Geriatric care physicians' perspectives on providing virtual care: a reflexive thematic synthesis of their online survey responses from Ontario, Canada.

BACKGROUND: During the COVID-19 pandemic, telemedicine was widely implemented to minimise viral spread. However, its use in the older adult patient population was not well understood. OBJECTIVE: To understand the perspectives of geriatric care providers on using telemedicine with older adults through telephone, videoconferencing and eConsults. DESIGN: Qualitative online survey study. SETTING AND PARTICIPANTS: We recruited geriatric care physicians, defined as those certified in Geriatric Medicine, Care of the Elderly (family physicians with enhanced skills training) or who were the most responsible physician in a long-term care home, in Ontario, Canada between 22 December 2020 and 30 April 2021. METHODS: We collected participants' perspectives on using telemedicine with older adults in their practice using an online survey. Two researchers jointly analysed free-text responses using the 6-phase reflexive thematic analysis. RESULTS: We recruited 29 participants. Participants identified difficulty using technology, patient sensory impairment, lack of hospital support and pre-existing high patient volumes as barriers against using telemedicine, whereas the presence of a caregiver and administrative support were facilitators. Perceived benefits of telemedicine included improved time efficiency, reduced travel, and provision of visual information through videoconferencing. Ultimately, participants felt telemedicine served various purposes in geriatric care, including improving accessibility of care, providing follow-up and obtaining collateral history. Main limitations are the absence of, or incomplete physical exams and cognitive testing. CONCLUSIONS: Geriatric care physicians identify a role for virtual care in their practice but acknowledge its limitations. Further work is required to ensure equitable access to virtual care for older adults.

Geriatric Specialists' Perspectives on Telemedicine during the COVID-19 Pandemic: a Concurrent Triangulation Mixed-Methods Study.

During the COVID-19 pandemic, physicians provided virtual care to minimize viral transmission. This concurrent triangulation mixed-methods study assesses the use of synchronous telephone and video visits with patients and asynchronous eConsults by geriatric providers, and explores their perspectives on telemedicine use during the pandemic. Participants included physicians practicing in Ontario, Canada who were certified in Geriatric Medicine, or Care of the Elderly, or who were the most responsible physician in a long-term care for at least 10 patients. Participants' perspectives were solicited using an online survey and themes were generated through a reflexive thematic analysis of survey responses. We assessed the current use of each telemedicine tool and compared the proportion of participants using telemedicine before the pandemic with self-predicted use after the pandemic. We received 29 surveys from eligible respondents (87.9% completion rate), with 75.9% being geriatricians. The telephone was most used (96.6%), followed by video (86.2%) and eConsults (64%). Most participants using telephone and video visits had newly implemented them during the pandemic and intend to continue using these tools post-pandemic. Our thematic analysis revealed that telemedicine plays an important role in the continuity of care during the pandemic, with increased self-reported positive perspectives and openness towards use of virtual care tools, although limited by inadequate physical exams or cognitive testing. Its ongoing use depends on the availability of continued remuneration.

Palliative Care Interventions Effects on Psychological Distress: A Systematic Review & Meta-Analysis.

BACKGROUND: Managing psychological distress is an objective of palliative care. No meta-analysis has evaluated whether palliative care reduces psychological distress. OBJECTIVES: Examine the effects of palliative care on depression, anxiety, and general psychological distress for adults with life-limiting illnesses and their caregivers. DESIGN: We searched PubMed, PsycInfo, Embase, and CINAHL for randomized clinical trials (RCTs) of palliative care interventions. RCTs were included if they enrolled adults with life-limiting illnesses or their caregivers, reported data on psychological distress at 3 months after study intake, and if authors had described the intervention as "palliative care." RESULTS: We identified 38 RCTs meeting our inclusion criteria. Many (14/38) included studies excluded participants with common mental health conditions. There were no statistically significant improvements in patient or caregiver anxiety (patient SMD: -0.008, P = 0.96; caregiver SMD: -0.21, P = 0.79), depression (patient SMD: -0.13, P = 0.25; caregiver SMD -0.27, P = 0.08), or psychological distress (patient SMD: 0.26, P = 0.59; caregiver SMD: 0.04, P = 0.78). CONCLUSIONS: Psychological distress is not likely to be reduced in the context of a typical palliative care intervention. The systemic exclusion of patients with common mental health conditions in more than 1/3 of the studies raises ethical questions about the goals of palliative care RCTS and could perpetuate inequalities.

