The purpose of the research was to determine the effectiveness of care for seniors in the acute phase of illness or injury admitted to acute geriatric units compared to seniors not admitted to these specialized centres.

“It is the first study to quantify the effectiveness of an innovative function-focused approach to older adults' acute hospital care,” says 91ŃÇÉ« Professor Mary Fox of the graduate program in nursing in 91ŃÇÉ«'s School of Nursing, Faculty of Health. She is the first author of the article, “”, published online Friday in the . It will also be published in an upcoming print version of the journal.

Mary Fox

As the principal investigator of the Canadian Institutes of Health Research-funded study, Fox conducted a systematic review and meta-analysis of 13 trials involving 6,839 acutely ill or injured octogenarians. Acute geriatric units are those with at least one Acute Care for Elders (ACE) component, either patient-centred care, frequent medical review, early rehabilitation, early discharge planning or prepared environment. The goal of ACE components is to prevent hospital-acquired complications and functional deterioration associated with common hospital medications, treatments and procedures for older adults.

The researchers also found that seniors admitted to acute geriatric units had less delirium and were more likely to be discharged home as opposed to a nursing facility.

“It demonstrated that this approach has significant beneficial effects in improving both patient- and system-level outcomes over usual care,” says Fox. “Hospital administrators may anticipate cost savings of approximately $246 per person, per length of hospital stay (in US dollars, standardized to year 2000) and a reduced length of hospital stay by more than half a day, when compared to usual care.”

Seniors aged 65 and older are considered the “core business” of hospitals. They account for 40 per cent of all hospital care days even though they comprise only 14 per cent of the Canadian population.

“As older adults account for 50 per cent of Canadian hospital expenditures,” says Fox, "this cost difference may represent a significant future source of financial saving to Canada's health-care system while improving patient outcomes.”

It is known that older adults face a higher risk of functional decline, falls, pressure ulcers and delirium when hospitalized, which is associated with increased hospital costs, institutionalization and death. “These poor outcomes are more often not related to their illness, but to other things, like not getting up and walking around while in the hospital or receiving treatments, such as drugs and catheters that make it difficult to move around. There are things that fall through the cracks,” says Fox. Early intervention is crucial in helping to circumvent these risks.

The goal is to develop senior-friendly hospitals by informing and engaging decision makers – clinicians, hospital administrators, policymakers and funders – about the best interventions to prevent physical, cognitive and psychosocial functional decline. Acute geriatric care units would not only save hospitals money, but provide the most beneficial care for seniors.

91ŃÇÉ« nursing Professors Malini Persaud, Deborah Tregunno and Ellen Schraa, along with 91ŃÇÉ« librarian IIo-Katryn Maimets, were co-authors of the study, which included a team of researchers from 91ŃÇÉ«, Ryerson University and the University of Toronto.

The study was also supported by a 91ŃÇÉ« Faculty of Health Junior Faculty award.

By Sandra McLean, YFile deputy editor

Republished courtesy of YFile– 91ŃÇɫ’s daily e-bulletin to research stories on the research website.

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The study, conducted at the Ontario Science Centre, looked at more than 1,000 children and adolescents from ages eight to 18. While boys and girls reported the same frequency of persistent pain – lasting three months or more – teenage girls experienced more anxiety and tended to catastrophize over pain to a greater degree than their male peers.  

“Boys who experience pain may feel less comfortable expressing their feelings because they are deemed socially inappropriate – or it may be that boys simply experience less anxiety in relation to pain,” says study lead author Samantha Fuss (MA ’10), a PhD student in psychology at 91ŃÇÉ«. “Even teenage girls who haven’t experienced persistent pain showed significantly higher levels of pain anxiety than boys their age.”   

Overall, 27 per cent of participants reported experiencing persistent pain. The study is published in the latest issue of the journal .

Study co-author Joel Katz, a 91ŃÇÉ« psychology professor and , says more research is needed to understand the psychological factors relating to pain in youth. 

Left: Joel Katz

“Persistent pain in children and teenagers isn’t a rare occurrence. There are gaps in our understanding of the time course of pain and the developmental trajectories,” Katz says. “For example, how does the presence of pain in these life stages relate to pain in adulthood?”

Researchers looked at psychological variables including anxiety, anxiety sensitivity and pain catastrophizing – a tendency to worry about pain and feel helpless in the face of it.

