CFN Funded ProjectsProducts
| Title |
Category |
Date |
Authors |
| Exposure to potentially inappropriate medication among long-term care residents with cognitive impairment in Ontario: Is therePoster presentation at Alzheimer’s Association International Conference (AAIC), Toronto, ON, July 24-28, 2016.
Abstract published in Journal of Alzheimer's association 2016;12(7):578SIG2014-M1 University of Waterloo, Queen's University, University of Toronto, University of Calgary, Mt. Sinai Hospital, ICES (Institute for Clincial Evaluative Sciences) | Publication | 2016-07-24 | | | Role of frailty in understanding the risks and benefits of pharmacotherapy in older adultsEvaluative Clinical Sciences Rounds, ICES & Sunnybrook, March 21, 2017, Toronto, ONSIG2014-M1 University of Waterloo, University of Calgary, Canadian Institute for Health Information (CIHI) | Publication | 2017-03-21 | | | Assisted Living vs. LTC: Characteristics and Challenges/Opportunities for ResearchPharmacotherapy in Older Adults with Cardiovascular Disease Workshop, American College of Cardiology/American Geriatrics Society/National Institutes of Health. Feb. 6-7, 2017. Washington, DCSIG2014-M1 University of Waterloo | Publication | 2017-02-06 | | | Exploring the relevance of frailty measures to medication use and outcomes in older adultsNational Webinar - Drug Safety and Effectiveness Network (DSEN) Seminar Series.SIG2014-M1 University of Waterloo, ICES (Institute for Clincial Evaluative Sciences) | Intellectual Property | 2018-02-22 | | | Resident and Facility Level Predictors of Antipsychotic Use in Assisted LivingPoster presentation at the 32nd International Conference on Pharmacoepidemiology & Therapeutic Risk Management; August 25-28, 2016, Dublin, Ireland
Abstract published in Pharmacoepidemiology and Drug Safety 2016;25(Suppl. 3):363-4.SIG2014-M1 University of Waterloo, Canadian Institute for Health Information (CIHI), University of Massachusetts, University of Calgary | Publication | 2016-08-25 | | | Statin therapy and mortality among new long-term care residents in Ontario, Canada: the contribution of clinical assessment data to a population-based cohort studyPoster presentation at International Population Data Linkage Conference (IPDLN), Wales, United Kingdom, August 24-26, 2016. (I)
Abstract published in International Journal for Population Data Science 2017;1(1): apr. 2017.SIG2014-M1 University of Waterloo, Mt. Sinai Hospital, ICES (Institute for Clincial Evaluative Sciences) | Publication | 2016-08-25 | | | The variation in statin therapy among long-term care residents, physicians, and facilities in Ontario.Poster presentation at AcademyHealth Research Meeting, Boston, MA, June 26-29, 2016. SIG2014-M1 University of Waterloo, ICES (Institute for Clincial Evaluative Sciences) | Publication | 2016-06-26 | | | Variation in appropriate medication use across long-term care homes and frailty: lessons from health administrative data in Ontario.Bronskill SE, Maxwell CJ. Variation in appropriate medication use across long-term care homes and
frailty: lessons from health administrative data in Ontario.
Oral presentation, Canadian Medical Directors 8th Annual Joint Meeting & 38th Annual Meeting Long Term Care for Practicing Clinicians: Leadership in Long Term Care, Toronto, ON, October 23-25, 2015.
