8):1116-219347783
Cites: JAMA. 1997 Nov 26;278(20):1677-819388087
Cites: JAMA. 1998 May 6;279(17):1377-829582046
Cites: N Engl J Med. 1998 Nov 19;339(21):1516-219819451
Cites: JAMA. 1999 Feb 17;281(7):613-2010029122
Cites: J Ambul Care Manage. 1999 Apr;22(2):27-4010387583
Cites: BMJ. 2004 Nov 27;329(7477):1251-215564235
Cites: Ann Intern Med. 2005 Apr 19;142(8):700-815838089
Cites: BMC Health Serv Res. 2005;5:5316102173
Cites: J Am Geriatr Soc. 2006 Feb;54(2):276-8316460379
Cites: J Am Geriatr Soc. 2006 Mar;54(3):507-1116551321
Cites: J Gerontol A Biol Sci Med Sci. 2006 Apr;61(4):367-7316611703
Cites: J Am Geriatr Soc. 2006 May;54(5):849-5216696754
Cites: Disabil Rehabil. 2008;30(9):696-70817852321
Cites: Am J Manag Care. 1999 Sep;5(9):1162-7210621082
Cites: Health Serv Res. 1999 Dec;34(5 Pt 2):1209-2410591280
Cites: J Gen Intern Med. 2000 Jul;15(7):441-5010940129
Cites: Arch Intern Med. 2001 Jan 22;161(2):202-1111176733
Cites: Med Care. 2001 Mar;39(3):254-6911242320
Cites: Med Care. 2001 Aug;39(8):889-90511468507
Cites: JAMA. 2001 Nov 28;286(20):2578-8511722272
Cites: Med Care. 2002 Mar;40(3):227-3611880795
Cites: Arch Intern Med. 2002 Nov 11;162(20):2269-7612418941
PubMed ID
19292905 View in PubMed
Less detail

Frailty and its association with disability and comorbidity in a community-dwelling sample of seniors in Montreal: a cross-sectional study.

https://arctichealth.org/en/permalink/ahliterature147151
Source
Aging Clin Exp Res. 2010 Feb;22(1):54-62
Publication Type
Article
Date
Feb-2010
Author
Chek Hooi Wong
Deborah Weiss
Nadia Sourial
Sathya Karunananthan
Jacqueline M Quail
Christina Wolfson
Howard Bergman
Author Affiliation
McGill/University of Montreal Solidage Research Group, Montreal, Canada.
Source
Aging Clin Exp Res. 2010 Feb;22(1):54-62
Date
Feb-2010
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Aged, 80 and over
Comorbidity - trends
Cross-Sectional Studies
Disabled persons - statistics & numerical data
Female
Frail Elderly - statistics & numerical data
Health status
Heart Diseases - epidemiology
Humans
Hypertension - epidemiology
Income
Male
Marital status
Prevalence
Quebec - epidemiology
Self Concept
Socioeconomic Factors
Vascular Diseases - epidemiology
Abstract
The term frailty is used to describe older persons at high risk for adverse health outcomes. In 2001, Fried et al. proposed a now widely cited definition which suggests that frailty is a clinical entity related to, but distinct from, ADL disability and comorbidity. Frailty status was assessed based on the presence of any three of the following five characteristics: shrinking, weakness, poor endurance, slowness, and low activity. The objectives of the current study are to estimate the prevalence of frailty in a sample of community-dwelling older persons, to identify sociodemographic and health variables associated with frailty, and to examine the complex relationships between frailty and comorbidity, ADL disability and IADL disability.
This study is based on cross-sectional analysis of 740 community-dwelling seniors from the Montreal Unmet Needs Study (MUNS). The five characteristics of frailty were operationalised using measures available in MUNS. The Cochran-Mantel-Haenszel test was used to identify variables associated with frailty. Overlaps between frailty, comorbidity and disability were assessed using proportions.
Overall, 7.4% were classified as frail, 49.7% prefrail and 42.8% non-frail. Frailty was associated with age, sex, income, education, number of chronic diseases, ADL disability, and IADL disability. Among those classified as frail, 29.1% had disabilities in ADLs, 92.7% in IADLs and 81.8% had comorbidity.
Findings on the relationship between frailty and sociodemographic variables, morbidity and disability, support previous studies, providing further evidence that although frailty seems to be a distinct geriatric concept, it also overlaps with other concepts.
PubMed ID
19940555 View in PubMed
Less detail

