Risk for short-term undesirable outcomes in older emergency department users: Results of the ER2 observational cohort study.

BACKGROUND: The "Emergency Room Evaluation and Recommendations" (ER2) is a clinical tool designed to determine prognosis for the short-term Emergency Department (ED) undesirable outcomes including long length of stay (LOS) in ED and in hospital, as well as the likelihood of hospital admission during an index ED visit. It is also designed to guide appropriate and timely tailor-made geriatric interventions. This study aimed to examine whether ER2 assessment part was: 1) usable by ED healthcare workers (e.g. nurses) and 2) scoring system associated with long LOS in ED and in hospital, as well as hospital admission in older ED users on stretchers. METHODS: Based on an observational, prospective and longitudinal cohort study 1,800 participants visiting the ED of the Jewish General Hospital (Montreal, Quebec, Canada) were recruited between September and December 2017. ER2 assessment determined three risk-levels (i.e., low, medium and high) for short-term ED undesirable outcomes. The rate of ER2 digital form completed, the time to fill ER2 items and obtain ER2 risk-levels, the LOS in ED and in hospital, and hospital admission were used as outcomes. RESULTS: ER2 was usable by ED nurses in charge of older ED users. High-risk group was associated with both increased ED stay (coefficient of regression ß = 3.81 with P≤0.001) and hospital stay (coefficient of regression ß = 4.60 with P = 0.002) as well as with hospital admission (HR = 1.32 with P≤0.001) when low ER2 risk level was used as referent level. Kaplan-Meier distributions showed that the three risk groups of participants differed significantly (P = 0.001). Those with high-risk level (P≤0.001) were discharged later from hospital to a non-hospital location compared to those with low risk. There was no significant difference between those classified in low-risk and in medium-risk groups (P = 0.985) and those in medium and high-risk groups (P = 0.096). CONCLUSION: The ER2 assessment part is usable in daily practice of ED care and its risk stratifications may be used to predict adverse outcomes including prolonged LOS in ED and in hospital as well as hospital admission. TRIAL REGISTRATION: NCT03964311.

Prognosis tools for short-term adverse events in older emergency department users: result of a Québec observational prospective cohort.

BACKGROUND: The "Program of Research on the Integration of Services for the Maintenance of Autonomy" (PRISMA-7) and "Emergency room evaluation and recommendations" (ER2) are both clinical tools used in Québec Emergency Departments (EDs) for screening of older ED users at higher risk of poor outcomes, such as prolonged length of stay (LOS) in EDs and in hospital. The study aimed to: 1) examine whether the PRISMA-7 and ER2 risk levels were associated with length of stays in ED and hospital, as well as hospital admission; and 2) compare the criteria performance (i.e., sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratios and area under receiver operating characteristic curve) of the PRISMA-7 and ER2 high-risk levels for these three ED adverse events in Québec older patients visiting ED on a stretcher. METHODS: A total of 1905 older patients who visited the ED of the Jewish General Hospital (Montreal, Québec, Canada) on stretchers were recruited in this prospective observational cohort. Upon their ED arrival, PRISMA-7 and ER2 were performed. The outcomes were LOS in ED and in hospital, and hospital admission. RESULTS: The PRISMA-7 and ER2 risk levels were associated with length of stay in ED and hospital as well as with hospital admission. Prolonged stays and higher hospitalization rates were associated with high-risk levels, whereas those in low-risk level groups had significantly shorter LOS and a lower rate of hospital admission (P < 0.006). While performance measures were poor for both assessment tools, ER2 had a greater prognostic testing accuracy compared with PRISMA-7. CONCLUSION: PRISMA-7 and ER2 were both associated with incidental short-term ED adverse events but their overall prognostic testing accuracy was low, suggesting that they cannot be used as prognostic tools for this purpose.

Long-term effects of the Montreal museum of fine arts participatory activities on frailty in older community dwellers: results of the A-Health study.

