Cannabis use in a Canadian long-term care facility: a case study.

BACKGROUND: Following the legalization of cannabis in Canada in 2018, people aged 65 + years reported a significant increase in cannabis consumption. Despite limited research with older adults regarding the therapeutic benefits of cannabis, there is increasing interest and use among this population, particularly for those who have chronic illnesses or are at end of life. Long-term Care (LTC) facilities are required to reflect on their care and policies related to the use of cannabis, and how to address residents' cannabis use within what they consider to be their home. METHODS: Using an exploratory case study design, this study aimed to understand how one LTC facility in western Canada addressed the major policy shift related to medical and non-medical cannabis. The case study, conducted November 2021 to August 2022, included an environmental scan of existing policies and procedures related to cannabis use at the LTC facility, a quantitative survey of Healthcare Providers' (HCP) knowledge, attitudes, and practices related to cannabis, and qualitative interviews with HCPs and administrators. Quantitative survey data were analyzed using descriptive statistics and content analysis was used to analyze the qualitative data. RESULTS: A total of 71 HCPs completed the survey and 12 HCPs, including those who functioned as administrators, participated in the interview. The largest knowledge gaps were related to dosing and creating effective treatment plans for residents using cannabis. About half of HCPs reported providing care in the past month to a resident who was taking medical cannabis (54.9%) and a quarter (25.4%) to a resident that was taking non-medical cannabis. The majority of respondents (81.7%) reported that lack of knowledge, education or information about medical cannabis were barriers to medical cannabis use in LTC. From the qualitative data, we identified four key findings regarding HCPs' attitudes, cannabis access and use, barriers to cannabis use, and non-medical cannabis use. CONCLUSIONS: With the legalization of medical and non-medical cannabis in jurisdictions around the world, LTC facilities will be obligated to develop policies, procedures and healthcare services that are able to accommodate residents' use of cannabis in a respectful and evidence-informed manner.

Prevalence of obesity and elevated body mass index along a progression of rurality: A cross-sectional study - The Canadian Longitudinal Study on Aging.

Introduction: Obesity is an important public health concern, and large studies of rural-urban differences in prevalence of obesity are lacking. Our purpose is to compare body mass index (BMI) and obesity in Canada using an expanded definition of rurality. Methods: A cross-sectional analysis of self-reported BMI across diverse communities of Canadians aged 45-85 years was conducted using data from the Canadian Longitudinal Study on Aging (CLSA), a national sample representative of community-dwelling residents. Rurality was identified in the CLSA based on residential postal codes, which were divided into 4 categories: urban, peri-urban, mixed and rural. Logistic regression models were constructed to calculate adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs) between obesity (BMI ≥30 kg/m2 from self-reported weight and height) and rurality, adjusting for age, sex, province, marital status, number of residents in household and household income. Results: Twenty-one thousand one hundred and twenty-six Canadian residents aged 45-85 years, surveyed during 2010-2015, were included. 26.8% were obese. Obesity was less prevalent amongst urban (25.2%) than rural (30.3%, P < 0.0001), mixed (28.7%, P < 0.0001) or peri-urban communities (28.1%, P < 0.0001). When compared to urban areas, the aOR (95% CI) for obesity was 1.09 (1.00-1.20) in rural regions and 1.20 (1.08-1.35) in peri-urban settings. In areas of mixed urban and rural residence, the aOR was 1.12 (0.99-1.27). Conclusion: One in four Canadian adults were obese. Living in a non-urban setting is an independent risk factor for obesity. Rural-urban health disparities could underlie rural-urban differences, but further research is needed.