Frailty markers predicting emergency department visits in a community-dwelling sample of vulnerable seniors in Montreal.

https://arctichealth.org/en/permalink/ahliterature130367
Source
Can J Aging. 2011 Dec;30(4):647-55
Publication Type
Article
Date
Dec-2011
Author
Anita Au
Martine T E Puts
John D Fletcher
Nadia Sourial
Howard Bergman
Author Affiliation
Department of Medicine, University of Alberta.
Source
Can J Aging. 2011 Dec;30(4):647-55
Date
Dec-2011
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Emergency Service, Hospital - utilization
Female
Forecasting
Frail Elderly - statistics & numerical data
Health Status Indicators
Humans
Male
Middle Aged
Quebec
Residence Characteristics
Vulnerable Populations
Abstract
Frailty puts individuals at increased risk for poor health outcomes. Elderly individuals use a disproportionate amount of emergency department (ED) resources. To investigate the relationship between frailty markers and the effect on ED use by community-dwelling seniors, we conducted a secondary analysis of a 22-month prospective randomized control trial in Montreal, Canada, using the Service Intégrés pour les Personnes Âgées en Perte d'Autonomie (SIPA) database. We assessed a sample of 565 individuals using five frailty markers: physical activity, strength, cognition, energy, and mobility. Univariate and multivariable logistic regression was performed to assess for potential relationship between frailty markers and ED visits. The findings revealed that 70 per cent of the participants had at least three frailty markers. No relationship was found between frailty markers and ED visits. These results suggest that in severely functionally disabled, community-dwelling elderly, the presence of frailty markers does not appear to predict ED visits.
PubMed ID
22008650 View in PubMed
Less detail

Health state profiles and service utilization in community-living elderly.

https://arctichealth.org/en/permalink/ahliterature153000
Source
Med Care. 2009 Mar;47(3):286-94
Publication Type
Article
Date
Mar-2009
Author
Louise Lafortune
François Béland
Howard Bergman
Joël Ankri
Author Affiliation
Department of Health Administration, University of Montréal, Québec, Canada. louise.lafortune.1@umontreal.ca
Source
Med Care. 2009 Mar;47(3):286-94
Date
Mar-2009
Language
English
Publication Type
Article
Keywords
Activities of Daily Living - classification
Aged
Aged, 80 and over
Community Health Planning
Comprehensive Health Care - economics - utilization
Delivery of Health Care, Integrated - economics - utilization
Female
Frail Elderly - statistics & numerical data
Health Care Costs
Health Services Accessibility
Health Services for the Aged - economics - utilization
Health Status Indicators
Humans
Male
Models, Econometric
Prevalence
Prospective Studies
Quebec - epidemiology
Residence Characteristics - statistics & numerical data
Socioeconomic Factors
Utilization Review
Abstract
We know that health status in older people is heterogeneous and that many need complex care. What is now required is a comprehensive description of this heterogeneity and the estimation of its effects on patterns of service utilization.
This study examines the possibility of classifying older people according to their complex health conditions and whether the way in which they consume services differs based on these classes.
We used latent class analysis to model heterogeneity and classify community living elderly into homogenous health state categories (ie, health profiles). The number of health profiles present in the sample was revealed using 17 health indicators collected at baseline in the demonstration project of SIPA (French acronym for System of Integrated Care for the frail elderly), a system of integrated care for frail older people (n = 1164). These profiles were then used in 2-part econometric models to study access and costs of several measures of services using data collected prospectively over the 22-months of the SIPA trial.
We identified 4 substantially meaningful health profiles (prevalence: 23%, 11%, 36%, 30%) characterized by differences along the physical, cognitive, and disability dimensions of health. Subsequent econometric modeling showed a differential effect of health profiles on use and costs along the continuum of health and social services.
For older people with complex care needs, classification into homogeneous health subgroups unmasks differences in utilization patterns that can be used by decision makers in their attempt to improve the trajectory of care and adjust the distribution of resources to the needs of older people.
PubMed ID
19165121 View in PubMed
Less detail