Association of death or illness from COVID-19 among family and friends on vaccine uptake within four months of the Emergency Use Authorization. Findings from a national survey in the United States.

OBJECTIVE: To examine the relationship between knowing that a friend or family member became ill with, or died from, COVID-19 and receiving a vaccine dose within four months of the FDA's Emergency Use Authorization. METHODS: A national sample of 1,517 respondents were surveyed from April 7 to April 12, 2021, 1,193 of whom were eligible for the vaccine when the data were collected. RESULTS: Respondents who knew someone who became ill with COVID-19 (AOR = 2.32, 95 % CI 1.74-3.09) or knew someone who died (AOR = 2.29, 95 % CI 1.32-3.99) from COVID-19 were more likely to receive at least a single COVID-19 vaccine dose. CONCLUSION: Encouraging people to share their COVID-19 illness and bereavement experiences with their local network such as friends, families, social-networks and via social media might help increase vaccine uptake.

Validation of the Sour Seven Questionnaire for screening delirium in hospitalized seniors by informal caregivers and untrained nurses.

BACKGROUND: Delirium is a common condition in hospitalized seniors that nonetheless often goes undetected by nurses or is delayed in being detected which negatively impacts quality of care and outcomes. We sought to develop a new screening tool for delirium, The Sour Seven Questionnaire, a 7-item questionnaire suitable to be completed from informal or untrained caregiver observation. The study aimed to develop the scoring criteria for a positive delirium screen and assess concurrent validity of the questionnaire against a geriatric psychiatrist's assessment. METHODS: A pilot study of 80 hospitalized seniors over age 65 recruited from three units (2 medical, 1 orthopedic). Participants were assessed using the Confusion Assessment Method (CAM) with a brief cognitive screen and the Sour Seven Questionnaire posed to the appointed informal caregiver (family member) or untrained nurse for up-to 7 days. Subjects testing positive on the CAM and a random sample of negatively CAM screened subjects were assessed by the geriatric psychiatrist. RESULTS: From 80 participants, 21 screened positive for delirium on the CAM. 18 of the 21 CAM positive screens were diagnosed to have delirium by the geriatric psychiatrist, and 17 of the 18 randomly assigned negative CAM screens were confirmed as not having delirium. From the questionnaires on these 39 participants, weighted scoring for each of the 7 questions of the Sour Seven Questionnaire was developed based on their relative risks for correctly predicting delirium when compared to the geriatric psychiatrist's clinical assessment. Total scoring of the questionnaire resulted in the following positive predictive values for delirium: 89% with a total score of 4 (sensitivity 89.5%, specificity 90%), and 100% with a total score of 9 (sensitivity 63.2%, specificity 100%). Comparison between scoring on questionnaires posed to informal caregivers versus untrained nurses showed no differences. CONCLUSION: A weighted score of 4 in the Sour Seven Questionnaire has concurrent validity as a screening tool for delirium and a score of 9 is diagnostic for delirium. The Sour Seven Questionnaire is the first screening tool for delirium shown to be suitable for use by informal caregivers and untrained nurses in hospitalized seniors.

Maternal and newborn health profile in a first nations community in Canada.