SIG2014-M1 ICES (Institute for Clincial Evaluative Sciences), University of Waterloo | Publication | 2015-10-23 | | | Frailty and potentially inappropriate medication use at nursing home transitionMany residents with cognitive impairment or dementia enter nursing homes on potentiall inappropriate medications (PIMs). PIMs are more likely to be started in frail individuals following admission. Interventions to support deprescribing of PIMs should be implemented targeting frail individuals during the transition to nursing home.SIG2014-M1 University of Waterloo, Mt. Sinai Hospital, University of Calgary, University of Toronto, Queen's University, St. Michael's Hospital, ICES (Institute for Clincial Evaluative Sciences) | Publication | 2017-10-01 | "LC. Maclagan ", Colleen Maxwell, "S. Gandhi ", "J. Guan ", Chaim Bell, David Hogan, Nick Daneman, Sudeep Gill, Andrew Morris, Lianne Jeffs, "M. Campitelli ", Dallas Seitz, Susan Bronskill | | The variation of statin use among nursing home residents and physicians: a cross-sectional analysis. Statin prescribing was substantial within nursing homes, even among frail residents. After controlling for resident characteristics, the prescribing of statins was not randomly distributed across physicians. Further studies are required to evaluate the risks and benefits of statin use, and discontinuation, among nursing home residents to inform clinical practice in this setting.SIG2014-M1 University of Waterloo, Mt. Sinai Hospital, University of Toronto, St. Michael's Hospital, University of Calgary, University of Massachusetts, Queen's University, ICES (Institute for Clincial Evaluative Sciences) | Publication | 2017-09-01 | "M. Campitelli ", Colleen Maxwell, "V. Giannakeas ", Chaim Bell, Nick Daneman, Lianne Jeffs, Andrew Morris, "PC Austin ", David Hogan, "DT Ko ", Kate Lapane, "LC. Maclagan ", Dallas Seitz, Susan Bronskill | | Cholinesterase inhibitor use among older adults with dementia prior to and after admission to long-term care: What is the influence of frailty?Poster presentation at 9th Canadian Conference on Dementia, Toronto, ON, November 2-4, 2017 SIG2014-M1 University of Waterloo, Canadian Institute for Health Information (CIHI), Queen's University, ICES (Institute for Clincial Evaluative Sciences) | Publication | 2017-11-02 | "Laura Maclagan ", Colleen Maxwell, "J. Guan ", "Michael Campitelli ", "N. Herman ", "KL Lapane ", "DB Hogan ", Joseph Amuah, Dallas Seitz, Sudeep Gill, Susan Bronskill | | Sex differences in potentially inappropriate medication use and frailty at nursing home transition: a retrospective cohort study. Poster presentation at International Conference on Pharmacoepidemiology (ICPE), Montreal, QC, August 27-30, 2017. SIG2014-M1 University of Waterloo, University of Calgary, University of Massachusetts, ICES (Institute for Clincial Evaluative Sciences) | Publication | 2017-08-27 | | | Antipsychotic use, frailty and health outcomes among residents of assisted living.Oral presentation at 32rd International Conference on Pharmacoepidemiology & Therapeutic Risk Management (ICPE).
Abstract published in Pharmacoepidemiology and Drug Safety 2016;25(Suppl. 3):263.SIG2014-M1 University of Waterloo, Canadian Institute for Health Information (CIHI), University of Massachusetts, ICES (Institute for Clincial Evaluative Sciences), Mt. Sinai Hospital, St. Michael's Hospital, University of Calgary | Publication | 2016-08-28 | | | Survival among older residents of nursing homes prescribed intensive-dose and moderate-dose statins: a propensity-score matched cohort studyGiven the absence of a survival advantage for those receiving intensive-dose statins compared to moderate-dose statins in long-term care, it may be prudent to reduce statin doses for specific residents of nursing homes at increased risk of statin-related adverse events.SIG2014-M1 University of Waterloo, Mt. Sinai Hospital, St. Michael's Hospital, University of Massachusetts, University of Toronto, ICES (Institute for Clincial Evaluative Sciences) | Publication | 2018-03-31 | | | The variation in statin therapy among long-term care residents, physicians, and facilities in Ontario.Oral presentation to Canadian Association for Health Services and Policy Research (CAHSPR) May 9-12, 2016, Toronto, ONSIG2014-M1 University of Waterloo, ICES (Institute for Clincial Evaluative Sciences) | Publication | 2016-05-09 | | | Utilizing population-based clinical and administrative data to explore the relevance of frailty to cholinesterase inhibitor use and discontinuation at nursing home transition.2018 International Population Data Linkage (IPDLN) Conference. Sept. 12-14, 2018, Banff, ABSIG2014-M1 University of Waterloo, University of Massachusetts, Canadian Institute for Health Information (CIHI), Queen's University, ICES (Institute for Clincial Evaluative Sciences) | Publication | 2018-09-12 | | | Examining the relevance of frailty to cholinesterase