The cumulative use of anticholinergic and sedative medications has been associated with lower physical function in older adults. This study aimed to identify which physical function attributes are most impacted in subgroups aged 45–64 and 65–85 years. Baseline data from 30,097 community-living Canadians in the Canadian Longitudinal Study on Aging were analysed using a cross-sectional design. Anticholinergic and sedative medications use was quantified using the Drug Burden Index (DBI). Physical functioning was measured via the timed 4-meter walk, Timed Up and Go (TUG), single leg balance, chair rise and grip strength. Physical functioning profiles were generated using latent profile analysis of the five tests. Associations between DBI scores and physical functioning were assessed through linear regression and multinomial logistic regression. The mean age of participants was 63.0, 50.9

Although social participation and connection are essential for healthy aging, many older adults face isolation. Since most studies are cross-sectional, little is known about the trajectories of social participation and connection. This study aimed to compare social participation and connection trajectories among aging women and men, and examine their predictors. Secondary analyses of six-year longitudinal data from the Canadian Longitudinal Study on Aging were conducted at baseline (2011-2015), and follow-ups 1 (2015-2018) and 2 (2018-2021; n = 51,338; 59.8 ± 10.2). Social participation and connection were modeled using group-based multi-trajectory modeling. Multilevel multinomial logistic regressions identified baseline individual and environmental predictors. Four trajectories were identified (most to least prevalent): Moderate-high, Moderate, Low, and High. Participation decreased but women globally maintained higher participation than men, and connection remained similar over time and across sexes. Being older, lower mobility, insufficient income, and poor mental and, for men only, physical health were associated with less favorable trajectories for both sexes. While immigration increased the odds of unfavorable trajectories among women, and of the Moderate trajectory among men, visible minority status was associated with the High trajectory. After adjustment, 17-28% of the variance in trajectories was attributable to community. Social deprivation increased the odds of less favorable trajectories, whereas rural areas were associated with higher odds of belonging to the High trajectory. Social participation and connection trajectories are shaped by place and space. These findings suggest that sex-specific, age-friendly urban planning and economic support are essential for maintaining social participation and connection in later life.

Cumulative exposure to anticholinergic and sedative medications has been associated with worsening physical function in older adults. We evaluated the feasibility of measuring physical function using wearable devices and explored the impact of reducing the anticholinergic and sedative medication burden in a pilot study of community-dwelling adults aged 60 years and older. Evaluations included the 10-meter walk test (10MWT), the Short Physical Performance Battery (SPPB), and the mini-BESTest. Two participants/month were recruited in one clinic in 2022. The five participants had a median age of 67, a median DBI of 1.7, and four were female. The feasibility analysis showed that the 10MWT and SPPB tests were completed on 12/12, and the mini-BESTest on 11/12. An exploratory analysis showed clinically meaningful improvements in gait speed (mean +0.18 m/s) and SPPB (mean +2.2 points). We showed the feasibility of measuring physical function by wearable devices during deprescribing of anticholinergic and sedative medications.

Potentially inappropriate medications (PIMs) are frequent in older adults, contributing to hospitalizations, adverse events, and healthcare burden. We aimed to estimate direct PIM cost trends from 2012 to 2021 among older women and men in Quebec, Canada. Using medico-administrative data, we assessed direct costs paid by the public insurer (medication cost and professional fee, excluding out-of-pocket payments by individuals) of PIMs claimed by adults ≥65 years covered by the public drug plan. Costs for 16 PIM classes, identified using 2015 and 2019 Beers criteria, were calculated and stratified by sex and age group (65-74, 75-84, ≥85) for each fiscal year. We assessed the proportion of PIMs among all medication expenditures. We computed average costs/enrollee and usage prevalence for the costliest PIM classes. Trends were estimated using univariate linear regression with 95% confidence intervals. We found a non-statistically significant decrease in total PIM claim costs, from $206 million in 2012 to $186 million in 2021 (trend: -2.9[-17.4; 11.6]), representing 5.4% of medication expenditures for adults ≥65 in 2021. The reduction in total costs was more accentuated in women, whose annual costs were higher than those of men in all age groups. Average cost/enrollee decreased from $179 to $119 (trend: -7[-19; 5]), with a drop from $216 to $142 for women and $132 to $92 for men. Costs/enrollee were higher in 75-84 and ≥85 age groups. Costliest PIM classes included proton-pump inhibitors, benzodiazepines, antipsychotics, antidepressants, estrogens (women), and hypoglycemic agents (men). Cost trends did not always follow prevalence trends for these PIM classes. PIM costs among older adults slightly decreased from 2012 to 2021. Appropriate prescribing and deprescribing appear crucial for reducing these costs. Further research should focus on estimating the societal impact and the cost-effectiveness analysis of deprescribing initiatives and other regulatory measures.