Résumé Introduction: L'obésité est un important problème de santé publique et des études de grande envergure sur les différences de prévalence de l'obésité entre les régions rurales et urbaines font défaut. Notre objectif est de comparer l'indice de masse corporelle (IMC) et l'obésité au Canada en utilisant une définition élargie de la ruralité. Méthodes: Une analyse transversale de l'IMC autodéclaré dans diverses communautés de Canadiens âgés de 45 à 85 ans a été réalisée à l'aide des données de l'Étude longitudinale canadienne sur le vieillissement (ELCV); un échantillon national représentatif des résidents vivant en communauté. Dans l'ELCV, la ruralité a été identifiée à partir des codes postaux résidentiels, qui ont été divisés en 4 catégories: urbain, périurbain, mixte et rural. Des modèles de régression logistique ont été construits pour calculer les rapports de cotes ajustés (RCa) avec des intervalles de confiance à 95% (95% IC) entre l'obésité (IMC ≥30 kg/m2 à partir du poids et de la taille autodéclarés) et la ruralité, en tenant compte de l'âge, du sexe, de la province, de l'état civil, du nombre de résidents dans le ménage et du revenu du ménage. Résultats: 21 126 résidents canadiens âgés de 45 à 85 ans, interrogés au cours de la période 2010-2015, ont été inclus. 26,8% étaient obèses. L'obésité était moins répandue dans les communautés urbaines (25,2%) que rurales (30,3%, P < 0,0001), mixtes (28,7%, P < 0,0001) ou périurbaines (28,1%, P < 0,0001). Par rapport aux zones urbaines, le RCa (95% IC) pour l'obésité était de 1,09 (1,00, 1,20) dans les régions rurales, et de 1,20 (1,08, 1,35) dans les milieux périurbains. Dans les zones de résidence mixte urbaine et rurale, le RCa était de 1,12 (0,99, 1,27). Conclusion: Un adulte canadien sur quatre était obèse. Le fait de vivre dans un milieu non urbain est un facteur de risque indépendant d'obésité. Les disparités en matière de santé entre les régions rurales et urbaines pourraient être à l'origine de ces différences, mais des recherches supplémentaires sont nécessaires. Mots-clés: Rural, Obésité, Indice de masse corporelle, ELCV.

Functional status in rural and urban adults: The Canadian Longitudinal Study on Aging.

PURPOSE: To document the prevalence of functional impairment in middle-aged and older adults from rural regions and to determine urban-rural differences. METHODS: We have conducted a secondary analysis using data from an ongoing population-based cohort study, the Canadian Longitudinal Study on Aging (CLSA). We used a cross-sectional sample from the baseline wave of the "tracking cohort." The definition of rurality was the same as the one used in the CLSA sampling frame and based on the 2006 census. This definition includes rural areas, defined as all territory lying outside of population centers, and population centers, which collectively cover all of Canada. We grouped these into "Urban," "Peri-urban," "Mixed" (areas with both rural and urban areas), and "Rural," and compared functional status across these groups. Functional status was measured using the Older Americans Resource Survey (OARS) and categorized as not impaired versus having any functional impairment. Logistic regression models were constructed for the outcome of functional status and adjusted for covariates. FINDINGS: No differences were found in functional status between those living in rural, mixed, peri-urban, and urban areas in unadjusted analyses and in analyses adjusting for sociodemographic and health-related factors. There were no rural-urban differences in any of the individual items on the OARS scales. CONCLUSIONS: We found no rural-urban differences in functional status.

Healthcare utilisation among Canadian adults in rural and urban areas - The Canadian Longitudinal Study on Aging.

OBJECTIVE: The objective is to determine the use of health-care services (physician visits, emergency department use and hospitalisations) in rural areas and examine differences in four geographic areas on a rural to urban spectrum. METHODS: We conducted a secondary analysis of cross-sectional data from a population-based prospective cohort study, the Canadian Longitudinal Study on Aging (CLSA). Participants included community-dwelling adults aged 45-85 years old from the tracking cohort of the CLSA (n = 21,241). Rurality was classified based on definitions from the CLSA sampling frame and similar to the 2006 census. Main outcome measures included self-reported family physician and specialist visits, emergency department visits and hospitalisations within the previous 12 months. Results were compared for four geographic areas on a rural-urban continuum. Univariate and bivariate analyses were performed on data from the 'tracking cohort' of the CLSA, Chi-square tests were used for categorical variables. Logistic regression models were created for the main outcome measures. RESULTS: Participants in rural and mixed rural and urban areas were less likely to have seen a family physician or a specialist physician compared to urban areas. Those living in rural and peri-urban areas were more likely to visit an emergency department compared to urban areas. These differences persisted after adjusting for sociodemographic and health-related variables. There were no significant rural-urban differences in hospitalisations. CONCLUSION: Rural-urban differences were found in visits to family physicians, specialists and emergency departments.