inhibitor (ChEI) use and discontinuation during transition to long-term care: a population-based cohort studyAccepted for poster presentation to 2018 International Conference on Promoting Healthy Brain Aging and Preventing Dementia: Research and Translation, June 20-22, 2018, Banff, ABSIG2014-M1 University of Waterloo, University of Massachusetts, University of Calgary, Canadian Institute for Health Information (CIHI), Queen's University, ICES (Institute for Clincial Evaluative Sciences) | Publication | 2018-06-20 | "L. Maglagan ", Colleen Maxwell, "J. Guan ", "M. Campitelli ", "N. Herrmann ", Kate Lapane, David Hogan, Joseph Amuah, Dallas Seitz, Sudeep Gill, Susan Bronskill | | Survival among residents of nursing homes aged 75 years and older prescribed intensive-dose and moderate-dose statins: a propensity-score matched cohort studyAccepted for oral presentation to Canadian Association of Health Services & Policy Research (CAHSPR) Conference, May 28-31, 2018, Montreal, QCSIG2014-M1 University of Waterloo, Mt. Sinai Hospital, St. Michael's Hospital, University of Massachusetts, University of Toronto, ICES (Institute for Clincial Evaluative Sciences) | Publication | 2018-05-28 | | | Frailty and unintended risks of medications. Frailty and unintended risks of medications.
Part of Journal Topical Collection on Epidemiology of AgingCAT2017-21 University of Calgary, University of Waterloo | Publication | 2020-04-07 | | | Frailty in PharmacyA summary report of this CFN-funded initiative was published in the Ontario Pharmacist Magazine on December 7, 2018.CAT2017-21 University of Waterloo, St. Michael's Hospital | Specialized Publication | 2018-12-07 | | | Exposure to potentially inappropriate medication among long-term care residents with cognitive impairment in Ontario: Is there an association with frailty? Oral presentation to Canadian Association for Health Services and Policy Research (CAHSPR), May 9-12, 2016. Toronto, ONSIG2014-M1 University of Waterloo, Queen's University, University of Toronto, University of Calgary, Mt. Sinai Hospital, ICES (Institute for Clincial Evaluative Sciences) | Publication | 2016-05-09 | "L. Maclagan ", "J. Guan ", "S. Gandhi ", Colleen Maxwell, "M. Campitelli ", Sudeep Gill, Nick Daneman, Dallas Seitz, David Hogan, Andrew Morris, Chaim Bell, Susan Bronskill | | Knowledge and Perceptions of Pharmacists Towards Frailty and Frailty AssessmentsReported on the results of the cross-sectional survey we conducted of licensed pharmacists currently practicing in Canada. The online survey instrument consisted of 43 questions. We reported descriptive statistics of all questions and conducted a multivariable logistic regression to explore relationships between characteristics and perceptions. CAT2017-21 University of Waterloo, St. Michael's Hospital | Publication | 2019-07-13 | | | “Fitting in the Pharmacist” – A qualitative analysis of the perceived relationship between community pharmacists and older adults with complex care needs.CAT2017-21 University of Waterloo, St. Michael's Hospital | Publication | 2021-06-15 | | | Conditions and factors associated with potentially inappropriate medication use in frail older adults: a mixed methods analysis in long-term care.Poster presentation at Canadian Association of Health Services & Policy Research (CAHSPR) Conference, Toronto, ON, May 24-26, 2017. SIG2014-M1 St. Michael's Hospital, University of Waterloo, Mt. Sinai Hospital, ICES (Institute for Clincial Evaluative Sciences) | Publication | 2017-05-24 | | | Prevalence of, and resident and facility characteristics associated with antipsychotic use in assisted living vs. long-term care facilities: a cross-sectional analysis from Alberta, Canada.Most of the clinical and policy attention directed at reducing antipsychotic use has been focused on the long-term care sector. However, concerns about high rates of antipsychotic use and associated risks of adverse events are clearly important to vulnerable residents of other care settings including assisted living facilities. We showed that potentially inappropriate antipsychotic use was more common among older assisted living vs. long-term care residents and that frailty was a strong predictor for receiving inappropriate antipsyhcotic use. Further, frail residents residing in facilities with relatively poor oversight by clinical and pharmacy staff were at particular risk of inappropriate antipsychotic exposure
2017 Jan;34(1):39-53.SIG2014-M1 Canadian Institute for Health Information (CIHI), University of Massachusetts, University of Calgary, University of Waterloo | Publication | 2017-01-01 | | | Frailty awareness and assessment: exploring the link between pharmacists' beliefs and behaviourThis abstract was presented as a poster at the Pharmacy Practice Research (PxP) Conference (June 3-5, 2019) and published in the Canadian Pharmacists Journal (Can Pharm J 2019; 152(5):S20.