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is the causative agent of COVID-19 and has infected >700 million persons worldwide. Individuals infected with SARS-CoV-2 are at risk for cognitive decline and at higher risk of dementia compared with those diagnosed with other respiratory tract infections. Data from animal models suggest that SARS-CoV-2 infection triggers an overaggressive neuroinflammatory response resulting in myelin loss. Whether SARS-CoV-2 is associated with myelin loss in older individuals remains unknown. We investigated the impact of SARS-CoV-2 on myelin in older individuals from the Canadian Longitudinal Study on Aging COVID-19 Brain Health Study who underwent brain MRIs. We included SARS-CoV-2 confirmed cases at baseline (2021-2022) via positive serological testing or health care provider diagnosis. Non-infected controls had negative serological testing and reported no COVID-19 diagnosis. Myelin data were acquired via myelin water imaging using a 3D MRI gradient and spin echo sequence for T2 measurement. Myelin content was extracted from 16 regions-of-interest within the cerebral white matter. 3D T1-weighted scans were acquired for registrations and to estimate intracranial volume. T2- and PD-weighted scans were acquired for segmentation of white matter lesions. We performed cross-sectional comparisons via analysis of covariance. Exploratory analyses were conducted to assess the association of SARS-CoV-2-related symptom incidence and severity with myelin content by group. All models were adjusted for age, age 2 , sex, ethnicity, white matter lesion burden, intracranial volume, and study site. We included 352 community-dwelling individuals (SARS-CoV-cases, n= 64; controls, n=288). Their mean [SD] age was 65.26 (8.35) years, and 50.3% were female. There were no differences between SARS-CoV-2 cases and controls on myelin content across all regions-of-interest. Cases showed greater incidence ( p <0.001) and severity ( p <0.001) of symptoms compared with controls (Figure 1). Exploratory analysis revealed significant interactions between symptom incidence and severity with group after correcting for multiple comparisons (Table 1, p corrected < 0.05). Post hoc analysis showed that symptom incidence and severity were inversely associated with myelin in SARS-CoV-2 cases but not in controls across multiple regions-of-interest (Figure 2). Myelin loss may occur in older individuals who experienced greater incidence and severity of SARS-CoV-2 infection symptoms.

Excessive polypharmacy, which is defined as the use of ten medications or more, poses considerable challenges regarding patient health and healthcare resources. Individuals who exhibit excessive polypharmacy are predisposed to adverse drug effects, drug interactions, and non-adherence, which can result in increased hospitalization, emergency room visits, and mortality. Given their expertise in medication management, pharmacists are uniquely positioned to address the risks associated with excessive medication use. Therefore, exploring their role in this phenomenon across their various fields of practice is essential. The aim of this review was to summarize the existing literature on the role of pharmacists in addressing excessive polypharmacy in different care settings and to highlight areas where more research is needed. A scoping review was conducted by adopting Arksey and O’Malley’s methodological framework, along with subsequent enhancements implemented by Levac et al. It was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) guidelines. A comprehensive search was conducted across five databases: MEDLINE, EMBASE, PubMed, CINAHL and Cochrane CENTRAL from their inception until June 2024. Covidence was used for data selection and extraction. The results were analyzed using narrative synthesis. We identified 5236 articles, of which 19 were included. All studies were available in English and were conducted in high-income countries with the majority (84

Medications with anticholinergic effects are widely used despite the mounting evidence of physical and cognitive impairment associated with their use among older adults. A systematic review was conducted to describe the prevalence of anticholinergic medication use in community-dwelling older adults, document the factors associated with their use and describe the most frequently used medication classes. MEDLINE, Embase and CINAHL were searched from inception to May 2024. All study designs except case reports and case studies were eligible if they included community-dwelling older adults aged 65 and older and assessed the factors associated with anticholinergic medication use. An open-source artificial intelligence screening tool was used to optimise title and abstract screening. The subsequent review of the full texts of potentially eligible studies and data extraction were conducted in the Covidence systematic review tool using standardised data collection forms. Study quality was assessed with the Newcastle–Ottawa scale. The study selection, data extraction and quality assessment were conducted independently by two reviewers. From 4139 records of interest, the seven selected studies included five cross-sectional and two retrospective studies, published between 2014 and 2021. The risk of bias was assessed to be low in five studies and high in two studies. Greater anticholinergic burden was associated with female sex, lower socioeconomic status, higher co-morbidity score, higher frailty probability, specific diseases, polypharmacy and greater use of healthcare, while increasing age was associated with both increased and decreased anticholinergic burden. Anticholinergic exposure, varied from a low of 6.2

