Rapidly screening and estimating the risk of long LOS in the Emergency Room, as well as in hospital after admission from the ER, in older inpatients is relevant as it can help prioritize simple protective interventions.
Screening of older patients presenting a high risk of long LOS upon arrival to the ER is, therefore, the first step of an effective hospital care plan.
Several clinical tools have been proposed to this end, but most of them screen for frailty or chance of frailty-related adverse events after ER discharge. In Quebec, the “Programme de Recherche sur l’Intégration des Services pour le Maintien de l’Autonomie” (PRISMA-7) is the reference tool which is promoted by the Ministry of Health and Social Services for use in ERs and acute care wards. This tool, which separates older patients in two risk levels (i.e., low versus high), has never been validated for its predictive value relatively to the risk of long LOS.
Thus, examining the association of PRISMA-7 risk levels with long LOS in ER could be helpful with regard to the choice of prognostic tools.

• To examine the relationship between the risk stratification level of PRISMA-7 and LOS in ER, in older adults visiting the ED of the Jewish General hospital.

A score of PRISMA-7 ≥ 7 is associated with increased LOS in ER and in
hospital after admission through ER.

To compare the predictive value of PRISMA-7 with ER2 for LOS prediction, by
analyzing the database of the ER2 pre-post interventional study.

Dementia is a significant health issue because of its high prevalence and incidence, which is estimated to reach 20% in older population, but also because of its adverse consequences for both patients (e.g., disability, institutionalization) and the broader healthcare system (e.g., increased expenditures).
Predicting individuals at risk for dementia provides an opportunity to act on potent risk factors, with the aim of reducing its incidence rate. Slow walking speed and subjective cognitive impairment (SCI), defined as perceived changes in cognition in the absence of objective impairment, are two clinical characteristics which have been independently associated with an increased risk of dementia.
MCR has all the characteristics required for a clinical screening risk assessment for dementia in primary care populations. However, five years after its initial definition, MCR’s utility and its value in the prediction of dementia are still under question. For instance, a recent non-systematic review underscored the possibility of an MCR paradox, describing this syndrome as “a condition to treat or a mere matter for research purpose.” Data accumulated since initial definition appears to conflict with this assumption.

– To improve knowledge of MCR syndrome
– To confirm clinical utility of MCR syndrome

The design is a systematic review and meta-analysis of the scientific publications on MCR and data analysis of the Canadian Longitudinal Aging study and EPIDOS study.

– To better understand the relationship between MCR and adverse health outcomes (i.e., dementia, cognitive impairment, abnormal brain structures, falls and mortality)
– To promote the taking in consideration of MCR syndrome in primary care
– To improve the screening of older individuals at risk of dementia in primary care setting
– To make a crucial breakthrough in terms of epidemiology of MCR syndrome in the Canadian population
– To create and further networking advances: proposals will establish a unique, innovative and common forum on relationship
between gait and cognition interaction for researchers and clinicians between Canada, the US and Europe

Structural and functional brain imaging methods have identified age-related changes in the brain structures involved in gait control.

• To investigate grey matter networks associated with gait control in aging using structural covariance analysis

The design is a cross-sectional study Walking speed was measured in 326 non-demented community-dwelling elders (age 71.3±4.5; 41.7% female) under three different walking conditions: Normal walking, normal walking + two challenging tasks, one motor (i.e.; fast speed) and one attention-demanding (i.e.; backward counting) executed in a dual-task context.

Three main individual grey matter regions were positively correlated with walking speed (i.e.; slower walking speed was associated with lower brain volumes): Right thalamus, right caudate nucleus and left middle frontal gyrus; for normal walking, rapid walking, and dual-task walking conditions, respectively. The structural covariance analysis revealed that prefrontal regions were part of the networks associated with all walking conditions; the right caudate was associated specifically with the hippocampus, amygdala and insula for the rapid walking condition and the left middle frontal gyrus with a network involving the cuneus for the dual-task condition.

These results suggest that brain networks associated with gait control vary according to walking speed and depend on different walking conditions. Gait control in aging involves a broad network of cerebral regions, including regions for emotional control, which are solicited in challenging walking conditions.

Angers University Hospital, France

Department of Neurology, Geneva University Hospital, Switzerland

Institut universitaire de gériatrie de Montréal, University of Montreal

The Hospital Elder Life Program (HELP) is a comprehensive inpatient-care program which ensures optimal care for older adults in the hospital. The primary goals of the HELP program are: Maintaining cognitive and physical function in high risk older adults throughout hospitalization, maximizing independence at discharge, assisting with the transition from hospital to home, and preventing unplanned hospital readmissions. These goals have been accomplished using a multicomponent intervention strategy. In addition to targeted interdisciplinary geriatric assessment, the program uses an innovative volunteer model to provide personal, supportive attention to vulnerable older inpatients. Thus, the HELP program is complementary to the AAPA program. Both HELP and AAPA program have been used in care practice at the JGH since 2016. The effects of these program on preventing adverse health events in geriatric inpatients hospitalized at JGH must now be evaluated.

To examine whether the HELP program:

• reduces the incidence of delirium
• reduces the incidence of falls
• reduces the incidence of prolonged length of stay in older (i.e.; ≥ 65 years) inpatients admitted to the orthopaedic ward for hip surgery after a fracture

The study is a pre-post intervention, sequential, single arm, open-label, uncontrolled and prospective study.

Two consecutive periods were defined: An observational phase (i.e., pre-intervention), used as reference (i.e., control) period for the interventional phase, followed by an interventional phase which was separated in two sub-phases: Implementation (i.e., start-up) phase and full phase.

