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St. John P.D.,University of Manitoba | Tyas S.L.,University of Waterloo | Montgomery P.R.,Vancouver Island Health Authority
International Journal of Geriatric Psychiatry | Year: 2015

Objective To determine if the modified mini-mental state examination (3MS) predicts functional status and if any effect on function is observed within the normal range of cognition. Design Cohort study. Setting Community-dwelling older adults in the Canadian province of Manitoba sampled in 1991 and followed in 1996. Participants Baseline sample of 1751 adults aged 65+ from a representative registry. Five years later, 1028 participants remained in the community and had no missing data. Measurements The 3MS, age, gender, education, living arrangements, self-rated health, and depressive symptoms were self-reported. Functional status was assessed using the Older Americans Resource Survey, which was dichotomized into no/mild disability versus moderate/severe disability. Results Baseline 3MS score predicted baseline functional status. This effect was a gradient across the entire 3MS score, extending into the normal range with no apparent threshold. In logistic regression models, the unadjusted odds ratio (OR, 95% confidence interval) for the association of 3MS score with disability was 0.94 (0.93, 0.95); the adjusted OR was 0.96 (0.95, 0.98) in models including age, gender, education, and other covariates. Baseline 3MS score also predicted functional status 5 years later: The unadjusted OR for disability was 0.94 (0.92, 0.95); the adjusted OR was 0.97 (0.95, 0.99). Again, the risk of functional impairment at time 2 was a gradient effect, extending into the normal range of baseline 3MS score. Conclusions The 3MS predicts functional decline, and this effect is a gradient effect. These results support the hypothesis that cognition is a continuum in risk. Copyright © 2014 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd. Source


Weinerman R.,Vancouver Island Health Authority
Healthcare quarterly (Toronto, Ont.) | Year: 2011

This article describes a new and innovative training program to assist family physicians to better care for their patients with mental health conditions. Trained family physician leaders train other family physicians. The training package includes a wide range of tools that can be used by physicians in their own offices. Preliminary results indicate that physicians want to be trained, and data indicate a high degree of success for the training module. Some 91% of physicians who attended the training indicated that it had improved their practice, and 94% indicated that it had improved patient care. The training materials are online for those who wish to learn more. Source


St John P.D.,University of Manitoba | Tyas S.L.,University of Waterloo | Montgomery P.R.,Vancouver Island Health Authority
International Psychogeriatrics | Year: 2013

Background: Frailty may be associated with reduced life satisfaction (LS). The objectives of this paper are to determine if (1) frailty is associated with LS in community-dwelling older adults in cross-sectional analyses; (2) frailty predicts LS five years later; and (3) specific domains of LS are preferentially associated with frailty. Methods: This paper presents analysis of an existing population-based cohort study of 1,751 persons aged 65+ who were assessed in 1991, with follow-up five years later. LS was measured using the terrible-delightful scale, which measures overall LS and LS in specific domains. Frailty was measured using the Brief Frailty Instrument. Analyses were adjusted for age, gender, education, and marital status. Results: Frailty was associated with overall LS at time 1 and predicted overall LS at time 2. This was seen in unadjusted analyses and after adjusting for confounding factors. Frailty was associated with all domains of LS at time 1, and predicted LS at time 2 in all domains except housing and self-esteem. However, the effect was stronger for LS with health than with other domains for both times 1 and 2. Conclusions: Frailty is associated with LS, and the effect is strongest for LS with health. Copyright © International Psychogeriatric Association 2013. Source


Daniels T.R.,St. Michaels Hospital | Younger A.S.E.,University of British Columbia | Penner M.,University of British Columbia | Wing K.,University of British Columbia | And 3 more authors.
Journal of Bone and Joint Surgery - Series A | Year: 2014

