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 researchers systematically screened more than 50,000 articles on existing studies of acute care for elders interventions, and included 63 different studies in either a narrative or meta-analysis.

91ŃÇÉ« nursing Professor Mary Fox, the study's principal investigator, unveiled the preliminary findings at 91ŃÇÉ« Central Hospital recently, while Michael Johnny of the Knowledge Mobilization (KM) unit provided KMb strategies to help the hospital determine how to disseminate the information.

Above: Mary Fox with participants at the unveiling at 91ŃÇÉ« Central Hospital

The goal of the research is to develop senior-friendly hospitals by informing and engaging decision makers about the best interventions to prevent functional cognitive, social and physical decline in older adults when they are hospitalized. Seventy-five per cent of people age 65 and older have two chronic illnesses and that can lead to a sudden worsening of their condition requiring hospitalization, says Fox.

Right: Mary Fox

“Sixty-two per cent of all day beds in acute care are filled with people 65 years of age and older and they make up only 13 per cent of the population. They really are the core care customer for acute care hospitals,” she says. “My role is to get the evidence and engage the decision makers and researchers in interpreting it for their context. We’re not just rolling it out, but engaging them from the very beginning so the information will be more useful.”

Left: Deborah Tregunno

The study also looked at what the system needs to provide and what interventions are needed to best serve seniors in acute care hospitals.

“I was interested in the study because there is really a lot of evidence that says when older people visit hospitals, they are at risk of experiencing bad outcomes,” says Fox. “The poor outcomes are not related to their illness, but to other things, like not getting up and walking around while in the hospital or not eating well. There are things that fall through the cracks.”

91ŃÇÉ« Central Hospital is interested in knowing what those things are so they can provide even better care for older adults.

Professor Deborah Tregunno and Professor Malini Persaud, a former post-doctoral fellow, both of 91ŃÇÉ«'s School of Nursing in the Faculty of Health, along with 91ŃÇÉ« librarian IIo-Katryn Maimets and researchers from Ryerson University and the University of Toronto, were co-investigators of the study.

The team also included Michael Johnny, Andrea England, director of research and partnerships in the Faculty of Health, 91ŃÇÉ« adjunct librarian Angela Hamiton and decision-making partners Tiziana Rivera, chief practice officer at 91ŃÇÉ« Central Hospital, and Dr. Mary Ferguson-ParĂ©, former vice-president of professional affairs and chief nurse executive at University Health Network.

By Sandra McLean, YFile writer

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

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It will not only ensure patients receive leading-edge care but help build a reputation for excellence at the hospital, the [91ŃÇÉ« Central] chief of emergency medicine says. And that's why he is participating in the initiative.

Knowledge translation, Ghosh explains, makes that important link between research and its application in health care. "We know there is good evidence-based, science-based research that has not been translated into clinical practice," he says. "A gap exists."

To narrow that gap, 91ŃÇÉ« Central Hospital made a decision to forge a collaborative effort with 91ŃÇÉ« about two years ago. Researchers with a specialty in two of YCH's areas of focus, seniors' health and chronic disease management, now have offices at the hospital.

For example, Dr. William Gage, whose research focuses on seniors' health, has connected 91ŃÇÉ« Central staff with a 91ŃÇÉ« researcher examining changes in motor performance among patients with mild cognitive impairment.

Researcher Sherry Grace [] worked with Tiziana Rivera, chief practice officer at 91ŃÇÉ« Central and others on publishing a review of studies on women and cardiac rehabilitation, program adherence and preference for alternative models of care. YCH staff can use the information when setting rehabilitation programs for their female cardiac patients.

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

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Beginning with the 2011 census, held every five years, Industry Minister Tony Clement is doing away with the mandatory long form, which had been sent to one in five Canadians. The much shorter survey that goes to all Canadians will remain compulsory.

Instead of forcing 20 per cent of the population to fill out the long form under threat of jail time and fines, Clement said a third of Canadians will be sent the long form, which they can voluntarily complete.

