Browsing by Author "Hirdes, John P."

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Profiling the medical, functional, cognitive, and psychosocial care needs of adults assessed for home care in Ontario, Canada: The case for long-term 'life care' at home
(Public Library of Science (PLOS), 2024) Saari, Margaret E.; Giosa, Justine L.; Holyoke, Paul; Heckman, George A.; Hirdes, John P.
Calls to leverage routinely collected data to inform health system improvements have been made. Misalignment between home care services and client needs can result in poor client, caregiver, and system outcomes. To inform development of an integrated model of community-based home care, grounded in a holistic definition of health, comprehensive clinical profiles were created using Ontario, Canada home care assessment data. Retrospective, cross-sectional analyses of 2017-2018 Resident Assessment Instrument Home Care (RAI-HC) assessments (n = 162,523) were completed to group home care clients by service needs and generate comprehensive profiles of each group's dominant medical, functional, cognitive, and psychosocial care needs. Six unique groups were identified, with care profiles representing home care clients living with Geriatric Syndromes, Medical Complexity, Cognitive Impairment and Behaviours, Caregiver Distress and Social Frailty. Depending on group membership, between 51% and 81% of clients had identified care needs spanning four or more Positive Health dimensions, demonstrating both the heterogeneity and complexity of clients served by home care. Comprehensive clinical profiles, developed from routinely collected assessment data, support a future-focused, evidence-informed, and community-engaged approach to research and practice in integrating home-based health and social care.
The effect of the COVID-19 pandemic on delirium incidence in Ontario long-term care homes: A retrospective cohort study
(Public Library of Science (PLOS), 2024) Kennedy, Lydia; Hirdes, John P.; Heckman, George; Searle, Samuel D.; McArthur, Caitlin
Objectives To describe delirium incidence before and during the COVID-19 pandemic and examine factors associated with delirium incidence in the long-term care setting. Methods We conducted a retrospective cohort study of Ontario long-term care residents without severe cognitive impairment or baseline delirium with an assessment between February 1, 2029, and March 31, 2021. Data were collected from the interRAI Minimum Data Set (MDS) 2.0. The outcome of interest was delirium development. Selected independent variables were entered into univariate longitudinal generalized estimating equations, followed by multivariate analysis. Odd ratios (ORs) and 95% confidence intervals (CIs) are reported. Results A total of 63,913 residents were included within the comparison sample from February 2019 to February 2020. The pandemic sample consisted of 54,867 residents from March 2020 to March 2021. Incidents of delirium in the comparison sample was 3.4% (2158 residents) compared to 3.2% (1746 residents) in the pandemic sample (P=0.06). Residents who were older, cognitively impaired, and increasingly frail had greater odds of developing delirium. Increased odds were associated with a diagnosis of bipolar disorder (OR 1.27, 95% Cl 1.07-1.51) and anxiolytic use (OR 1.12, 95% Cl 1.01-1.25). Residents who were newly admitted (OR 0.65, 95% Cl 0.60-0.71) and those dependent for activities of daily living (OR 046, 95% Cl 0.33-0.64) had lower odds of delirium development. Conclusions and implications The incidence of delirium did not differ between the year prior to and the first year of the COVID-19 pandemic, indicating that preventative interventions employed by long-term care homes may have been effective. Long-term care residents who are older, frail, cognitively impaired, or had unstable health would benefit from targeted interventions to prevent delirium. Newly admitted residents or those dependent in activities of daily living had lower odds of developing delirium, which could indicate under detection in these groups.
The Long-Term Care Pandemic: International Perspectives on COVID-19 and the Future of Nursing Homes
(Balsillie School of International Affairs, 2020-07-15) Hirdes, John P.; Declercq, Anja; Finne-Soveri, Harriet; Fries, Brant E.; Geffen, Leon; Heckman, George; Lum, Terry; Meehan, Brigette; Millar, Nigel; Morris, John N.
Five major changes to long-term care can protect the elderly from the ravages of infectious disease and provide a greater quality of care and quality of life.