The objective was to examine associations between pharmacists’ beliefs and behaviours regarding frailty. Pharmacists across Canada strongly agreed that community pharmacists should understand frailty. Only a third of pharmacists reported incorporating this into their practice. Our findings suggest the importance of diverse experience and/or training in the care of older vulnerable patients.CAT2017-21 University of Waterloo, St. Michael's Hospital | Publication | 2019-06-03 | | | The coexistence of frailty, dementia and depression in older adultsPoster presentation, 3rd Annual TVN Conference on improving care for frail elderly Canadians, Toronto, ON, Sept 27-29, 2015.SIG2014-M1 University of Calgary, ICES (Institute for Clincial Evaluative Sciences), University of Waterloo | Publication | 2015-09-27 | | | Potentially Inappropriate Medication Use in Long-Term Care: Preliminary Findings from a Qualitative Analysis Poster presentation at CFN Annual Meeting April 22, 2017, Toronto, ON, CanadaSIG2014-M1 St. Michael's Hospital, Mt. Sinai Hospital, ICES (Institute for Clincial Evaluative Sciences), University of Waterloo | Publication | 2017-04-22 | | | Going beyond antimicrobial stewardship to identify outliers in drug prescribing: a protocol for a cohort study of frail older adultsPoster presentation at CFN annual meeting, April 22, 2017, Toronto, ON, CanadaSIG2014-M1 Mt. Sinai Hospital, University of Toronto, St. Michael's Hospital, University of Waterloo, ICES (Institute for Clincial Evaluative Sciences) | Publication | 2017-04-22 | | | Influences on the start, selection and duration of treatment with antibiotics in long-term care facilitiesAntibiotic prescribers exhibit individual, measurable, historical tendencies towards antibiotic initiation, use of prolonged treatment duration and class selection; prescriber audit-and-feedback may be a promising tool to optimize antibiotic use in long-term care.SIG2014-M1 University of Toronto, Mt. Sinai Hospital, University of Waterloo, St. Michael's Hospital, ICES (Institute for Clincial Evaluative Sciences) | Publication | 2017-06-26 | | | Prescriber tendencies influence antibiotic initiation, selection and duration in long term care facilitiesPoster presentation at the AMMI Canada – CACMID Annual Conference 2017, Toronto, ON, May 4-6, 2017.
Abstract published in Journal of the Association of Medical Microbiology and Infectious Disease Canada 2017;Supplement:105.SIG2014-M1 University of Toronto, Mt. Sinai Hospital, University of Waterloo, St. Michael's Hospital, ICES (Institute for Clincial Evaluative Sciences) | Publication | 2017-05-04 | | | Prescriber tendencies influence antibiotic initiation, selection and duration in long term care facilitiesAbstract published in Journal of the Association of Medical Microbiology and Infectious Disease Canada 2017;Supplement:105.SIG2014-M1 University of Toronto, Mt. Sinai Hospital, University of Waterloo, St. Michael's Hospital, ICES (Institute for Clincial Evaluative Sciences) | Publication | 2017-05-03 | | | The identification of frailty and its role as an effect modifier of adverse drug-related outcomes among assisted living residents. Stock K, Hogan DB, Tyas S, Bronskill SE, Morris AM, Bell CM, Jeffs L, Maxwell CJ. The identification
of frailty and its role as an effect modifier of adverse drug-related outcomes among assisted living
residents.
