FIT HIPS: Getting Fit for Hip Replacement

Aim: To determine the feasibility of conducting a Randomized Control Trial (RCT) comparing a pre-operative multi-modal intervention for pre-frail/frail patients undergoing total hip replacement surgery compared to usual care. Secondary objectives include examining change in frailty (Fried Frailty Phenotype, GERAS Fit Frailty Index).​

The cost-effectiveness of the proposed program will be evaluated alongside our pilot RCT.  We will compare changes in quality-adjusted life years (QALYs), rates of hospitalization or re-admission and healthcare resource use (costs) over the period of 12 months in 62 eligible participants, randomly assigned to either multimodal frailty intervention or usual care.​

Overview: The overall aim of our Fit‐Hips pilot randomized controlled trial (RCT) is to determine the feasibility of introducing preventive multi-modal strategies for pre-frail/frail seniors in regional joint assessment program (RJAP)- Hamilton Site, Ontario. This study will recruit 62 pre-frail or frail participants aged 65 years or older, planned for an elective unilateral total hip replacement at the HHS-Juravinski RJAP site. The multi-modal frailty intervention will consist of a tailored exercise program, combined with protein and vitamin D supplementation and medication review.

Outcomes – Primary feasibility outcomes include:

  • Recruitment rate (targeting ≥ 70%)
  • Retention rate (targeting ≥ 80%)
  • Data collection (targeting ≥ 80% completeness)
  • Adherence to all intervention components (targeting ≥ 80% completeness)

Additionally, this feasibility study will allow us to pilot clinical economic outcome measures.

LIVE Study: Evaluating Long Term Care Homes’ IntraVenous Therapy Experience

Aim: To develop and evaluate a clinical pathway that will support best practice of IV treatment delivery in long term care and avoid unnecessary emergency department transfers and hospitalizations.

Overview: Drs. Alexandra Papaioannou, Scientific Director of the GERAS Centre, Afeez Hazzan, postdoctoral fellow and George Ioannidis, GERAS Associate Scientific Director, will lead this year-long study that will be conducted in Hamilton and Grimsby with a team of interdisciplinary study partners including Medical Pharmacies Group Limited (MPGL), the Nurse-Led Outreach Team (NLOT), the HNHB Long-Term Care Council, Community Care Access Centre (CCAC), Behavioural Support Ontario (BSO), Emergency Medical Services (EMS), emergency department (ED) physicians, and geriatricians.

Summary: In Ontario, administration of IV therapy in long-term care (LTC) homes is fragmented due to poorly coordinated services among health care providers and a lack of an evidence-based pathway for the management of IV therapies.

Furthermore, IV therapy has traditionally been performed in controlled settings such as hospitals and emergency departments. This is costly and often results in unfavorable outcomes. The LIVE Study will assess resident, family caregiver, and key stakeholder’s (LTC staff, service partners) perceptions of a new clinical pathway for IV therapy in LTC homes.

LIVE Study partners have indicated their commitment to adopting the clinical pathway model in long term care homes across Ontario if the intervention for IV therapy proves to be successful.​

Learn more about this project from the video below.

Investigators

TAPESTRY: Teams Advancing Patient Experience Strengthening Quality

TAPESTRY is a partner of the GERAS Centre.

Aim: To develop and enhance public participation in the way health services are planned and how health decisions are made and delivered, and raise awareness within the health system about community issues facing older adults (and other at risk populations).

The program will also find ways to meet the self-identified health goals of older adults (and other at risk populations) to assist them with staying healthy longer.​

Overview: TAPESTRY is an 8.7 million dollar primary healthcare development and research program that is part of the Faculty of Health Sciences, McMaster University. It is being coordinated by the Department of Family Medicine in collaboration with the McMaster Family Health Team and other Program Partner sites across Canada.

Two important components of TAPESTRY are:

  1. Integration of a personal health record, including specialized TAPESTRY Applications (eg. life and health goals, diabetes, exercise, sleep, hypertension), into patients’ personal healthcare management.
  2. Trained community volunteers visiting patients in the home, building a social connection and collecting relevant information through a specially designed tablet computer application.

The interprofessional team has adapted their activities to review newly available information and consider opportunities to improve the delivery of proactive care. Early identification of problems such as nutritional deficiencies, inactivity, polypharmacy and social isolation will emphasize an informed and proactive approach to care and is one that allows patients, their families and their health care providers better access to health care, so as to make changes before a crisis arises.

For more information visit: Health Tapestry

Gaining Optimal Osteoporosis Assessments in Long-Term Care (GOAL)

Aim: To increase the awareness of the new LTC osteoporosis guidelines, improve appropriate osteoporosis prescribing, and document LTC residents who are at high risk for fracture, and those who fall & fracture.

Overview: GOAL is a knowledge translation initiative targeted at inter-professional teams in 50 LTC homes across the province. This collaborative quality improvement program delivered by McMaster University and Medical Pharmacy Group Limited.

Intervention Components (6 month):

  • 2 Interactive sessions with Interprofessional team members at the LTC homes
  • 2 video presentations delivered by GOAL experts regarding the management of osteoporosis
  • Novel electronic pharmacists risk assessment tool that identified high risk residents and provided management recommendations
  • Prescribing feedback reports
  • Action planning for quality improvement

Results: GOAL results were presented at the International Osteoporosis Foundation meeting in Milan, Italy and suggested that a prior diagnosis of osteoporosis, prior clinical vertebral fractures, and current glucocorticoid use are factors that trigger the use of osteoporosis medications in high risk residents.