PURPOSE: The study aims (1) to examine the long-term effects (i.e., at 12 months) of the Montreal museum of fine arts (MMFA) participatory art-based activities on frailty in a subset of participants of the Art and Health (A-Health) study and (2) to compare these long-term effects with short-term effects (i.e., at 3 months). METHODS: The A-Health study is a pre-post intervention, single arm, prospective and longitudinal study. A subset of 101 participants (67.3%) who completed the 12-month follow-up assessment was selected for this study. The intervention consisted in one weekly structured participatory art-based workshop over a 3-month period. Participants were separated according to their frailty status: vigorous (i.e., no frailty) versus mild frailty, moderate frailty and frailty merging mild and moderate frailty. Frailty was assessed before the intervention (M0), at the end of the 3-month intervention (M3) and 12 months (M15) after the end of the intervention. RESULTS: The mean value of frailty score was lower after the intervention compared to the beginning, regardless of the time of the assessments (i.e., M3 and M15). The proportion of vigorous participants increased and the proportion of mild frail participants decreased at the end of the intervention (i.e., M3) but no long-term effect was shown (i.e., M15) compared to M0. The proportion of moderate frail participants and frail participants at M15 were significantly lower compared to M0. CONCLUSION: The MMFA participatory art-based activities improved frailty at short and long terms, suggesting that it could be an effective way to promote an active and healthy aging. TRIAL REGISTRATION: NCT03557723; Title: Effect of Art Museum Activity Program for the Elderly on Health: A Pilot Study; First submission date: January 31, 2018; First posted date: June 15, 2018; prospectively registered.

Effects of participatory art-based painting workshops in geriatric inpatients: results of a non-randomized open label trial.

BACKGROUND: Art-based activities like painting workshops demonstrated health benefits in older individuals living in home care facilities. Few studies examined the effects of painting workshops in geriatric inpatients. AIM: The study aims to examine whether the participation in painting workshops performed in patients admitted to a geriatric acute care ward reduced the number of medications taken daily, use of psychoactive medications, the length of stay and inhospital mortality. METHODS: Based on a non-randomized open label trial, 79 inpatients who participated in painting workshops and 79 control inpatients were recruited in the geriatric acute care ward of the Jewish general hospital (Montreal, Quebec, Canada). Four outcomes were used: the number of medications taken daily and use of psychoactive medications the day of discharge to geriatric acute care ward, the length of hospital stay and inhospital mortality. RESULTS: The participation in Painting workshops were associated with a lower number of medications taken daily at discharge (Coefficient of regression ß = - 1.35 with P = 0.001) and lower inhospital mortality (odd ratio (OR) = 0.09 with P = 0.031). No significant association was reported with use of psychoactive medications and length of stay. CONCLUSION: The participation in painting workshops reduced the number of medications taken daily and incident inhospital mortality in geriatric inpatients admitted to a geriatric acute care ward, suggested a positive effect on health condition of this participatory art-based activity.

Effects of "Thursdays at the Museum" at the Montreal Museum of Fine Arts on the mental and physical health of older community dwellers: the art-health randomized clinical trial protocol.

BACKGROUND: Recently, we demonstrated that the Montreal Museum of Fine Arts' (MMFA) participatory art-based activity, known as "Thursdays at the Museum," improved the well-being, quality of life, and physical health (i.e., frailty) of older community dwellers by using a pre-post intervention, single arm, prospective and longitudinal experimental design. The present randomized clinical trial (RCT), known as the Art-Health RCT (A-Health RCT), aims to compare changes in well-being, quality of life, frailty, and physiological measures in older community dwellers who participate in "Thursdays at the Museum" (intervention group) and in their counterparts who do not participate in this art-based activity (control group). METHODS/DESIGN: The current unicenter, randomized, clinical, controlled, comparative trial recruits 150 older community dwellers to two parallel arms (75 participants in the intervention group and 75 participants in the control group). The intervention is a 3-month cycle of weekly "Thursdays at the Museum," which are structured 2-h-long art-based workshops performed in a group setting at the MMFA. The control group is composed of participants who do not take part in art-based activities, receive their usual health and/or social services, and commit to report any other activity practiced during the same time. Assessments of the primary outcome (well-being) and the secondary outcomes (quality of life, frailty, and physiological measures including heart rate, daily step count, sleep duration, and its phases) are performed on six occasions: at baseline, at the beginning of the second and third months, at the end of the third month, as well as 6 and 12 months after the last workshop. Statistical analyses are performed with the intention to treat and per protocol. Comparisons of changes in outcome measures between intervention and control groups use repeated measures tests. DISCUSSION: Art-based activities carried out at museums have been receiving increased interest from researchers and policy-makers because of their benefits to mental and physical health. There are few robust studies, such as RCTs, that focus on older community dwellers or assess the efficacy of these participatory museum activities. The A-Health RCT study provides an opportunity to confirm the benefits of a participatory art-based museum activity on the elderly population and to show the key role played by museums in public health promotion. TRIAL REGISTRATION: NCT03679715 ; Title: A-Health RCT: Effects of Participatory Art-Based Activity on Health of Older Community Dwellers; First posted date: September 20, 2018; prospectively registered.