Oral presentation, 44th Annual Scientific & Educational Meeting, Canadian Association on
Gerontology, Calgary, AB, Oct 23-25, 2015.
Abstract published in C J Aging
SIG2014-M1 University of Calgary, ICES (Institute for Clincial Evaluative Sciences), Mt. Sinai Hospital, St. Michael's Hospital, University of Waterloo | Publication | 2015-10-23 | | | Pharmacists’ knowledge, perceptions and practices regarding frailty: A cross-sectional survey across practice settings in CanadaFrailty describes the health and resilience of older adults and is associated with risk of adverse drug events, especially related to polypharmacy. We surveyed Canadian pharmacists’ understanding, beliefs, and practices in the assessment of frailty. Integrating frailty into the pharmacists' workup, and the pathway to frailty-based medication interventions are discussed.CAT2017-21 University of Waterloo, St. Michael's Hospital, University of Calgary | Publication | 2023-02-22 | | | Frailty and recognizing appropriate medications in geriatrics and long term care [FRAMING-LTC]: Protocol. Poster presentation, 3rd Annual TVN Conference on improving care for frail elderly Canadians, Toronto, ON, Sept 27-29, 2015.SIG2014-M1 St. Michael's Hospital, Mt. Sinai Hospital, ICES (Institute for Clincial Evaluative Sciences), University of Waterloo | Publication | 2015-09-27 | | | Frailty, drug use and hospitalization among older assisted living residentsPoster presentation, 3rd Annual TVN Conference on improving care for frail elderly Canadians, Toronto, ON, Sept 27-29, 2015.SIG2014-M1 University of Calgary, ICES (Institute for Clincial Evaluative Sciences), Mt. Sinai Hospital, St. Michael's Hospital, University of Waterloo | Publication | 2015-09-27 | | | Antipsychotic use and hospitalization among older assisted living residents: Does risk vary by frailty status? There is emerging interest regarding whether an assessment of frailty may help to better differentiate both the potential risks as well as benefits of medications in older adults. We showed that two different approaches to defining frailty (the frailty index and physical phenotype) showed similar findings in modifying the risk of hospitalization associated with prevalent antipsychotic use among older Assisted Living residents. Not only was risk elevated among frail antipsychotic users, hospitalization risk was significantly lower for users of antipsychotics among non-frail residents.SIG2014-M1 University of Calgary, University of Massachusetts, Canadian Institute for Health Information (CIHI), ICES (Institute for Clincial Evaluative Sciences), Mt. Sinai Hospital, St. Michael's Hospital, University of Waterloo | Publication | 2017-07-01 | | | Frailty and other predictors of cholinesterase inhibitor use and discontinuation during transition to nursing home: a population-based cohort studyAccepted for poster presentation to Canadian Association of Health Services & Policy Research (CAHSPR) Conference, May 28-31, 2018, Montreal, QCSIG2014-M1 ICES (Institute for Clincial Evaluative Sciences), University of Massachusetts, University of Calgary, Canadian Institute for Health Information (CIHI), Queen's University, University of Waterloo | Publication | 2018-05-28 | "L. Maclagan ", Susan Bronskill, "J. Guan ", "M. Campitelli ", "N. Herrmann ", Kate Lapane, David Hogan, Joseph Amuah, Dallas Seitz, Sudeep Gill, Colleen Maxwell | | Risk of fall-related injuries in residents of nursing homes receiving low-dose trazodone compared to benzodiazepines: a matched cohort studyWe found that new use of low-dose trazodone was no safer than new use of benzodiazepines in protecting against fall-related injuries in Ontario nursing homes. In Canada, nursing homes care for a particularly frail population of older adults. When our study findings are jointly considered with rising