Background and Aims:Delivering preventive care to older adults presents challenges due to the lack of consensus on screening items, particularly regarding geriatric syndromes. Furthermore, chronological age often differs from biological age, which requires primary care clinicians (PCCs) to assess each patient's aging profile and tailor preventive interventions accordingly. Periodic Health Assessments (PHAs) offer an opportunity to administer preventive care. While several authors have developed Structured Clinical Tools (SCTs) to assist clinicians during PHAs, no SCT is widely used across clinicians. The study aims to identify existing SCTs for the PHA of older adults and evaluate their content, formats, and practical usability. Methods:We conducted a scoping review following the 6-step methodology recommended by Arksey and O'Malley (2005) and Levac (2010). We searched in PubMed, CINAHL, and Ageline, as well as in the grey literature, using keywords related to four main concepts: older adults, primary care, periodic health assessment, and SCT. We retrieved SCTs published in French and English between 2000 and 2024. Data were screened and charted by two independent reviewers. For step six (consultation), we gathered opinions of 10 PCCs on the practical usability of different SCTs. Results:Among the 8029 identified publications, we retrieved 16 distinct SCTs. Design objectives and conception processes of these SCTs varied. They were presented in various formats, including questionnaires, tables, schemas, checklists, acronyms, and mnemonics. While all SCTs addressed geriatric syndromes, only two adapted their recommendations to patients' aging profiles. Consulted PCCs emphasized that an ideal SCT should be integrated into an electronic health record, accommodate various aging profiles, and rely on evidence-based medicine. Conclusions:A reliable and user-friendly SCT for the PHA of older adults would facilitate the delivery of preventive care. However, no published SCTs to date meet the expectations of PCCs. Further research is necessary to develop one.

BackgroundThere is an increasing prevalence of multiple conditions (multimorbidity) and multiple medications (polypharmacy) across many populations. Previous literature has focused on the prevalence and impact of these health states separately, but there is a need to better understand their co-occurrence.Methods and findingsThis study reported on multimorbidity and polypharmacy among middle-aged and older adults in two national datasets: the Canadian Longitudinal Study on Aging (CLSA) and the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). Using consistent methodology, we conducted a cross-sectional analysis of CLSA participants and CPCSSN patients aged 45 to 85 years as of 2015. When multimorbidity was defined as two or more conditions, the prevalence was 66.7% and 52.0% in the CLSA and CPCSSN cohorts, respectively. The prevalence of polypharmacy was 14.9% in the CLSA cohort and 22.6% in the CPCSSN cohort when defined as five or more medications. Using the same cut-points, the co-occurrence of multimorbidity and polypharmacy was similar between the two cohorts (CLSA: 14.3%; CPCSSN: 13.5%). Approximately 20% of older adults (65 to 85 years) were living with both multimorbidity and polypharmacy (CLSA: 21.4%; CPCSSN: 18.3%), as compared to almost 10% of middle-aged adults (45 to 64 years) living with this co-occurrence (CLSA: 9.2%; CPCSSN: 9.9%). Across both cohorts and age groups, females had consistently higher estimates of multimorbidity, polypharmacy and the co-occurrence of multimorbidity and polypharmacy.ConclusionsThis study found that multimorbidity and polypharmacy are not interchangeable in understanding population health needs. Approximately one in five older adults in the CLSA and CPCSSN cohorts were living with both multimorbidity and polypharmacy, double the proportion in the younger cohorts. This has implications for future research, as well as health policy and clinical practice, that aim to reduce the occurrence and impact of multimorbidity and unnecessary polypharmacy to enhance the well-being of aging populations.