Implementing frailty into clinical practice: a cautionary tale.

https://arctichealth.org/en/permalink/ahliterature114184
Source
J Gerontol A Biol Sci Med Sci. 2013 Dec;68(12):1505-11
Publication Type
Article
Date
Dec-2013
Author
Nadia Sourial
Howard Bergman
Sathya Karunananthan
Christina Wolfson
Hélène Payette
Luis Miguel Gutierrez-Robledo
François Béland
John D Fletcher
Jack Guralnik
Author Affiliation
*These authors contributed equally to the design of the study and to the preparation of the article.
Source
J Gerontol A Biol Sci Med Sci. 2013 Dec;68(12):1505-11
Date
Dec-2013
Language
English
Publication Type
Article
Keywords
Aged
Canada - epidemiology
Chronic Disease - epidemiology
Data Interpretation, Statistical
Disability Evaluation
Disabled persons - statistics & numerical data
Female
Frail Elderly - statistics & numerical data
Geriatric Assessment - methods - statistics & numerical data
Humans
Incidence
Male
Models, Statistical
Nutrition Assessment
Prognosis
Prospective Studies
Risk factors
Sex Factors
United States - epidemiology
Abstract
Little is known about the contribution of frailty in improving patient-level prediction beyond readily available clinical information. The objective of this study is to compare the predictive ability of 129 combinations of seven frailty markers (cognition, energy, mobility, mood, nutrition, physical activity, and strength) and quantify their contribution to predictive accuracy beyond age, sex, and number of chronic diseases.
Two cohorts from the Established Populations for Epidemiologic Studies of the Elderly were used. The model with the best predictive fit in predicting 6-year incidence of disability was determined using the Akaike Information Criterion. Predictive accuracy was measured by the C statistic.
Incident disability was 23% in one cohort and 20% in the other cohort. The "best model" in each cohort was found to be a model including between five and seven frailty markers including cognition, mobility, nutrition, physical activity, and strength. Predictive accuracy of the 129 models ranged from 0.73 to 0.77 across both cohorts. Adding frailty markers to age, sex, and chronic disease increased predictive accuracy by up to 3% in both cohorts (p
Notes
Cites: J Gerontol A Biol Sci Med Sci. 2007 Jul;62(7):744-5117634322
Cites: Arch Intern Med. 2008 Feb 25;168(4):382-918299493
Cites: Age Ageing. 2008 Mar;37(2):161-618238805
Cites: BMC Geriatr. 2008;8:2718851754
Cites: J Am Geriatr Soc. 2008 Dec;56(12):2211-11619093920
Cites: J Am Geriatr Soc. 2009 Sep;57(9):1532-919682112
Cites: J Clin Epidemiol. 2010 Jun;63(6):647-5419880286
Cites: J Am Coll Surg. 2010 Jun;210(6):901-820510798
Cites: J Am Geriatr Soc. 2010 Aug;58(8):1526-3120633198
Cites: J Am Coll Cardiol. 2010 Nov 9;56(20):1668-7621050978
Cites: JAMA. 2011 Jan 5;305(1):50-821205966
Cites: BMC Geriatr. 2011;11:2321569509
Cites: Arch Gerontol Geriatr. 2012 Jan-Feb;54(1):16-2021339007
Cites: Arch Intern Med. 2011 Oct 24;171(19):1721-621788535
Cites: Arch Intern Med. 2011 Oct 24;171(19):1701-222025427
Cites: Circ Cardiovasc Qual Outcomes. 2012 Mar 1;5(2):222-822396586
Cites: Arch Intern Med. 2012 Jul 23;172(14):1096-10222710902
Cites: J Nutr Health Aging. 2012 Jul;16(7):599-60022836699
Cites: J Nutr Health Aging. 2012 Jul;16(7):601-822836700
Cites: J Gerontol A Biol Sci Med Sci. 2013 Jan;68(1):62-722511289
Cites: J Am Geriatr Soc. 1983 Dec;31(12):721-76418786
Cites: Biometrics. 1988 Sep;44(3):837-453203132
Cites: Radiology. 1982 Apr;143(1):29-367063747
Cites: Aging Clin Exp Res. 2003 Jun;15(3 Suppl):1-2914580013
Cites: J Gerontol A Biol Sci Med Sci. 2001 Mar;56(3):M146-5611253156
Cites: BMJ. 1999 Dec 11;319(7224):1562-510591726
Cites: Stat Med. 2008 Jan 30;27(2):157-72; discussion 207-1217569110
Cites: J Nutr Health Aging. 2008 Jan;12(1):29-3718165842
Cites: J Gerontol A Biol Sci Med Sci. 2007 Jul;62(7):731-717634320
Cites: N Engl J Med. 2006 Dec 21;355(25):2615-717182986
Cites: J Am Geriatr Soc. 2006 Jun;54(6):975-916776795
Cites: J Clin Epidemiol. 2005 Nov;58(11):1180-716223662
Cites: J Am Geriatr Soc. 2005 Aug;53(8):1321-3016078957
Cites: Aging (Milano). 1993 Feb;5(1):27-378481423
PubMed ID
23640761 View in PubMed
Less detail

