Browsing by Author "Seitz, Dallas"
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- ItemOpen AccessBarriers and facilitators to development and implementation of a rural primary health care intervention for dementia: a process evaluation(2019-10-17) Morgan, Debra; Kosteniuk, Julie; O’Connell, Megan E; Kirk, Andrew; Stewart, Norma J; Seitz, Dallas; Bayly, Melanie; Froehlich Chow, Amanda; Elliot, Valerie; Daku, Jean; Hack, Tracy; Hoium, Faye; Kennett-Russill, Deb; Sauter, KristenAbstract Background With rural population aging there are growing numbers of people with dementia in rural and remote settings. The role of primary health care (PHC) is critical in rural locations, yet there is a lack of rural-specific PHC models for dementia, and little is known about factors influencing the development, implementation, and sustainability of rural PHC interventions. Using a community-based participatory research approach, researchers collaborated with a rural PHC team to co-design and implement an evidence-based interdisciplinary rural PHC memory clinic in the Canadian province of Saskatchewan. This paper reports barriers and facilitators to developing, implementing, and sustaining the intervention. Methods A qualitative longitudinal process evaluation was conducted over two and half years, from pre- to post-implementation. Data collection and analyses were guided by the Consolidated Framework for Implementation Research (CFIR) which consists of 38 constructs within five domains: innovation characteristics, outer setting, inner setting, individual characteristics, and process. Data were collected via focus groups with the PHC team and stakeholders, smaller team workgroup meetings, and team member interviews. Analysis was conducted using a deductive approach to apply CFIR codes to the data and an inductive analysis to identify barriers and facilitators. Results Across all domains, 14 constructs influenced development and implementation. Three domains (innovation characteristics, inner setting, process) were most important. Facilitators were the relative advantage of the intervention, ability to trial on a small scale, tension for change, leadership engagement, availability of resources, education and support from researchers, increased self-efficacy, and engagement of champions. Barriers included the complexity of multiple intervention components, required practice changes, lack of formal incentive programs, time intensiveness of modifying the EMR during iterative development, lack of EMR access by all team members, lack of co-location of team members, workload and busy clinical schedules, inability to justify a designated dementia care manager role, and turnover of PHC team members. Conclusions The study identified key factors that supported and hindered the development and implementation of a rural-specific strategy for dementia assessment and management in PHC. Despite challenges related to the rural context, the researcher-academic partnership was successful in developing and implementing the intervention.
- ItemOpen AccessCorrection to: Factors infuencing sustainability and scaleup of rural primary healthcare memory clinics: perspectives of clinic team members(2022-02-15) Morgan, Debra; Kosteniuk, Julie; O’Connell, Megan E.; Seitz, Dallas; Elliot, Valerie; Bayly, Melanie; Chow, Amanda F.; Cameron, Chelsie
- ItemOpen AccessFactors influencing sustainability and scale-up of rural primary healthcare memory clinics: perspectives of clinic team members(2022-02-04) Morgan, Debra; Kosteniuk, Julie; O’Connell, Megan E.; Seitz, Dallas; Elliot, Valerie; Bayly, Melanie; Chow, Amanda F.; Cameron, ChelsieAbstract Background The aging of rural populations contributes to growing numbers of people with dementia in rural areas. Despite the key role of primary healthcare in rural settings there is limited research on effective models for dementia care, or evidence on sustaining and scaling them. The purpose of this study was to identify factors influencing sustainability and scale-up of rural primary care based memory clinics from the perspective of healthcare providers involved in their design and delivery. Methods Participants were members of four interdisciplinary rural memory clinic teams in the Canadian province of Saskatchewan. A qualitative cross-sectional and retrospective study design was conducted. Data were collected via 6 focus groups (n = 40) and 16 workgroup meetings held with teams over 1 year post-implementation (n = 100). An inductive thematic analysis was used to identify themes. Results Eleven themes were identified (five that influenced both sustainability and scale-up, three related to sustainability, and three related to scale-up), encompassing team, organizational, and intervention-based factors. Factors that influenced both sustainability and scale-up were positive outcomes for patients and families, access to well-developed clinic processes and tools, a confident clinic leader-champion, facilitation by local facilitators and the researchers, and organizational and leadership support. Study findings revealed the importance of particular factors in the rural context, including facilitation to support team activities, a proven ready-to-use model, continuity of team members, and mentoring. Conclusions Interdisciplinary models of dementia care are feasible in rural settings if the right conditions and supports are maintained. Team-based factors were key to sustaining and scaling the innovation.