This study aimed to develop an efficient data collection and curation process for all drugs and natural health products (NHPs) used by participants to the Canadian Longitudinal Study on Aging (CLSA). The three-step sequential process consisted of (a) mapping drug inputs collected through the CLSA to the Health Canada Drug Product Database (DPD), (b) algorithm recoding of unmapped drug and NHP inputs, and (c) manual recoding of unmapped drug and NHP inputs. Among the 30,097 CLSA comprehensive cohort participants, 26,000 (86.4%) were using a drug or an NHP with a mean of 5.3 (SD 3.8) inputs per participant user for a total of 137,366 inputs. Of those inputs, 70,177 (51.1%) were mapped to the Health Canada DPD, 20,729 (15.1%) were recoded by algorithms, and 44,108 (32.1%) were manually recoded. The Direct algorithm correctly classified 99.4 per cent of drug inputs and 99.5 per cent of NHP inputs. We developed an efficient three-step process for drug and NHP data collection and curation for use in a longitudinal cohort.

Abstract Background Randomized clinical trials have shown that, under optimal conditions, statins reduce the risk of cardiovascular events in older adults. Given the prevalence and consequences of suboptimal adherence to statin among older adults, it is essential to document strategies designed to increase statin adherence in this population. The objective of this systematic review is to describe and summarize the effectiveness of interventions to improve statin adherence in older adults (≥ 65 years old). Methods This review followed PRISMA guidelines. Studies were identified from PubMed, PsycINFO, Embase, CINAHL and Web of Science. Study selection was conducted independently by four reviewers working in pairs. Included studies reported data on interventions designed to increase adherence to statin therapy in older adults and were original trials or observational studies. Interventions were pragmatically regrouped into 8 different categories going from patient to administrative level. Two reviewers extracted study data and assessed study quality independently. Given the heterogeneity between the included studies, a narrative critique and summary was conducted. Results Twelve out of the 2889 identified articles were included in the review. Our review showed that simplifying patients’ drug regimen, administrative improvements and large-scale pharmacy-led automated telephone interventions show positive effects on patient adherence to statin therapy, with odds ratios between > 1.0 and 3.0, while education-based strategies and intensified patient care showed mixed results. Conclusions Current evidence suggests that some interventions can increase statin adherence in older adults, which could help in the reduction of the risk of a cardiovascular event in this population.

Objectives To produce a consensus list of the top 10 signs and symptoms suggestive of adverse drug events (ADEs) for monitoring in residents of long-term care facilities (LTCFs) who use antipsychotics, benzodiazepines, or antidepressants. Design A 3-round Delphi study. Setting and Participants Geriatricians, psychiatrists, pharmacologists, general practitioners, pharmacists, nurses, and caregivers from 13 Asia Pacific, European, and North American countries. Methods Three survey rounds were completed between April and June 2023. In Round 1, participants indicated their level of agreement on a 9-point Likert scale on whether 41 signs or symptoms identified in a systematic review should be routinely monitored. Participants considered signs and symptoms that reduce quality of life or cause significant harm, are observable or measurable by nurses or care workers, and can be assessed at a single time point. Round 1 statements were included in a list for prioritization in Round 3 if ≥ 70% of participants responded ≥7 on the Likert scale. Statements were excluded if ≤ 30% of participants responded ≥7. In Round 2, participants indicated their level of agreement with statements that did not reach initial consensus, plus amended statements based on Round 1 participant feedback. Round 2 statements were included in Round 3 if ≥ 50% of the participants responded ≥7 on the Likert scale. In Round 3, participants prioritized the signs and symptoms. Results Forty-four participants (93.6%) completed all 3 rounds. Four of 41 signs and symptoms reached consensus for inclusion after Round 1, and 9 after Round 2. The top 10 signs and symptoms prioritized in Round 3 were recent falls, daytime drowsiness or sleepiness, abnormal movements (eg, shaking or stiffness), confusion or disorientation, balance problems, dizziness, postural hypotension, reduced self-care, restlessness, and dry mouth. Conclusions and Implications The top 10 signs and symptoms provide a basis for proactive monitoring for psychotropic ADEs.