Integrated services for frail elders (SIPA): a trial of a model for Canada.

https://arctichealth.org/en/permalink/ahliterature168840
Source
Can J Aging. 2006;25(1):5-42
Publication Type
Article
Date
2006
Author
François Béland
Howard Bergman
Paule Lebel
Luc Dallaire
John Fletcher
André-Pierre Contandriopoulos
Pierre Tousignant
Author Affiliation
Université de Montréal-McGill University Research Group on Integrated Services for Older Persons, Canada. francois.beland@umontreal.ca
Source
Can J Aging. 2006;25(1):5-42
Date
2006
Language
English
French
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Canada
Community Health Services - economics - organization & administration
Delivery of Health Care, Integrated - economics - organization & administration
Frail Elderly
Health Care Costs
Health Expenditures
Health Services for the Aged - economics - organization & administration
Humans
Male
Middle Aged
Patient satisfaction
Abstract
The complex formed by chronic illness, episodes of acute illness, physiological disabilities, functional limitations, and cognitive problems is prevalent among frail elderly persons. These individuals rely on assistance from social and health care programs, which in Canada are still fragmented. SIPA (Services intégrés pour les personnes âgées fragiles) is an integrated service model based on community services, a multidisciplinary team, case management that retains clinical responsibility for all the health and social services required, and the capacity to mobilize resources as required and according to the care protocol. The SIPA demonstration project used an experimental design, with random allocation of the 1,230 participants from two areas of Montreal to an experimental and a control group. The costs of institutional services were $4,270 less for those in the SIPA group compared to the control group; the costs of community care were $3,394 more. The proportion of persons waiting in acute care hospitals for nursing home placement was twice as high in the control group as in the SIPA group. The costs of acute hospitalizations for persons in the SIPA group with ADL disabilities were at least $4,000 lower than those for persons in the control group. In conclusion, the SIPA trial showed that it is possible to undertake ambitious and rigorous demonstration projects in Canada. These results were obtained without an increase in the overall costs of health and social services, without reducing the quality of care, and without increasing the burden on elderly persons and their relatives.
PubMed ID
16770746 View in PubMed
Less detail

A multidisciplinary systematic literature review on frailty: overview of the methodology used by the Canadian Initiative on Frailty and Aging.