Effects of Vitamin D and Calcium Fortified Yogurts on Gait, Cognitive Performances, and Serum 25-Hydroxyvitamin D Concentrations in Older Community-Dwelling Females: Results from the GAit, MEmory, Dietary and Vitamin D (GAME-D2) Randomized Controlled Trial.

BACKGROUND: Vitamin D3 fortified food may improve serum vitamin D level, suggesting that the prevention of adverse consequences of hypovitaminosis D is possible with food fortification. The aim of this randomized controlled trial (RCT) was to examine the effects of vitamin D and calcium fortified yogurt on spatiotemporal gait parameters, cognitive performance, handgrip strength, and serum 25OHD levels in healthy older females. METHODS: Forty older community-dwelling females were recruited in a single-blind, randomized, controlled, superiority clinical trial in two parallel groups (20 participants in the intervention group and 20 in the control group) with intent-to-treat. The intervention group took fortified yogurts daily (i.e., 400 UI of vitamin D3 and 800 mg calcium) for 3 months. The non-fortified yogurts contained similar proteins, carbohydrates and lipids, as well as a lower dose of calcium (300 mg) and no vitamin D3 supplementation. Spatiotemporal gait parameters (mean value and coefficient of variation) were assessed using a computerized walkway. Handgrip strength was measured with hydraulic dynamometers. Cognitive performances, including global cognitive functioning assessed with the Mini Mental Status Examination (MMSE) were recorded. All the outcomes were assessed at baseline and at the end of follow-up. The primary outcome was the coefficient of variation of stride time. RESULTS: The intervention group maintained its global cognitive performance and serum 25OHD concentrations, whereas these outcomes decreased (i.e., worst performance) in the control group. The changes in the MMSE score (p = 0.022) and serum 25OHD concentrations were different (p ≤ 0.001) with better values reported in the intervention group compared to the control group. There was no significant change in gait parameters (p ≥ 0.518) and handgrip strength (p ≥ 0.600). CONCLUSIONS: Fortified yogurts with vitamin D (i.e., 200 IU) and calcium (i.e., 400 mg) twice a day maintained global cognitive performance and vitamin D status in older females, but not gait performances, signifying that they mainly prevent hypovitaminosis D-related extra-skeletal disorders.

[The DATEL (diagnosis for territorial action environment and longevity), a territorial diagnosis for a future with our elders]. / Le diagnostic action territorial environnement longévité (Datel) : un diagnostic territorial pour construire un avenir commun avec les aînés.

The territorial structure is such that it is necessary to go through a step of diagnosis. Ageing must be apprehended in all its aspects, but the multiplicity of actors involved prevents the local powers from getting a comprehensive vision of the stakes and from implementing the adequate policies. The gerontopôle of "Pays de Loire" has developed an original method of diagnosis consisting in a comprehensive approach so called DATEL (diagnosis for territorial action environment and longevity). It is based on three aspects: an analysis of the geographical areas, a diagnosis shared by citizens and local councilors according to the Vancouver method, and a prospective review of the medico-social and health situation which integrates all services and forces at work and their potential demographic evolution. This DATEL aims to give local politicians the means to take well-informed decisions that will sustain the rapid demographic evolution of the ageing population and will maintain a good quality of life for our elders.