OBJECTIVES:Evidence concerning the effect of statins in primary prevention of cardiovascular disease (CVD) among older adults is lacking. Using Quebec population-wide administrative data, we emulated a hypothetical randomized trial including older adults >65 years on April 1, 2013, with no CVD history and no statin use in the previous year. STUDY DESIGN AND SETTING:We included individuals who initiated statins and classified them as exposed if they were using statin at least 3 months after initiation and nonexposed otherwise. We followed them until March 31, 2018. The primary outcome was the composite endpoint of coronary events (myocardial infarction, coronary bypass, and percutaneous coronary intervention), stroke, and all-cause mortality. The intention-to-treat (ITT) effect was estimated with adjusted Cox models and per-protocol effect with inverse probability of censoring weighting. RESULTS:A total of 65,096 individuals were included (mean age = 71.0 ± 5.5, female = 55.0%) and 93.7% were exposed. Whereas we observed a reduction in the composite outcome (ITT-hazard ratio (HR) = 0.75; 95% CI: 0.68-0.83) and mortality (ITT-HR = 0.69; 95% CI: 0.61-0.77) among exposed, coronary events increased (ITT-HR = 1.46; 95% CI: 1.09-1.94). All multibias E-values were low indicating that the results were not robust to unmeasured confounding, selection, and misclassification biases simultaneously. CONCLUSION:We cannot conclude on the effectiveness of statins in primary prevention of CVD among older adults. We caution that an in-depth reflection on sources of biases and careful interpretation of results are always required in observational studies.

Latent class growth analysis is increasingly proposed as a solution to summarize the observed longitudinal treatment into a few distinct groups. When latent class growth analysis is combined with standard approaches like Cox proportional hazards models, confounding bias is not properly addressed because of time-varying covariates that have a double role of confounders and mediators. We propose to use latent class growth analysis to classify individuals into a few latent classes based on their medication adherence pattern, then choose a working marginal structural model that relates the outcome to these groups. The parameter of interest is defined as a projection of the true marginal structural model onto the chosen working model. Simulation studies are used to illustrate our approach and compare it with unadjusted, baseline covariates adjusted, time-varying covariates adjusted, and inverse probability of trajectory groups weighted adjusted models. Our proposed approach yielded estimators with little or no bias and appropriate coverage of confidence intervals in these simulations. We applied our latent class growth analysis and marginal structural model approach to a database comprising information on 52,790 individuals from the province of Quebec, Canada, aged more than 65 and who were statin initiators to estimate the effect of statin-usage trajectories on a first cardiovascular event.

Context: The advanced access (AA) model has shown considerable success in improving timely access for patients in primary care settings. However, despite its widespread use, few providers other than physicians and nurse practitioners have implemented the model. Among those who have integrated it into their practice, wide variations in the level of implementation of AA processes have been observed, suggesting a need to support primary care teams in continuous improvement with AA implementation. Objective: To document the processes and measure outcomes of a practice facilitation intervention aimed to improve the implementation of AA within interprofessional teams. Study design and analysis: Primary care teams at various levels of organizational AA implementation took part in a quality improvement process facilitated by an external coach who was an expert in AA processes. Data were collected through reflective surveys and electronic medical records. Setting: Eight interprofessional primary care teams in the province of Quebec, Canada. Teams mainly included physicians, nurses, social workers, and pharmacists. Population studied: All healthcare providers, administrative assistants, and managers were invited to participate. Intervention/instrument: The interprofessional primary care teams were independently coached through Plan-Do-Study-Act cycles over 12 to 40 months. Outcome measures: Five key indicators on access and continuity of care were plotted and interpreted using control charts to support the improvement process. Findings: Results are from a total of 151 individuals across the eight teams. Significant improvements were observed at the team level in time to the 3rd next available appointment (decrease of 4 days), use of walk-in clinics (decrease of 20%), availability for urgent reasons for consultation (within 48 hours; increase of 48%), and continuity of care (above 80%). No shows did not vary significantly, but were estimated to be about 2% at baseline. Conclusion: Quality improvement through external coaching can significantly improve access and continuity of care. The implementation of AA processes can be broadened to a diverse group of primary care providers.

Advancements on the Internet of Things (IoT) have enabled the development of advanced monitoring systems that can track human behavior and vital signs in real-time, which can have a real impact in the way healthcare is provided. This paper presents a system implementation to monitor and analyze a subject's behavior changes over time using IoT, with the objective of detecting the impact of an inhibitor drug on the subject's activity levels. In this research we present a case study by which we showed it is possible to follow the effect of an anticholinergic drug by means of an unobtrusive IoT system. We have monitored the physical activity of a subject in his residence for seven consecutive months to study the effect of the inhibiting drug doses introduced at three known specific timestamps. Following, we compared our detection results for the subject’s physical activity change timestamps with the medical staff medication doses timestamps. Our results show that we can detect the physical activity change at close timestamps compared to those indicated by the medical staff.