https://arctichealth.org/en/permalink/ahliterature148030
Source
BMC Med Res Methodol. 2009;9:68
Publication Type
Article
Date
2009
Author
Sathya Karunananthan
Christina Wolfson
Howard Bergman
François Béland
David B Hogan
Author Affiliation
Solidage Research Group, McGill University/Université de Montréal, Montreal, Canada. sathya.karunananthan@mail.mcgill.ca
Source
BMC Med Res Methodol. 2009;9:68
Date
2009
Language
English
Publication Type
Article
Keywords
Aged
Aging
Biomedical Research - standards
Canada
Databases, Bibliographic
Frail Elderly
Geriatrics
Humans
Abstract
Over the past two decades, there has been a substantial growth in the body of literature on frailty in older persons. However, there is no consensus on its definition or the criteria used to identify frailty. In response to this lack of consensus, the Canadian Initiative on Frailty and Aging carried out a set of systematic reviews of the literature in ten areas of frailty research: biological basis; social basis; prevalence; risk factors; impact; identification; prevention and management; environment and technology; health services; health and social policy. This paper describes the methodology that was developed for the systematic reviews.
A Central Coordination Group (CCG) was responsible for developing the methodology. This involved the development of search strategies and keywords, article selection processes, quality assessment tools, and guidelines for the synthesis of results. Each review was conducted by two experts in the content area, with the assistance of methodologists and statisticians from the CCG.
Conducting a series of systematic literature reviews involving a range of disciplines on a concept that does not have a universally accepted definition posed several conceptual and methodological challenges. The most important conceptual challenge was determining what would qualify as literature on frailty. The methodological challenges arose from our goal of structuring a consistent methodology for reviewing literature from diverse fields of research. At the outset, certain methodological guidelines were deemed essential to ensure the validity of all the reviews. Nevertheless, it was equally important to permit flexibility in the application of the proposed methodology to capture the essence of frailty research within the given fields.
The results of these reviews allowed us to establish the status of current knowledge on frailty and promote collaboration between disciplines. Conducting systematic literature reviews in health science that involve multiple disciplines is a mechanism to facilitate interdisciplinary collaboration and a more integrated understanding of health. This initiative highlighted the need for further methodological development in the performance of multidisciplinary systematic reviews.
Notes
Cites: J Gerontol A Biol Sci Med Sci. 2004 Mar;59(3):255-6315031310
Cites: Am J Med. 2004 Feb 1;116(3):179-8514749162
Cites: Control Clin Trials. 1996 Feb;17(1):1-128721797
Cites: J Gerontol B Psychol Sci Soc Sci. 1998 Jan;53(1):S9-169469175
Cites: Assist Technol. 1997;9(2):140-5110177451
Cites: Arch Pediatr Adolesc Med. 1998 Jul;152(7):700-49667544
Cites: J Epidemiol Community Health. 1998 Jun;52(6):377-849764259
Cites: Ann Intern Med. 1999 Jun 1;130(11):945-5010375351
Cites: J Am Geriatr Soc. 2005 Jan;53(1):40-715667374
Cites: Ann Intern Med. 2005 Jun 21;142(12 Pt 2):1112-915968036
Cites: Age Ageing. 2005 Sep;34(5):432-416107450
Cites: BMJ. 2005 Nov 5;331(7524):1064-516230312
Cites: J Am Geriatr Soc. 2006 Apr;54(4):728-916686901
Cites: J Gerontol A Biol Sci Med Sci. 2007 Jul;62(7):731-717634320
Cites: Biol Psychiatry. 2000 Jan 15;47(2):144-5010664831
Cites: J Gerontol A Biol Sci Med Sci. 2001 Mar;56(3):M146-5611253156
Cites: Maturitas. 2001 Aug 25;39(2):147-5911514113
Cites: Evid Rep Technol Assess (Summ). 2002 Mar;(47):1-1111979732
Cites: Arch Phys Med Rehabil. 2003 Jun;84(6):890-712808544
Cites: Aging Clin Exp Res. 2003 Jun;15(3 Suppl):1-2914580013
Cites: J Gerontol A Biol Sci Med Sci. 2004 Sep;59(9):M962-515472162
PubMed ID
19821972 View in PubMed
Less detail

Opening the black box of clinical collaboration in integrated care models for frail, elderly patients.