- ItemOpen AccessProtocol for a systematic review and meta-analysis of the prevalence of mental illness among nursing home residents(2024-04-16) Holt, Jared; Bhar, Sunil; Schofield, Penelope; Koder, Deborah; Owen, Patrick; Seitz, Dallas; Bhowmik, JaharAbstract Background There is a high prevalence of mental illness in nursing home residents compared to older adults living in the community. This was highlighted in the most recent comprehensive systematic review on the topic, published in 2010. In the context of a rapidly aging population and increased numbers of older adults requiring residential care, this study aims to provide a contemporary account of the prevalence of mental illness among nursing home residents. Methods This protocol was prepared in line with the PRISMA-P 2015 Statement. Systematic searches will be undertaken across six electronic databases: PubMed, Embase, Web of Science, PsycNET, CINAHL, and Abstracts in Social Gerontology. Peer-reviewed studies published from 2009 onwards which report the prevalence of mental illness within nursing home populations will be included. Database searches will be supplemented by forward and backward citation searching. Titles and abstracts of records will be screened using a semi-automated process. The full text of selected records will be assessed to confirm inclusion criteria are met. Study selection will be recorded in a PRISMA flowchart. A pilot-tested form will be used to extract data from included studies, alongside the JBI Critical Appraisal Checklist for Studies Reporting Prevalence Data. A study characteristics and results table will be prepared to present key details from each included study, supported by a narrative synthesis. Random-effects restricted maximum likelihood meta-analyses will be performed to compute pooled prevalence estimates for mental illnesses represented in the identified studies. Heterogeneity will be assessed using Cochran’s Q and Higgins’ I2 statistics. A Funnel plot and Egger’s test will be used to assess publication bias. The GRADE approach will be used to assess the quality of the body of evidence identified. Discussion The study will provide a comprehensive and contemporary account of the prevalence of mental illness among nursing home residents. Meta-analyses will provide robust prevalence estimates across a range of presentations. Key insights will be highlighted, including potential sources of heterogeneity. Implications for residents, researchers, care providers, and policymakers will be noted. Systematic review registration PROSPERO: CRD42023456226.
- ItemOpen AccessVariation in the health outcomes associated with frailty among home care clients: relevance of caregiver distress and client sex(2018-09-12) Maxwell, Colleen J; Campitelli, Michael A; Diong, Christina; Mondor, Luke; Hogan, David B; Amuah, Joseph E; Leslie, Sarah; Seitz, Dallas; Gill, Sudeep; Thavorn, Kednapa; Wodchis, Walter P; Gruneir, Andrea; Teare, Gary; Bronskill, Susan EAbstract Background The identification of contextual factors that modify associations between client frailty and their health and service use outcomes is essential for informed home health care and policy planning. Our objective was to examine variation in the associations between frailty and select 1-year health outcomes by caregiver distress and client sex among community-residing older care recipients. Methods We conducted a retrospective cohort study using linked population-based clinical and health administrative databases for all long-stay home care clients (n = 234,552) aged 66+ years assessed during April 2010–2013 in Ontario, Canada. Frailty was assessed using a previously validated 72-item frailty index (FI). Presence of caregiver distress was derived from clinical assessment items administered by trained home care assessors. Multivariable log-binomial regression models were used to examine variations in the associations between frailty and outcomes of interest (mortality, nursing home [NH] placement, all-cause and prolonged hospitalization) by caregiver distress, with further model stratification by client sex. Results Frailty prevalence varied little by sex (19.3% women, 19.9% men) despite significant sex-differences in clients’ sociodemographic and health characteristics. In both sexes, frailty was significantly associated with all outcomes, particularly NH placement (RR = 3.84, 95%CI 3.75–3.93) and death (RR = 2.32, 95%CI 2.27–2.37), though risk ratios were greater for women. Caregiver distress was more common with increasing frailty and for male clients, and a significant independent predictor of NH placement and prolonged hospitalization in both sexes. The association between frailty and NH placement (but not other outcomes) varied by caregiver distress for both men and women (p < 0.001 interaction terms), showing a greater magnitude of association among clients without (vs. with) a distressed caregiver. Conclusions As caregiver distress varies by client sex, represents a key driver of NH placement (even among relatively robust clients), and modifies the impact of other risk factors such as frailty, it should be routinely assessed. Further, sex-differences should be considered when developing and evaluating community-based services for older adults and their caregivers.