Boys 12 to 18 years of age were significantly more likely to experience persistent pain than younger boys, while there was no difference between age groups for girls.

Fuss points out that girls more frequently seek medical attention for illness and pain than do boys – which makes their findings all the more intriguing.

“Our sample wasn’t drawn from a clinical setting – such as interviewing patients at a walk-in clinic,” she says. “This is a fairly representative sample of Toronto children and adolescents who happened to be visiting the Science Centre with their parents.”

Katz notes that the greater prevalence of chronic pain in women versus men may be tied to psychological factors that appear in childhood.

“Anxiety sensitivity is thought to be a vulnerability factor for the development of chronic pain. The finding that girls had higher levels of anxiety sensitivity than boys may partly explain why the prevalence of chronic pain is greater in women than men,” he says.

“It’s a complex web to untangle in terms of physical versus psychological,” says Fuss. “Is it that the psychological experience of pain differs between the sexes – or even age groups – or is it differences in the physical experience of pain? How are they linked? These are certainly important questions in terms of diagnosis and pain management.”

Fuss’ research is supervised by Katz. Their work is funded by a Canadian Institutes of Health Research Canada Graduate Scholarship to Fuss, and a Canada Research Chair in Health Psychology to Katz.

Republished courtesy of YFile– 91ŃÇɫ’s daily e-bulletin.

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Join Professor William Gage, associate dean of research & innovation in the Faculty of Health (FoH) at 91ŃÇÉ«, and Professor Andrew Eckford of 91ŃÇɫ’s Department of Computer Science & Engineering in the Faculty of Science & Engineering (FSE), for the launch of the eHealth Alliance brown bag lecture series. They will discuss the importance of accelerometers in studying the walking behaviour and interactions of participants in their natural environment.

Right: William Gage

The first eHealth Alliance lecture, “Wireless Accelerometers to Monitor Walking Activity and Behaviour”, will take place Thursday, Oct. 20, from 3 to 4pm at 402 Health, Nursing & Environmental Studies Building (HNES), Keele campus.

Gage and Eckford will also look at why these walking measurements are changing how scientists understand the activity levels of healthy individuals, and importantly, how illness and injury alter activity levels.

“We will describe the development our sensor system and contrast this development with other sensor systems in the literature; we will focus the application of our measurement system with healthy individuals, patients with stroke and patients with knee replacement,” says Gage, also a professor in the School of Kinesiology & Health Science, where he teaches a graduate level course in biomechanics and neuromuscular control of posture and gait.

Left: Andrew Eckford

Gage holds scientific appointments as an associate scientist in the Centre for Stroke Recovery at Sunnybrook Health Science Centre and as a scientist at Toronto Rehabilitation Institute. He is particularly interested in how balance and walking are affected by age, by joint disease, such as arthritis, and by stroke.

A graduate of the Royal Military College of Canada and the University of Toronto, Eckford has written many papers on wireless networking and has research interests in wearable wireless networks, as well as signal processing for biomechanics. He also holds an adjunct professorship at the University of Toronto.

The eHealth Alliance came about after some 30 faculty members from the School of Health Policy & Management, FoH, and the Department of Computer Science & Engineering, FSE, got together. They discussed the need for building a 91ŃÇÉ« alliance in e-health that would bring the two Faculties together with relevant 91ŃÇÉ« and external partners, such as industry leaders, 91ŃÇÉ« Region hospitals and the Central LHIN - Local Health Integration Network, says Professor Serban Dinca, undergraduate program director, coordinator of the Health Informatics Certificate in the School of Health Policy & Management and eHealth Alliance chair.

“The eHealth Alliance lecture series is the first step in coagulating the alliance and making connections with the industry,” says Dinca.

See the following list for upcoming eHealth Alliance lecture presenters:

• Nov. 17 - Serban Dinca, undergraduate program director and coordinator of the Health Informatics Certificate in the School of Health Policy & Management, from 3 to 4pm at 402 HNES Building
• Dec. 15 - Amir Asif, chair of the Department of Computer Science & Engineering, from 3 to 4pm at 3033 Computer Science & Engineering Building
• Jan. 19 - Harvey Skinner, dean of the Faculty of Health, from 3 to 4pm at 402 HNES Building
• Feb. 16 - Professor Farah Ahmad of the School of Health Policy & Management, from 3 to 4pm at 402 HNES Building

Republished courtesy of YFile– 91ŃÇɫ’s daily e-bulletin.

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