[This corrects the article DOI: 10.1371/journal.pdig.
View Article and Find Full Text PDFObjectives: Medications are often needed to manage distressing end-of-life symptoms (eg, pain, agitation, dyspnea). We evaluated whether physician billing in long-term care (LTC) was associated with LTC residents' receipt of an end-of-life symptom management medication prescription.
Design: Retrospective cohort study using administrative health data.
Health Expect
August 2025
Background: Although many people nearing the end of life wish to die at home, many patients experience re-hospitalisation and hospital death. No end-of-life hospital-to-home interventions have been developed with patients and caregivers, and none have been tested in Canada. Through an iterative, participatory design approach, we codesigned an intervention in partnership with potential users of the final intervention: patients, family caregivers (FCs) and healthcare providers (HCPs).
View Article and Find Full Text PDFObjective: To examine the caregiving factors, sociodemographic characteristics, and self-reported health of caregivers who retired from the labor force to provide full-time, unpaid care to their care recipient.
Design: Matched case-control study.
Setting And Participants: Caregiver respondents from the Canadian Longitudinal Study on Aging baseline (2011-2015), follow-up 1 (2015-2018), and follow-up 2 (2018-2021) cycles.
Background: Older patients frequently experience delays in discharge post-hip fracture surgery. Our study aimed to describe the sociodemographic and clinical characteristics of patients who had a surgical repair for a hip fracture and to examine the associations between these characteristics and delayed discharge (> 6 days post-surgery) for frail vs. non frail patients.
View Article and Find Full Text PDFJ Pain Symptom Manage
October 2025
Context: Nearing the end of life (EOL), a variety of medications can be prescribed for symptom management during the dying process.
Objectives: To describe the prescribing of subcutaneous symptom management medications during the last six weeks of life among home care recipients in Ontario, Canada, and to assess the association of prescribing medications with EOL outcomes.
Methods: This retrospective cohort study included individuals in Ontario who died between January 1, 2017, and March 17, 2020, aged 66-105 at death and who received publicly-funded home care at least one month prior to death.
Geriatr Orthop Surg Rehabil
June 2025
Objective: We conducted a systematic review and meta-analysis to compare post-operative rehabilitation outcomes between two common treatments in patients who have suffered an intertrochanteric hip fracture: intramedullary nails vs dynamic hip screws.
Methods: We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science up to August 10, 2022. The inclusion criteria were defined as Population: adults (>18 years old); Interventions/Comparators: intramedullary nails and dynamic hip screws; Outcomes: function, quality of life and survival; and Study type: randomized controlled trials and non-randomized studies.
J Am Med Dir Assoc
August 2025
Objective: To determine if health care settings in the last year of life and location of death differ between long-term care (LTC) residents with and without schizophrenia.
Design: A retrospective cohort study using health administrative data.
Setting And Participants: All adults who died in Ontario between January 1, 2010, and December 31, 2019, who were living in LTC homes 1 year before death, and who died of natural causes.
Background: People with heart failure (HF) are treated by multiple physician specialties as they approach the end of life (EOL). Patterns of physician involvement and health outcomes are not well understood. Elucidation of care patterns for this population may identify opportunities to minimize fragmentation and improve EOL continuity.
View Article and Find Full Text PDFObjectives: To evaluate the association between long-term care (LTC) home ownership models and operator characteristics and the prevalence of probable delirium.
Design: Cross-sectional study using provincial health administrative data.
Setting And Participants: All LTC residents aged 65-105 years in Ontario, Canada, who underwent assessment via the Resident Assessment Instrument-Minimum Data Set, version 2.
Importance: Care decisions for long-term care (LTC) residents should be frailty-informed to maximize well-being and avoid burdensome treatments that do not align with patient wishes.
Objective: To investigate the incidence and time spent living with severe impairment among LTC residents to help inform person-centered decision-making.
Design, Setting, And Participants: This retrospective cohort study was conducted among a population-based cohort of incident admissions to LTC facilities between April 1, 2013, and March 31, 2018, determined using administrative health data in Ontario, Canada.
Importance: Cannabis use is associated with short-term memory impairment and long-term changes in brain structure; however, little is known about whether disordered cannabis use is associated with an increased risk of a dementia diagnosis.
Objective: To investigate the association between emergency department visits or hospitalizations (acute care encounters) due to cannabis and future dementia diagnosis.
Design, Setting, And Participants: Population-based, retrospective, matched cohort study using health administrative data from Ontario, Canada, between 2008 and 2021 (with follow-up until 2022) including all individuals aged 45 to 105 years living in Ontario who were eligible and did not have a diagnosis of dementia at cohort entry (2 620 083 individuals excluded).
Objectives: To determine the occurrence and clinicodemographic associations of hospital-based specialist palliative care (SPC) referral before and during the COVID-19 pandemic, timing of completed SPC consultation and comparative prevalence of 'no cardiopulmonary resuscitation (CPR)' orders, and end-of-life medication use, according to SPC involvement.
