Browsing by Author "McArthur, Caitlin"

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    Assessing the feasibility of an integrated collection of education modules for fall and fracture prevention (iCARE) for healthcare providers in long term care: A longitudinal study
    (Public Library of Science (PLOS), 2024) Rodrigues, Isabel B.; Ioannidis, George; Kane, Lauren L.; Hillier, Loretta M.; Adachi, Jonathan; Heckman, George; Hirdes, John; Holroyd-Leduc, Jayna; Jaglal, Susan; Kaasalainen, Sharon; Marr, Sharon; McArthur, Caitlin; Straus, Sharon; Tarride, Jean-Eric; Abbas, Momina; Costa, Andrew P.; Lau, Arthur N.; Thabane, Lehana; Papaioannou, Alexandra
    Falls and hip fractures are a major health concern among older adults in long term care (LTC) with almost 50% of residents experiencing a fall annually. Hip fractures are one of the most important and frequent fall-related injuries in LTC. There is moderate to strong certainty evidence that multifactorial interventions may reduce the risk of falls and fractures; however, there is little evidence to support its implementation. The purpose of this study was to determine the feasibility (recruitment rate and adaptations) with a subobjective to understand facilitators to and barriers of implementing the PREVENT (Person-centred Routine Fracture PreEVENTion) model in practice. The model includes a multifactorial intervention on diet, exercise, environmental adaptations, hip protectors, medications (including calcium and vitamin D), and medication reviews to treat residents at high risk of fracture. Our secondary outcomes were to determine if there was a change in knowledge uptake of the guidelines among healthcare providers and in the proportion of fracture prevention prescriptions post-intervention. We conducted a mixed-methods longitudinal cohort study in three LTC homes across southern Ontario. A local champion was selected to help guide the implementation of the model and promote best practices. We reported recruitment rates using descriptive statistics and challenges to implementation using content analysis. We reported changes in knowledge uptake and in the proportion of fracture prevention medications using the McNemar's test. We recruited three LTC homes and identified one local champion for each home. We required two months to identify and train the local champion over three, 1.5-hour train-the-trainer sessions, and the local champion required three months to deliver the intervention to a team of healthcare professionals. We identified several facilitators, barriers, and adaptations to PREVENT. Benefits of the model include easy access to the Fracture Risk Scale (FRS), clear and succinct educational material catered to each healthcare professional, and an accredited Continuing Medical Educational module for physicians and nurses. Challenges included misperceptions between the differences in fall and fracture prevention strategies, fear of perceived side effects associated with fracture prevention medications, and time barriers with completing the audit report. Our study found an increase knowledge uptake of the guidelines and an increase in the proportion of fracture prevention prescriptions post-intervention.
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    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.