Division of Geriatric Medicine

CGS Research and Education

Canadian Geriatrics Society Abstracts/Presentations

  1. Presented by Nancy Santesso (oral presentation)

    Title: Adapting osteoporosis guidelines for frail elderly using GRADE

    Key Messages:

    • Osteoporosis Canada developed guidelines for the diagnosis and management of osteoporosis for people >50 at high risk of fragility fractures (2010). These guidelines did not address frail elderly where access to diagnostic technology, such as bone mineral density, and research is limited.
    • The GRADE process which incorporates family and resident values and preferences, was used to develop guidelines applicable to frail elderly. This process included a consensus panel of over 50 key stakeholders in the Long-term care sector.
    • The GRADE process helped to identify gaps in the literature for important outcomes; the impact of baseline risks; and the importance of balancing benefits and harms, and their value and consequences in this population.

  2. Presented by Courtney Kennedy (oral presentation)

    Title: Uptake of Evidence-based Osteoporosis Practices in Long-term Care (LTC)

    Key Messages:

    • Since 2006, the Ontario Osteoporosis Strategy for Long-term Care has engaged in outreach activities to increase uptake of evidence-based osteoporosis/fracture prevention strategies (www.osteoporosislongtermcare.ca).
    • A baseline environmental scan revealed a wide spectrum of prescribing practices between LTC homes was identified, reflecting the lack of standardized guidelines and academic detailing. The objective of the present study was to describe current osteoporosis prescribing practices across Ontario LTC homes.
    • Results indicate that wide-scale implementation of outreach activities resulted in uptake by many LTC homes, particularly for Vitamin D, with half the homes prescribing at approximately 60% or better. Currently, osteoporosis consensus guidelines for LTC are being developed

  3. Presented by Naomi Dore (oral presentation)

    Title: Evaluation of Osteoporosis treatment in hip fracture patients post rehabilitation discharge: The Fracture?, Think Osteoporosis Program

    Key messages:

    • The purpose of this evaluation was to determine the rates in which hip fracture patients receive osteoporosis treatment, calcium and vitamin D supplementation and bone mineral density testing following discharge from a rehabilitation unit.
    • The FTOP program was successful in improving calcium and vitamin D supplementation and somewhat effective in initiation of pharmacological treatment. There is room for improvement in rates of BMD testing.

  4. Presented by Courtney Kennedy (poster presentation)

    Title: Is a Multifaceted Knowledge Translation Intervention Feasible and Acceptable in Long- Term Care? A Qualitative Study with ViDOS Participants

    Key Messages:

    • Few studies in long-term care (LTC) have examined the feasibility and acceptability of knowledge translation (KT) programs. We conducted a qualitative evaluation of LTC professionals’ experience with a multifaceted, interdisciplinary KT intervention.
    • Medical Directors, Directors of Care (Nursing), and Consultant Pharmacists who participated in the Vitamin D and Osteoporosis Study (ViDOS), a randomized controlled trial conducted in 40 Ontario LTC homes (19 intervention, 21 control) were invited to participate.
    • The on-site involvement of an expert opinion leader was seen as most useful by all participant groups. Perceived utility of the other KT components varied by group: Directors of Care highly valued audit & feedback whereas Consultant Pharmacists highly valued small-group learning and internally nominated champions.
    • Common themes for improvement include ready-to-use educational fact sheets and having Expert Opinion Leaders attend in person or via video conference.

  5. Presented by Keya Shah (poster presentation)

    Title: Osteoporosis Management and Fracture Prevention in Long-Term Care: A Family Member Preference Survey

    Key Messages:

    • Hip fracture is the leading cause of transfer to acute care for long-term care (LTC) residents. Osteoporosis and falls put LTC residents at a high risk for fractures that lead to pain, loss of mobility, heavy costs to patients, their families and the healthcare system; and increased mortality. Effective prevention includes pharmaceutical and non-pharmacological interventions to decrease fractures.
    • We conducted a pilot telephone survey of LTC residents’ family members. Survey questions asked about awareness of and preference for falls and fracture prevention interventions available in LTC.
    • Results indicate that family members support pharmaceutical interventions as per recommendations in the 2010 Clinical Practice Guidelines for reducing the risk of fractures and falls in LTC residents. All respondents supported Vitamin D supplements without any concerns; 82% supported calcium + vitamin D use but worried about swallowing difficulties.
    • Many of them believe pain prevention and quality of life are more important than extending life which should be considered in guideline development for this population.

  6. Presented by Michelle Wall (poster presentation)

    Title: Fracture Risk Assessment in Long-term Care

    Key messages:

    • Study objectives aimed to explore current practices to fracture risk assessment by LTC physicians and describe barriers to applying OCG for fracture assessment and prevention in LTC. A cross-sectional survey was conducted with the Ontario Long-Term Care Physicians Association using an online questionnaire.
    • 87% of LTC physicians considered the prevention of fragility fractures important, but a minority (34%) reported using validated fracture risk assessment tools, while 33% did not use any. Clinical risk factors recommended by OCG for assessing fracture risk considered applicable included; glucocorticoid use (99%), fall history (93%), age (92%), and fracture history (90%).  Recommended clinical measurements considered applicable included: weight (84%), TSH (78%), creatinine (73%), height (61%), and Get-Up-and-Go (60%).
    •  Perceived barriers to assessing fracture risk included difficulty acquiring necessary information (35%) due to lack of access to tests (bone mineral density, spine x-rays) or obtaining medical history; resource constraints (30%), and a sentiment that assessing fracture risk is futile in this population because of short life expectancy and polypharmacy (28%).
    • These findings highlight the necessity to adapt the OC guidelines so that they are evidence-based and applicable to the LTC sector.