https://arctichealth.org/en/permalink/ahliterature120871
Source
Gerontologist. 2013 Apr;53(2):313-25
Publication Type
Article
Date
Apr-2013
Author
Matthieu de Stampa
Isabelle Vedel
Howard Bergman
Jean-Luc Novella
Laurent Lechowski
Joel Ankri
Liette Lapointe
Author Affiliation
University of Versailles St-Quentin, UPRES EA 2506 Santé-Environnement-Vieillissement Research Group, Sainte Périne Hospital, AP-HP, 49 rue Mirabeau 75016, Paris, France. matthieu.destampa@spr.aphp.fr
Source
Gerontologist. 2013 Apr;53(2):313-25
Date
Apr-2013
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Canada
Cooperative Behavior
Delivery of Health Care, Integrated - organization & administration
Diffusion of Innovation
Frail Elderly
France
Health Services for the Aged - organization & administration
Humans
Interdisciplinary Communication
Interviews as Topic
Models, organizational
Patient care team
Physicians, Primary Care - psychology
Primary Health Care - organization & administration
Qualitative Research
Questionnaires
Abstract
The purpose of the study was to understand better the clinical collaboration process among primary care physicians (PCPs), case managers (CMs), and geriatricians in integrated models of care.
We conducted a qualitative study with semistructured interviews. A purposive sample of 35 PCPs, 7 CMs, and 4 geriatricians was selected in 2 integrated models of care for frail elderly patients in Canada and France: System of Integrated Care for Older Patients of Montreal and Coordination of Care for Older Patients of Paris. Data were analyzed using a grounded theory approach.
The dynamics of the collaboration process develop in three phases: (1) initiating relationships, (2) developing real two-way collaboration, and (3) developing interdisciplinary teamwork. The findings suggest that CMs and geriatricians collaborated well from the start and throughout the care management process. Real collaboration between the CMs and the PCPs occurred only later and was mostly fostered by the interventions of the geriatricians. PCPs and geriatricians collaborated only occasionally.
The findings provide information about PCPs' commitment to the integrated models of care, the legitimization of the CM's role among PCPs, and the appropriate positioning of geriatricians in such models.
PubMed ID
22961463 View in PubMed
Less detail

Prevalence, attributes, and outcomes of fitness and frailty in community-dwelling older adults: report from the Canadian study of health and aging.

https://arctichealth.org/en/permalink/ahliterature176276
Source
J Gerontol A Biol Sci Med Sci. 2004 Dec;59(12):1310-7
Publication Type
Article
Date
Dec-2004
Author
Kenneth Rockwood
Susan E Howlett
Chris MacKnight
B Lynn Beattie
Howard Bergman
Réjean Hébert
David B Hogan
Christina Wolfson
Ian McDowell
Author Affiliation
Division of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. kenneth.rockwood@dal.ca
Source
J Gerontol A Biol Sci Med Sci. 2004 Dec;59(12):1310-7
Date
Dec-2004
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Canada - epidemiology
Cohort Studies
Female
Frail Elderly - statistics & numerical data
Humans
Male
Physical Fitness
Prevalence
Prospective Studies
Abstract
Frailty and fitness are important attributes of older persons, but population samples of their prevalence, attributes, and outcomes are limited.
The authors report data from the community-dwelling sample (n = 9008) of the Canadian Study of Health and Aging, a representative, 5-year prospective cohort study. Fitness and frailty were determined by self-reported exercise and function level and testing of cognition.
Among the community-dwelling elderly population, 171 per 1000 were very fit and 12 per 1000 were very frail. Frailty increased with age, so that by age 85 years and older, 44 per 1000 were very frail. The risk for adverse health outcomes increased markedly with frailty: Compared with older adults who exercise, those who were moderately or severely frail had a relative risk for institutionalization of 8.6 (95% confidence interval, 4.9 to 15.2) and for death of 7.3 (95% confidence interval, 4.7 to 11.4). These risks persist after adjustments for age, sex, comorbid conditions, and poor self-rated health. At all ages, men reported higher levels of exercise and less frailty compared with women. Decreased fitness and increased frailty were also associated with poor self-ratings of health (42% in the most frail vs 7% in the most fit), more comorbid illnesses (6 vs 3), and more social isolation (34% vs 29%).
Fitness and frailty form a continuum and predict survival. Exercise influences survival, even in old age. Relative fitness and frailty can be determined quickly in a clinical setting, are potentially useful markers of the risk for adverse health outcomes, and add value to traditional medical assessments that focus on diagnoses.
PubMed ID
15699531 View in PubMed
Less detail

12 records – page 1 of 2.