Background: Surgical treatments for end-stage ankle arthritis include total ankle replacement and ankle arthrodesis. Although arthrodesis is a reliable procedure, ankle replacement is often preferred by patients. This prospective study evaluated intermediate-term outcomes of ankle replacement and arthrodesis in a large cohort at multiple centers, with variability in ankle arthritis type, prosthesis type, surgeon, and surgical technique. We hypothesized that patient-reported clinical outcomes would be similar for both procedures. Methods: Patients in the Canadian Orthopaedic Foot and Ankle Society (COFAS) Prospective Ankle Reconstruction Database were treated with total ankle replacement (involving Agility, STAR, Mobility, or HINTEGRA prostheses) or ankle arthrodesis by six subspecialty-trained orthopaedic surgeons at four centers between 2001 and 2007. Data collection included demographics, comorbidities, and the Ankle Osteoarthritis Scale (AOS) and Short Form-36 (SF-36) scores. The preoperative and latest follow-up scores for patients with at least four years of follow-up were analyzed. Sensitivity analyses excluded ankles that had undergone revision. A linear mixed-effects regression model compared scores between the groups, adjusting for age, sex, side, smoking status, body mass index, inflammatory arthritis diagnosis, baseline score, and surgeon. Results: Of the 388 ankles (281 in the ankle replacement group and 107 in the arthrodesis group), 321 (83%; 232 ankle replacements and eighty-nine arthrodeses) were reviewed at a mean follow-up of 5.5 ± 1.2 years. Patients treated with arthrodesis were younger, more likely to be diabetic, less likely to have inflammatory arthritis, and more likely to be smokers. Seven (7%) of the arthrodeses and forty-eight (17%) of the ankle replacements underwent revision. The major complications rate was 7% for arthrodesis and 19% for ankle replacement. The AOS total, pain, and disability scores and SF-36 physical component summary score improved between the preoperative and final follow-up time points in both groups. The mean AOS total score improved from 53.4 points preoperatively to 33.6 points at the time of follow-up in the arthrodesis group and from 51.9 to 26.4 points in the ankle replacement group. Differences in AOS and SF-36 scores between the arthrodesis and ankle replacement groups at follow-up were minimal after adjustment for baseline characteristics and surgeon. Conclusions: Intermediate-term clinical outcomes of total ankle replacement and ankle arthrodesis were comparable in a diverse cohort in which treatment was tailored to patient presentation; rates of reoperation and major complications were higher after ankle replacement. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2014 By The Journal Of Bone And Joint Surgery, Incorporated. Source


St. John P.D.,University of Manitoba | Tyas S.L.,University of Waterloo | Montgomery P.R.,Vancouver Island Health Authority
International Journal of Geriatric Psychiatry | Year: 2013

Background Frailty and depressive symptoms are common issues facing older adults and may be associated. Objectives To determine if: (i) depressive symptoms are associated with frailty; (ii) there is a gradient in this effect across the range of depressive symptoms; and (iii) the association between depressive symptoms and frailty is specific to particular types of depressive symptoms (positive affect, negative affect, somatic complaints, and interpersonal relations). Method Secondary analysis of an existing population-based study was conducted. Population In 1991, 1751 community-living adults aged 65+ years were interviewed. Measures Depressive symptoms were measured using the Center for Epidemiologic Studies - Depression (CES-D) scale. Frailty was graded from 0 (no frailty) to 3 (moderate/severe frailty). Age, gender, education, marital status, self-rated health, and the number of comorbid conditions were self-reported. Analyses Logistic regression models were constructed with the outcome of no frailty/urinary incontinence only versus frailty. Results Depressive symptoms were strongly associated with frailty, and there was a gradient effect across the entire range of the CES-D scale. The odds ratio and 95% confidence interval was 1.08 (1.06, 1.09) per point of the CES-D in unadjusted models. After potential confounding factors were adjusted, the adjusted odds ratio (95% confidence interval) was 1.03 (1.01, 1.05). Positive affect, negative affect, and somatic complaints were all associated with frailty, whereas interpersonal relations were not associated with frailty. Conclusions Depressive symptoms are associated with frailty. Clinicians should consider assessing frail older adults for the presence of depression. Copyright © 2012 John Wiley & Sons, Ltd. Source

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