51 subjects were included, 28 in the observational phase and 23 in the interventional phase.

Populations in the observational and the interventional phases are quite identical, except that higher risk subjects were selected during the interventional phase.

No conclusive effects on length of stay were shown for the intervention. With regard to the small number of subjects included, and the impossibility to conclude on the effects of the HELP intervention, a new study can be designed. It can be a retrospective protocol concerned with all patients, demented or not, receiving surgery for all types of fractures in the Department of Orthopaedics at the Jewish General Hospital.

Foundation of the Jewish General Hospital

Department of Orthopaedics, Jewish General Hospital

Hospital Elder Life Program, Jewish General Hospital

Antipsychotics (AP) are frequently used in Quebec long-term care centres (LCT), especially in older residents with major neurocognitive disorders (MNCD), and behavioural and psychological symptoms of dementia (BPSD), with prevalence up to 50%. There are issues related to the prescription of APs: They are associated with adverse health events, high costs and poor quality of life; their appropriateness is often questioned because due to poor efficacy and safety concerns. Their high prevalence is an indicator of suboptimal care. In 2017, the Quebec Health and Social Services Ministry in partnership with the Canadian Foundation for Healthcare Improvement launched the pilot phase of OPUSAP in 24 LTC with the overall objective to 1) Improve the appropriateness of AP use in older residents with MNCD and BPSD and 2) Prioritize the use of non-pharmacological interventions. OPUS-AP is a conference and webinar-based training (integrated knowledge) program designed to mentor healthcare personnel (i.e., physicians, pharmacologists, nurses, physiotherapists, orderlies) which has been designed to: 1) Improve knowledge on the optimal use of AP, 2) Provide guidelines on AP deprescribing, and use of patient-centred care and non-pharmacological interventions to treat BPSD. OPUS-AP is a solution designed to develop standardized and objective best practices using a structured online assessment with recurring assessments of health condition and AP prescription in LTC residents, as well as of the occurrence of adverse health events including falls, admission in acute care and death. OPUS-AP is an epidemiologic method of monitoring of the evolution of AP prescription and health condition in older residents living in LTC, and changes in professional practices.

• To examine the effects of OPUS-AP on changes in AP prescription, health condition and use of non-pharmacological interventions in older LTC residents with MNCD and BPSD
• To perform a qualitative analysis of the implementation of OPUS-AP in LTC staff daily practice

The design is a longitudinal, prospective, multicentre cohort study designed with repetitive measures. Quantitative and qualitative variables are recorded.

OPUS-AP is composed of two consecutive phases: A pilot phase in 24 LTC facilities, followed by an extension phase to 136 LTC centres which will include around 3,000 residents in total.

To improve clinical practices, in particular the deprescribing of APs by staff working in longterm care centres

To support changes to best practices for the prescription of APs through adequate training methods and standardized follow-up assessments

To develop the OPUSAP online platform, which is a specific tool built for spreading OPUS-AP program knowledge and maintaining thusly acquired skills

CIUSSS Estrie CHUSs, CISSSs and CIUSSSs of Quebec

Ministry of Health and Social Services

Canadian Foundation for Healthcare Improvement (CFHI)

National Institute of Excellence in Health and Social Services

Regroupement provincial des comités des usagers

Quebec Federation of Alzheimer Societies

We previously developed and validated a simple clinical tool, known as ER², for use upon arrival at the hospital during an Emergency Department (ED) visit to screen older ED users at risk of adverse events. ER² provides risk stratification on three levels (i.e., low, moderate and high), which predicts prolonged hospital stays, readmissions after ED visits, and in-hospital and long-term mortality. ER² has many criteria (i.e., easy to use, objective, standardized and based on collection of clinical information) required for an efficient and effective risk stratification of unplanned hospital admissions. Therefore, its use in primary care could be helpful for the care continuum. ER² has not yet been used in primary care to identify community-dwelling elders who are at risk for unplanned hospital admission. We hypothesized that ER² and its a priori risk stratification could be associated with incident unplanned, primary care hospital admissions in community-dwelling elders who consult with their general practitioner (GP).

• To examine the association between the a priori risk stratification levels of ER² as performed by a GP during a primary care consultation and incident unplanned hospital admissions in community-dwelling elders

The design is an observational prospective population-based cohort study. 668 participants (mean age 84.7±3.9 years; 64.7% female) were recruited by their GPs during an index primary care visit. The 6-item BGA was performed at baseline assessment to provide an a priori risk stratification on three levels (low, moderate, high).

Incident unplanned hospital admissions were recorded during a 6-month follow-up period. The incidence of unplanned hospital admissions increased with the risk level defined by the 6-item BGA, with the highest prevalence (35.3%) being reported at the high-risk level (P=0.001). The risk for unplanned hospital admissions in the high-risk level was significant (crude Odds Ratio (OR)=5.48, P=0.001 and fully adjusted OR=3.71, P=0.032, crude Hazard ratio (HR)=4.20; P=0.002 and fully adjusted HR=2.81; P=0.035). The Kaplan-Meier distribution of incident unplanned hospital admissions differed significantly between the three risk levels (P-value=0.002). Participants at the high-risk level were more frequently admitted to hospital than those at the low risk level (P=0.001).

Further research is needed to confirm this first result, to allow for recommending this clinical tool as early as possible for preventative or curative action on unplanned hospital admission risk factors.

Gérontopôle des Pays de la Loire, France Laboratoires MSD France