Objectif: Déterminer l'utilisation des services de santé (consultations chez un médecin, visites à l'urgence et hospitalisations) dans les régions rurales et examiner les différences dans 4 régions géographiques sur un spectre rural-urbain. Méthodologie: Nous avons réalisé une analyse secondaire des données transversales tirées d'une étude de cohorte prospective de population, l'étude CLSA (Canadian Longitudinal Study on Aging). La population était composée d'adultes vivant en communauté de 45 à 85 ans ayant participé à la cohorte de suivi de l'étude CLSA (N = 21 241). La ruralité était classée en fonction des définitions du cadre d'échantillonnage de l'étude CLSA et était semblable au recensement de 2006. Les principaux paramètres d'évaluation étaient les consultations rapportées par les patients chez un médecin de famille et un spécialiste, les visites à l'urgence et les hospitalisations durant les 12 mois précédents. Les résultats ont été comparés sur un continuum rural-urbain dans 4 régions géographiques. Des analyses univariées et bivariées ont été réalisées sur les données de la " cohorte de suivi " de l'étude CLSA, les tests de chi carré ont été utilisés pour les variables catégoriques. Des modèles de régression logistique ont été créés pour les principaux paramètres d'évaluation. Résultats: Les participants des régions rurales et mixtes rurales-urbaines avaient moins tendance à avoir vu un médecin de famille ou un spécialiste comparativement aux participants des régions urbaines. Les sujets des régions rurales et périurbaines avaient plus tendance à s'être rendus à l'urgence comparativement aux sujets des régions urbaines. Ces différences ont persisté après ajustement en fonction des variables sociodémographiques et liées à la santé. On n'a observé aucune différence significative des hospitalisations entre les régions rurales et urbaines. Conclusion: Des différences entre les régions rurales et urbaines ont été observées pour les consultations aux médecins de famille et aux spécialistes, et les visites à l'urgence. Mots-clés: Canadian Longitudinal Study on Aging, disparités rurales-urbaines, visites chez le médecin, hospitalisations, utilisation des soins de santé.

Pressure Ulcers Among Newly Admitted Nursing Home Residents: Measuring the Impact of Transferring From Hospital.

OBJECTIVES: Pressure ulcers (PUs) are reported more often among newly admitted nursing home (NH) residents who transfer from hospital versus community. We examine for whom this increased risk is greatest, further defining hospitalized patients most in need of better PU preventive care. RESEARCH DESIGN: Retrospective observational cohort study. SUBJECTS: All NH residents (N=5617) newly admitted between April 1, 2008 and March 31, 2012 in Winnipeg, MB, Canada. MEASURES: RAI-MDS 2.0 data were linked to administrative health care use files capturing each person's NH admission date, their presence of a PU at this time, whether they transferred into NH from hospital or community, and their PU susceptibility (eg, amount of help needed to maneuver in bed or to transfer from one surface to another, frequency of incontinence, presence of diabetes, amount of food consistently left uneaten). Log-binomial regression with interaction terms was used to analyze data. RESULTS: 67.6% of our cohort transferred into a NH directly from hospital; 9.2% of these residents were reported to have a stage 1+ PU on NH admission versus 2.6% of those who transferred from community. From regression models, transferring from hospital versus community was associated with increased PU risk equally across various subgroups of less and more susceptible residents. CONCLUSIONS: Transferring from hospital versus community places both more and less susceptible newly admitted NH residents at increased PU risk. Using evidence-based preventive care practices is thus needed for all subgroups of hospital patients before NH use, to help reduce PU risk.