trends in the use of low-dose trazodone in Ontario nursing homes, our findings suggest that increased vigilance related to off-label substitution of trazodone for other psychotropic drug therapies is recommended.SIG2014-M1 ICES (Institute for Clincial Evaluative Sciences), Mt. Sinai Hospital, St. Michael's Hospital, University of Waterloo | Publication | 2018-03-31 | Susan Bronskill, "Michael Campitelli ", "A. Iaboni ", "N. Herrmann ", "J. Guan ", "L. Maclagan ", "J. Watt ", "P. Rochon ", Andrew Morris, Lianne Jeffs, Chaim Bell, Colleen Maxwell | | Risk of fall-related injuries in residents of nursing homes receiving low-dose trazodone compared to benzodiazepines: a matched cohort studyAccepted for oral presentation to Canadian Association of Health Services & Policy Research (CAHSPR) Conference, May 28-31, 2018, Montreal, QCSIG2014-M1 ICES (Institute for Clincial Evaluative Sciences), Mt. Sinai Hospital, St. Michael's Hospital, University of Waterloo | Publication | 2018-04-04 | Susan Bronskill, "M. Campitelli ", "A. Iaboni ", "N. Herrmann ", "J. Guan ", "L. Maclagan ", "J. Watt ", "PA Rochon ", Andrew Morris, Lianne Jeffs, Chaim Bell, Colleen Maxwell | | Prevalence of Prescription and Non-Prescription Polypharmacy by frailty and sex among middle-aged and older CanadiansBackground:
Estimates of polypharmacy have primarily been derived from prescription claims, and less is known about the use of non-prescription medications (alone or in combination with prescription medications) across the frailty spectrum or by sex. Our objectives were to estimate the prevalence of polypharmacy (total, prescription, non-prescription, and concurrent prescription and non-prescription) overall, and by frailty, sex and broad age group.
Data:
Canadian Health Measures Survey, Cycle 5, 2016 to 2017.
Methods:
Among Canadians aged 40 to 79 years, all prescription and non-prescription medications used in the month prior to the survey were documented. Polypharmacy was defined as using five or more medications total (prescription and non-prescription), prescription only and non-prescription only. Concurrent prescription and non-prescription use was defined as two or more and three or more of each. Frailty was defined using a 31-item frailty index (FI) and categorized as nonfrail (FI ≤ 0.1) and pre-frail or frail (FI > 0.1). Survey-weighted descriptive statistics were calculated overall and age standardized.
Results:
We analyzed 2,039 respondents, representing 16,638,026 Canadians (mean age of 56.9 years; 51% female). Overall, 52.4% (95% confidence interval [CI] = 47.3 to 57.4) were defined as pre-frail or frail. Age-standardized estimates of total polypharmacy, prescription polypharmacy and concurrent prescription and non-prescription medication use were significantly higher among pre-frail or frail versus non-frail adults (e.g., total polypharmacy: 64.1% versus 31.8%, respectively). Polypharmacy with non-prescription medications was common overall (20.5% [95% CI = 16.1 to 25.8]) and greater among women, but did not differ significantly by frailty.
Interpretation:
Polypharmacy and concurrent prescription and non-prescription medication use were common among Canadian adults, especially those who were pre-frail or frail. Our findings highlight the importance of considering non-prescribed medications when measuring the exposure to medications and the potential risk for adverse outcomes. CAT2017-21 University of Waterloo, St. Michael's Hospital, University of Calgary, ICES (Institute for Clincial Evaluative Sciences) | Publication | 2022-06-08 | "Daniel Harris ", "Yanling Guo ", Nardine Nakhla, Mina Tadrous, David Hogan, "Deirdre Hennessy ", "Kelly Langlois ", "Rochelle Garner ", Sarah Leslie, Susan Bronskill, George Heckman, Colleen Maxwell |
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