Impacts of CIHR-funded research: Aging
Breaking down the myths of palliative care
Not everyone wants to be a caregiver
Overview
Dying at home is considered the "gold standard" of end-of-life care but, according to research by Dr. Kelli Stajduhar of the University of Victoria, while patients may feel this way, the family members who are caring for them don't necessarily share their view.
Impact
When Dr. Stajduhar communicated her findings to her local health authority, the authority began to speak publicly about the difficulties of dying at home for families and opened 10 more palliative care beds to take the pressure off family caregivers.
First Published
CIHR Research Profile, 2009
New cells for old brains
Physical exercise promotes brain health
Overview
A 20-minute walk with the dog may not send you to the Olympics – but it may help maintain that Olympic-calibre brain as people age. Dr. Brian Christie of the University of Victoria was one of the first to demonstrate the now widely accepted notion that physical exercise can create new brain cells, resulting in better learning and memory skills among seniors. These effects hold true for all forms of exercise, even if they are mild. As well as creating new neurons, though, Dr. Christie has found that exercise improves communication among existing brain cells, probably due to increased blood flow from the exercise.
Impact
This research provides yet more evidence for the importance of remaining physically active as people age.
First Published
Research profile, August 2008
The adaptable brain
People with Alzheimer's disease can use other areas of their brain
Overview
Nearly a quarter of a million Canadians suffer from Alzheimer's disease and, by 2030, those numbers are expected to more than double, to nearly 500,000 Canadians. Research by Dr. Cheryl Grady of Toronto's Baycrest Hospital has found that people who suffer from early-stage Alzheimer's disease can engage other areas of the brain to perform memory tasks. Now, Dr. Grady and colleagues are looking at the brains of older adults before and after memory training to see which brain areas become engaged after the training.
Impact
Much of Dr. Grady's work is basic research, trying to understand the conditions that might encourage other areas of the brain to "take over" memory tasks. However, Dr. Grady's is also seeking to apply the knowledge gains from her research to encouraging such changes in the brains of older adults.
First Published
CIHR Health Research Results, 2003-04; updated 2009
Dancing your troubles away
Learning to tango can improve balance, memory
Overview
Nine of 14 seniors (aged 62-90) who took tango lessons dramatically reduced their risk of a severe fall, compared to only three out of 10 seniors who walked twice a week, according to research by Dr. Patricia McKinley of McGill University. All of the seniors participating in the study had suffered a fall in the past year and had developed a fear of falling – a major factor in reducing their autonomy. Dancing led to better coordination and balance and, an added bonus, also led to improvements in "working" memory – needed for tasks such as reordering random letters or numbers in a logical sequence – that lasted for weeks after the end of lessons. Dr. McKinley has gone on to compare the benefits of tango with those of meditation for people with mild to moderate depression. She is also hoping to undertake an international study of the use of tango for people with age-related macular degeneration, with the ultimate goal of producing a "turn-key" program for use in community settings.
Impact
A community seniors' centre in Montreal offers space for tango practice, while a tango club in Montreal offers afternoon classes for seniors and students, in part to foster inter-generational activities. Publicity generated by the original tango project has resulted in a dance and movement workshop to be offered in February 2010 as part of a Gait and Mental Function Congress. And Dr. McKinley is using dance and music as a vehicle to improve movement and quality of life in people with Parkinson's disease at a Montreal seniors' centre.
First Published
CIHR Health Research Results, 2004-05; updated 2009
The fall doctor is in
Preventing debilitating falls
Overview
Half of all Canadians aged 70 and older fall each year. Of the thousands who break a hip, one-fifth will die within a year. Dr. Vicki Scott of the University of British Columbia has conducted research that helps home support workers and seniors themselves take an active role in preventing falls through an interactive falls prevention checklist and action plan to identify and reduce risks. Dr. Scott also notes that it's important that we adapt our building codes and built environment, from sidewalks to stairs, to help prevent seniors from falling.
Impact
Dr. Scott's 2006 research resulted in a 43% reduction in falls over a six-month period among the study population. Her work has resulted in the publication of the Canadian Falls Prevention Curriculum (CFPC) in 2008. The CFPC builds on existing knowledge and skills of health professionals and community leaders working to prevent falls among seniors, by giving them the tools they need to select and integrate effective programs and policies.
First Published
Researcher profile, December 2007; updated 2009
Focus on eating well
Tools ensures seniors are getting the nutrients they need
Overview
Dr. Heather Keller from Ontario's Guelph University has developed a simple-to-use screening tool to help doctors and other health professionals spot possible risk factors for poor nutrition among their senior patients. The SCREEN© (Seniors in the Community Risk Evaluation for Eating and Nutrition) and an associated tool kit capture patient information about physical factors, such as difficulty chewing or swallowing, as well as social factors, such as eating alone or difficulties with shopping or cooking.
Impact
Dr. Heather Keller from Ontario's Guelph University has developed a simple-to-use screening tool to help doctors and other health professionals spot possible risk factors for poor nutrition among their senior patients. The SCREEN© (Seniors in the Community Risk Evaluation for Eating and Nutrition) and an associated tool kit capture patient information about physical factors, such as difficulty chewing or swallowing, as well as social factors, such as eating alone or difficulties with shopping or cooking.
First Published
Grey Matters, newsletter of the CIHR Institute of Aging, November 2007; updated 2009.