But the change has prompted an outcry across the country from people who believe making the long form voluntary will result in less accurate information.

91ŃÇÉ« Professor Valerie Preston, director of CERIS, told Toronto Community News she is upset with the changes. “We have a 97 per cent compliance response to the (mandatory) long form and so it gives us a very complete picture of Canadians. A voluntary survey will not give us anything like that compliance rate. It won’t even approach it,” she said.

Communities such as recent immigrants and lower-income Canadians who move often will be less likely to fill out a voluntary survey, she added. And less reliable census information could mean the needs of the most vulnerable, such as newcomers to Canada, the elderly, the poor and single parents, will be ignored, she said.

“I’m very concerned,” she said. “Without that information, how are you going to transfer (government) funds where they are most needed?”

Preston argued reputable public polling firms, which rely on voluntary responses, can start out with a sample of 17,000 possible respondents but only end up getting answers from 1,000 people.

Republished courtesy of

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In February, Barbara Crow will meet with her mother-in-law’s quilting bunch in Peterborough, her mother’s synagogue friends in Toronto and a group of retirees in Duncan, British Columbia. She and co-researcher Kim Sawchuk of Concordia University want to know whether and how seniors use cellphones.

Right: Barbara Crow

“Many senior citizens use these mobile technologies, yet they are completely absent from any discussion on their use,” says Crow (BA Hons. ’84, MA ’86, PhD ’94), a communications and women’s studies professor and now associate dean of research for 91ŃÇɫ’s Faculty of Liberal Arts & Professional Studies.

Seventy-two per cent of Canadians have access to cellphones, and wireless carriers offer coverage to more than 99 per cent of Canadians. More than a phone, it is increasingly versatile – the communications device of choice for sending text messages, taking photos, surfing the Internet, listening to music, playing games and updating a calendar.

The industry markets almost exclusively to youth and middle-aged professionals. And researchers studying cellphone use have also focused on the young and upwardly mobile.

Left: Kim Sawchuk

Crow and (PhD ’86, PhD ’91) have begun preliminary research to find out if, how and why seniors are using mobile technologies. “We both have aging parents and we’ve been watching how cellphones are changing everyday lives,” says Crow. They have received a three-year standard grant totalling $103,903 to complete this research by 2011.

“Kim and I argue that individuals over 60 are soon going to make up a larger proportion of the population than youth,” says Crow, who has been studying digital technologies and their social, cultural, political and economic impact since the early 1980s.

“So many government services are online,” says Crow. Yet many older people, especially impoverished women, have no way to access those services. “Do we think because people can’t afford them, they shouldn’t have access to them?” The question is, “How can we ensure their needs are going to be served?”

Compared to other countries, information and communication technology services in Canada – including cellphone and Internet – cost more and deliver less, says Crow. A 2009 by Harvard University's Berkman Center for Internet & Society ranked Canada in the bottom third among 30 countries for speed and cost.

If these new communications devices are so critical and costs are high, who is being penalized? Those on lower incomes, including the elderly, suggest Crow and Sawchuk.

“With our research, we’ll be able to say to government, here’s a list of things you should think about when designing public services,” says Crow, who, believe it or not, doesn’t own a cellphone.

“This is about making a group who can provide us with wisdom and reflection a part of significant changes that are happening,” says Crow.

This research could lead to other projects. For Crow and Sawchuk, the growing popularity of cellphones raises questions around communications policy: What portion of the spectrum of airwaves used to transmit digital signals should be public and not commercial? How do we address privacy issues? Cellphones work best in urban areas, but should the government ensure rural and remote parts of Canada also have access?

Crow and Sawchuk are also co-directors of the , which supports interdisciplinary research into wireless communications and mobile technology. They are co-editors, along with 91ŃÇÉ« Professor Michael Longford, of The Wireless Spectrum: The Politics, Practices, and Poetics of Mobile Media, to be published by  the University of Toronto Press this year.

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

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