OBJECTIVES: We sought to characterize maternal health profiles and birth outcomes among First Nations people living in Southern Ontario. METHODS: We performed a retrospective chart review of all 453 women from the Six Nations Reserve, Ontario, who were pregnant between 2005 and 2010. Maternal health behaviours, past medical history, physical measurements, birth outcomes, and newborn characteristics were abstracted. Key maternal and newborn characteristics were compared with those of a cohort of non-First Nations women recruited from nearby Hamilton, Ontario. RESULTS: The average age of women in the study cohort was 25.1 ± 6.2 (mean ± SD) years, and 75.8% were multiparous. The mean pre-pregnancy BMI was 28.3 ± 6.6 kg/m(2), and the average weight gain in pregnancy was 14.9 ± 8.3 kg. Mean weight gain during pregnancy was inversely associated with pre-pregnancy BMI, and 57.1% of women gained more than the recommended weight. The prevalence of type 2 diabetes or gestational diabetes was 4.7%, hypertension was present before or during pregnancy in 5.6%, and 35% used tobacco during pregnancy. The mean gestational age at delivery was 39.5 ± 1.7 weeks and the mean crude birth weight was 3619 ± 557 g. The main determinants of newborn weight included sex of the newborn, pre-pregnancy BMI, and weight gain during pregnancy. Compared with a contemporary cohort of 622 non-First Nations mothers and newborns, First Nations mothers were, on average, younger (25.1 vs. 32.1 years; P < 0.001), had a higher mean pre-pregnancy BMI (28.3 vs. 26.8 kg/m(2); P < 0.001), and were more likely to use tobacco during pregnancy (35.0% vs. 14.4%; P < 0.001). First Nations newborns had significantly higher mean birth weight (+176 grams) and length (+2.3 cm) than non-First Nations newborns. CONCLUSION: First Nations mothers from the Six Nations Reserve tended to have a high pre-pregnancy BMI, tended to gain more than the recommended weight during pregnancy, and commonly used tobacco during pregnancy. Programs to prevent overweight/obesity and excess weight gain during pregnancy and to minimize smoking are required among women of child-bearing age in this community.

Objectifs : Nous avons cherché à caractériser les profils de santé maternelle et les issues de l'accouchement chez les peuples des Premières Nations vivant dans le sud de l'Ontario. Méthodes : Nous avons mené une analyse rétrospective des dossiers des 453 femmes de la Six Nations Reserve, en Ontario, qui étaient enceintes entre 2005 et 2010. Les comportements de santé maternelle, les antécédents médicaux, les mesures physiques, les issues de l'accouchement et les caractéristiques néonatales ont fait l'objet d'un résumé. Les caractéristiques maternelles et néonatales clés ont été comparées à celles d'une cohorte de femmes n'étant pas issues des Premières Nations qui ont été recrutées tout près, à Hamilton, en Ontario. Résultats : L'âge moyen des femmes de la cohorte d'étude était de 25,1 ± 6,2 ans (moyenne ± σ) et 75,8 % d'entre elles étaient multipares. L'IMC prégrossesse moyen était 28,3 ± 6,6 kg/m2 et le gain pondéral moyen pendant la grossesse était de 14,9 ± 8,3 kg. Le gain pondéral moyen pendant la grossesse était inversement proportionnel à l'IMC prégrossesse et 57,1 % des femmes ont dépassé le gain pondéral recommandé. La prévalence du diabète de type 2 ou du diabète gestationnel était de 4,7 %, une hypertension était présente avant ou pendant la grossesse chez 5,6 % des participantes et 35 % d'entre elles ont consommé du tabac pendant la grossesse. L'âge gestationnel moyen au moment de l'accouchement était de 39,5 ± 1,7 semaines et le poids de naissance brut moyen était de 3 619 ± 557 g. Parmi les principaux déterminants du poids néonatal, on trouvait le sexe du nouveau-né, l'IMC prégrossesse et le gain pondéral pendant la grossesse. Par comparaison avec une cohorte contemporaine de 622 mères et nouveau-nés n'étant pas issus des Premières Nations, les mères issues de ces dernières étaient, en moyenne, plus jeunes (25,1 vs 32,1 ans; P < 0,001), présentaient un IMC prégrossesse moyen plus élevé (28,3 vs 26,8 kg/m2; P < 0,001) et étaient plus susceptibles de consommer du tabac pendant la grossesse (35,0 % vs 14,4 %; P < 0,001). Les nouveau-nés issus des Premières Nations présentaient une longueur (+2,3 cm) et un poids de naissance (+176 grammes) moyens considérablement plus élevés, par comparaison avec les nouveau-nés n'étant pas issus des Premières Nations. Conclusion : Les mères issues des Premières Nations de la Six Nations Reserve ont eu tendance à présenter un IMC prégrossesse élevé et à dépasser le gain pondéral recommandé pendant la grossesse, en plus de consommer couramment du tabac pendant cette période. Des programmes qui visent la prévention de la surcharge pondérale / de l'obésité et du gain pondéral excédentaire pendant la grossesse, et qui visent à minimiser le tabagisme s'avèrent requis pour les femmes en âge de procréer de cette communauté.