Helping seniors stay on their medication
Expanding pharmacists' roles is key
Overview
In 2006, seniors in Canada between the ages of 60-79 had an average of 35 prescriptions in a year, while those aged 80 and over averaged 74 prescriptions – and this doesn't count over-the-counter and herbal medications. Dr. Lisa Dolovich of McMaster University has provided reliable research evidence that is helping seniors manage all of these prescriptions and avoid common problems, such adverse drug reactions and remembering to take different medications in the right dosage at the right time. Her research demonstrated that having pharmacists in family physicians' offices helps to optimize medication regimes and improve monitoring of medications.
Impact
As a result of this study, the Ontario Ministry of Health now funds full-time pharmacist positions for family health primary care teams and, as of 2009, there are about 90 Ministry of Health-funded pharmacists in these positions.
First Published
CIHR Institute of Aging Biennial Report, 2005-07; updated 2009
Keeping seniors on the road – safely
Research a sound road map for policy
Overview
CanDRIVE, a CIHR-funded interdisciplinary research program aimed at improving the safety of older drivers, is led by Drs. Malcolm Man-Son-Hing of the Ottawa Health Research Institute and Shawn Marshall of the Élisabeth Bruyère Research Institute. The program is now the accepted expert on older drivers in Canada.
Impact
CanDRIVE has written policies on driving and dementia for the Canadian Council of Motor Transport Administrators (CCMTA), the Canadian Medical Association and the Canadian Consensus Conference on Dementia. The program also participated in developing the 7th edition of Determining medical fitness to operate motor vehicles, a publication of the Canadian Medical Association that is the primary tool physicians use to decide when their patients should no longer be driving.
First Published
CIHR Institute of Aging, Biennial Report, 2005-07.
Getting better at detecting danger
Measuring the risks of frailty
Overview
Frail seniors – as many as 20% of Canadian seniors – are at greater risk for acute and chronic diseases, disability and death. Being able to measure frailty in seniors delays efforts to prevent these outcomes. Dr. Kenneth Rockwood of Dalhousie University has developed and tested the Seven-Point Clinical Frailty Scale as an easy-to-use predictive tool to measure frailty in seniors.
Impact
The new scale is being used clinically at the Queen Elizabeth II Health Sciences Centre in Halifax to help physicians quickly and accurately measure the frailty of patients, enabling them to better manage the condition and reduce the risk of other serious ailments. It is also being beta tested by Providence Health Care in B.C. Dr. Janet McElhaney, MD, program director or Elder Care Acute Services at Providence Health Care and division head of geriatric medicine at the University of British Columbia (UBC). Estimates that the frailty Scale and Index could save $4-billion out of Canada's $17-billion acute care budget by improving the appropriateness of care to elderly. The scale, in a slightly expanded form, is also being used in a range of research studies, including REALISTIC-80 at Queen's University.
First Published
CIHR Health Research Snapshots, 2007; updated 2009
Preventing drug-related deaths in seniors with dementia
Study finds heightened risk in antipsychotic drugs
Overview
Antipsychotic drugs are approved for treating psychotic conditions such as schizophrenia and mania. But they are also widely prescribed to manage behavioural symptoms of dementia, such as agitation, verbal or physical aggression and delusions, hallucinations or paranoia. According to research by Dr. Sudeep Gill, antipsychotic drugs are associated with an increased risk of death in elderly patients with dementia. Dr. Gill tracked seniors with dementia for 180 days after they started taking the drugs and, he says, given the short timeframe, even a slight increase in death rates is significant, particularly as these medications might not be beneficial for many elderly dementia patients.
Impact
The United States' Food and Drug Administration recently cited Dr. Gill's study in its decision to issue a warning about antipsychotic medications and its plans to add boxed warnings to the labels of these drugs.
First Published
CIHR Health Research Results, 2007-08.
Diagnosing urinary problems
New technique is pain-free, non-invasive
Overview
Urinary problems become more frequent as people age, and have a significant impact on quality of life. Diagnosing urinary problems is done through a test that requires catheterization, which can be uncomfortable for many people – so much so that as many as 20-30% of patients turn down the test, progressing straight to medication or surgery. Dr. Andrew Macnab of the University of British Columbia has developed a pain-free and non-invasive way to diagnose urinary problems using near-infrared light. The technique has undergone extensive clinical testing in Canada and the United States. Vancouver-based Urodynamix has licensed the technology and is exploring new applications for it, including monitoring for excessive pressure on organs among patients in intensive care units.
Impact
The device has been approved for use in both Canada and the United States and is being marketed, although lack of a fee code for its use is slowing down its widespread adoption. Dr. Macnab is continuing his work, including using near infrared light on a vaginal probe to diagnose stress incontinence in women due to weakness in the pelvic floor (usually as a result of childbirth), as well as a wireless version of the device that makes diagnosis in children, particularly, much easier.
First Published
CIHR Health Research Results, 2006-07; updated 2009
Keeping seniors on their feet
Restoring a sense of stability
Overview
CIHR-funded researcher Dr. Stephen Perry of Wilfred Laurier University spent 15 years studying how to prevent falls among seniors. Dr. Perry's research led him to develop a new kind of shoe insole that improves balance and prevents seniors from falling. The sole has a thin ridge that extends around the side and back of the insole. When the wearer goes off-balance, he/she senses the ridge and readjusts balance. Normally, natural pressure sensors on the soles of our feet provide the information we need to stay upright. As we age, however, we lose sensitivity in our feet, making balance more difficult and making us prone to falls.
Impact
When a group of 20 seniors wore the Sole Sensors for 2 weeks, they had half the falls of a similar group who didn't wear the insoles. The Sole Sensor has been commercialized by Ontario-based Hart Mobility and is scheduled to appear on the market in 2009.
First Published
Grey Matters, the newsletter of the CIHR Institute of Aging, March 2007, Updated 2009
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