Components of Success: Through educational sessions, participants have learned key components of the fracture prevention guidelines including the recognition of high risk residents; and the use of calcium/vitamin D, hip protectors, and pharmacological therapies.

View the latest Long-Term Care recommendations.

Primary Investigators

AGE-ON

AGE-ON, formerly ‘iLearn, iLiveWell’, is an iPad education course that helps older adults become familiar with their iPad.  The 6-week course covers everything from turning the iPad on, to navigating the internet, to sharing photos with family and friends. Participants recieve a binder with 100+ pages of step-by-step iPad, and are led through the hands-on modules by an educator with support from student volunteer mentors. The program also aims to reduce and/or prevent social isolation and loneliness that may be experienced by older adults through interaction with mentors, and use of technology. 

AGE-ON education sessions are offered regularly both by RGPc and in partnership with other community-based organizations.

What participants are saying about the program:

“It’s been very helpful. What I have liked very much are the at each table. It’s made a big difference, and helps us to kep because there’s a completely different lingo all together. I had no experience of this before and I’ve found this very helpful”
– AGE-ON participant

Interested in accessing iPad education designed for seniors? E-mail RGPc at age-on@rgpc.ca or visit the RGP Central website.

Artful Moments

Artful Moments aims to improve the quality of life in the moment for persons with dementia and reduce caregiver stress through art appreciation and art making. Working collaboratively, the Art Gallery of Hamilton (AGH) and the Behavioural Health Unit at St. Peter’s Hospital developed an arts based experience that facilitated art appreciation and art making. These involved exposure to pieces of art, as well as discussions on how the art impacted the individual and their caregivers.​

In total, the pilot project sought 8 participants and their family members. Each individual consented and attended the research educational sessions that took place at the AGH and St. Peter’s over a one year period.​

The program was effective in allowing program staff to determine the duration of a program in order to engage the participants. This allows the participants and their caregivers to enjoy the highest quality of interaction.

“It doesn’t matter where you are on the spectrum on dementia, everyone is capable of engaging with life and their loved ones.”

To learn more about this project, visit our research page.

Keeping it Together – Supporting Osteoporosis Knowledge in Long-Term Care Homes

In the webinar “Keeping it Together – Supporting Osteoporosis Knowledge in Long-Term Care Homes”, the OARC and the Ontario Osteoporosis Strategy for Long-Term Care introduced their new newly developed “Keeping it Together” Resident Conversation Sheet about osteoporosis. ​

“Keeping it Together” is designed specifically for residents to facilitate understanding of the importance of fracture prevention practice within their Long-Term Care Homes, thereby helping to promote good bone health among LTC residents, with a view to improving the quality of life for all residents.​

“You have a voice, if you feel that there is something wrong then you have to ask yourself these questions” explained Devora Greenspon, Secretary and Treasurer of the OARC. “if you answer yes to them, then you need to make sure that your illness is part of your care plan”.

Watch the webinar:

Geriatric Certificate Program

About the Geriatric Certificate Program (GCP):

The GCP was developed and launched in Hamilton, Ontario, Canada in 2013. Our program consists of core educational courses/workshops that are offered through partnerships with well-known healthcare organizations and clinician educators, which are specific to each education stream available through the GCP. Courses/workshops are offered in-person Canada-wide, as well as through online distance platforms.  This unique program is available to both Regulated and Non-Regulated healthcare professionals.

The Curriculum:

Presently, there are two education streams available designed to reflect learning priorities and geriatric core competencies that are most applicable to the learners previous education and current field of practice. GCP has designed education streams to align with learners in either regulated or non-regulated health professional roles.  The GCP Curriculum consists of five required courses, and two electives that have been specially designed for both the Regulated and Non-Regulated Stream.​

The planning and development of the GCP has been reviewed and endorsed by the McMaster University Continuing Health Sciences Education Office.

Benefits for Healthcare Professionals Registering for the GCP:

  •          Improve confidence and competence
  •          Expand career opportunities in Geriatrics
  •          Develop new practical skills and knowledge to your education portfolio
  •          Become equipped with new evidence-based approaches to care for older adults
  •          Access to current research and core competencies in geriatrics

Visit Geriatric Certificate Program to enroll today!

ABLE: Arts-Based exercise enabling LongEvity

What is ABLE?

ABLE, Arts-Based exercise enabling LongEvity, puts a unique spin on interactive technology for exercise by taking advantage of the therapeutic effects of art and music. ABLE responds to movement, tracked through a discrete wireless insole, and creates a painting and musical tune as a reward.

Why do we need ABLE?

The ABLE study team aims to revolutionize at home exercise by making it fun and engaging. Older adults referred to home care physiotherapy often only see their physiotherapist three to five times and are prescribed at home exercises. Blending art, music, and fitness, the team is developing an easy-to-use app with the goal of helping older adults stick to the at home exercise plans prescribed to them by their physiotherapist.

How is ABLE different?

Interactive technology has been shown to increase participation in at home exercises and improve strength and balance. However, ABLE will be the first study to investigate the effectiveness of interactive technology for exercise for frail, older adults.​​

What are the aims of the study?

The study aims to see if ABLE can help 25 older adult participants exercise at home over a three-month period. A physiotherapist will visit the older adults three times in their homes and show them how to use ABLE and which exercises to do. The older adult’s strength and balance with be measured both before and after using the program. Feedback on ABLE from the participants themselves, along with their family members, will be collected. The results of this study will help determine if a bigger study should be done to test the effectiveness of ABLE in a larger group of older adults, and to further explore the effects of ABLE on strength and balance. This study would also incorporate the valuable feedback from older adults and their families to improve ABLE design and function.

Study team:

GERAS, Centre for Aging Research.