- ItemOpen AccessWhite matter hyperintensities and smaller cortical thickness are associated with neuropsychiatric symptoms in neurodegenerative and cerebrovascular diseases(2023-06-20) Ozzoude, Miracle; Varriano, Brenda; Beaton, Derek; Ramirez, Joel; Adamo, Sabrina; Holmes, Melissa F.; Scott, Christopher J. M.; Gao, Fuqiang; Sunderland, Kelly M.; McLaughlin, Paula; Goubran, Maged; Kwan, Donna; Roberts, Angela; Bartha, Robert; Symons, Sean; Tan, Brian; Swartz, Richard H.; Abrahao, Agessandro; Saposnik, Gustavo; Masellis, Mario; Lang, Anthony E.; Marras, Connie; Zinman, Lorne; Shoesmith, Christen; Borrie, Michael; Fischer, Corinne E.; Frank, Andrew; Freedman, Morris; Montero-Odasso, Manuel; Kumar, Sanjeev; Pasternak, Stephen; Strother, Stephen C.; Pollock, Bruce G.; Rajji, Tarek K.; Seitz, Dallas; Tang-Wai, David F.; Turnbull, John; Dowlatshahi, Dar; Hassan, Ayman; Casaubon, Leanne; Mandzia, Jennifer; Sahlas, Demetrios; Breen, David P.; Grimes, David; Jog, Mandar; Steeves, Thomas D. L.; Arnott, Stephen R.; Black, Sandra E.; Finger, Elizabeth; Rabin, Jennifer; Tartaglia, Maria C.Abstract Background Neuropsychiatric symptoms (NPS) are a core feature of most neurodegenerative and cerebrovascular diseases. White matter hyperintensities and brain atrophy have been implicated in NPS. We aimed to investigate the relative contribution of white matter hyperintensities and cortical thickness to NPS in participants across neurodegenerative and cerebrovascular diseases. Methods Five hundred thirteen participants with one of these conditions, i.e. Alzheimer’s Disease/Mild Cognitive Impairment, Amyotrophic Lateral Sclerosis, Frontotemporal Dementia, Parkinson’s Disease, or Cerebrovascular Disease, were included in the study. NPS were assessed using the Neuropsychiatric Inventory – Questionnaire and grouped into hyperactivity, psychotic, affective, and apathy subsyndromes. White matter hyperintensities were quantified using a semi-automatic segmentation technique and FreeSurfer cortical thickness was used to measure regional grey matter loss. Results Although NPS were frequent across the five disease groups, participants with frontotemporal dementia had the highest frequency of hyperactivity, apathy, and affective subsyndromes compared to other groups, whilst psychotic subsyndrome was high in both frontotemporal dementia and Parkinson’s disease. Results from univariate and multivariate results showed that various predictors were associated with neuropsychiatric subsyndromes, especially cortical thickness in the inferior frontal, cingulate, and insula regions, sex(female), global cognition, and basal ganglia-thalamus white matter hyperintensities. Conclusions In participants with neurodegenerative and cerebrovascular diseases, our results suggest that smaller cortical thickness and white matter hyperintensity burden in several cortical-subcortical structures may contribute to the development of NPS. Further studies investigating the mechanisms that determine the progression of NPS in various neurodegenerative and cerebrovascular diseases are needed.