Design: Cross-sectional secondary analysis of a retrospective cohort study with a pre-pandemic (November 2019 to February 2020) group (Pre-COVID, n=170) and two intra-pandemic (March to August 2020) groups, one without (COVID-ve, n=170) and one with COVID-19 infection (COVID+ve, n=85). In the cohort study, Pre-COVID and COVID-ve group decedents were matched 2:1 on age, sex and care service (internal medicine/intensive care unit (ICU)) at death with COVID+ve decedents.
Background: Prescribing rates for subcutaneous medications may be an indicator of quality of end-of-life care in long-term care (LTC). It is not known if this system level measure is valid across jurisdictions. We compared prescribing rates of medications used for end-of-life symptom relief among LTC residents in Alberta and Ontario.
View Article and Find Full Text PDFBackground: As individuals approach death, they experience declines in their cognitive, physical, motor, sensory, physiologic, and psychosocial functions. In this exploratory study we examined individuals' physiologic changes in the last year of life by examining laboratory tests commonly used in clinical practice.
Methods: Using health administrative datasets, we conducted an observational matched cohort study to assess laboratory test use and values over a decedent's last 12 months and a matched observation window for non-decedents.
Objective: To describe and compare the factors that impact initial rehabilitation type after hip fracture surgery.
Design: Retrospective population-based cohort study.
Setting And Participants: People aged between 50 and 105 with a hip fracture who had a surgical repair in Ontario, Canada, between January 1, 2015, and December 31, 2021.
JAMA Netw Open
February 2025
Importance: Although dementia is a contraindication for feeding tube placement, guidelines recommending against its use are inconsistently followed, and factors associated with its use are unclear.
Objective: To describe the incidence of feeding tube placement among hospitalized older adults (aged ≥65 years) with dementia and their health outcomes during and after hospitalization and to identify factors associated with placement of feeding tubes (ie, gastrostomy, gastrostomy-jejunostomy, and jejunostomy tubes).
Design, Setting, And Participants: This population-based retrospective cohort study was conducted using a linked database in Ontario, Canada.
Introduction: Early colon cancer detection is critical for improving outcomes. The diagnostic interval is a useful approach to conceptualizing time-to-diagnosis within the healthcare system and understanding the diagnostic journey. Adults with severe psychiatric illness (SPI) are less likely to participate in cancer screening and more likely to be diagnosed with advanced cancers.
View Article and Find Full Text PDFImportance: Despite public health concerns that cannabis legalization may increase the number of cases of schizophrenia caused by cannabis, there is limited evidence on this topic.
Objective: To examine changes in the population-attributable risk fraction (PARF) for cannabis use disorder (CUD) associated with schizophrenia after liberalization of medical cannabis and legalization of nonmedical cannabis in Canada.
Design, Setting, And Participants: This population-based cohort study was conducted in Ontario, Canada, from January 1, 2006, to December 31, 2022, among 13 588 681 people aged 14 to 65 years without a history of schizophrenia.
BMJ Open
January 2025
Introduction: Long-term care (LTC) residents are frequently transferred to acute care hospitals. Transfer decisions should align with residents' wishes and goals. Decision to transfer to hospital, when not aligned with the resident's wishes, can result in transfers that are harmful to residents, leaving residents in a state of disability that could be considered worse than death.
View Article and Find Full Text PDFIntroduction: Long-term care (LTC) residents require extensive assistance with daily activities due to physical and cognitive impairments. Medical treatment for LTC residents, when not aligned with residents' wishes, can cause discomfort without providing substantial benefits. Predictive models can equip providers with tools to guide treatment recommendations that support person-centred medical decision-making.
View Article and Find Full Text PDFObjective: The COVID-19 pandemic highlighted and exacerbated health inequities worldwide. While several studies have examined the impact of individual social factors on COVID infection, our objective was to examine how interactions of social factors were associated with the risk of testing positive for SARS-CoV-2 during the first two years of the pandemic.
Study Design And Setting: We conducted an observational cohort study using linked health administrative data for Ontarians tested for SARS-CoV-2 between January 1st, 2020, and December 31st, 2021.
J Am Med Dir Assoc
February 2025
Objectives: To examine transitions to a nursing home among residents of assisted living relative to community-dwelling home care recipients.
Design: Population-based retrospective cohort study emulating a target trial.
Setting And Participants: Linked, individual-level health system data were obtained from older adults (aged ≥65 years) who made an incident application for a bed in a nursing home in Ontario, Canada, between April 1, 2014, and March 31, 2019, and were followed until December 31, 2019.
Introduction: Older adults are at increased risk of severe illness and mortality from Coronavirus disease of 2019 (COVID-19) infection. However, public health strategies aimed at reducing spread of COVID-19 may have resulted in increased mental health symptoms, particularly among older adults. Currently, little is known about whether older Veterans were more likely to experience persistent mental health symptoms during the COVID-19 pandemic than non-Veterans.
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