ANNUAL REPORT 2016–2017 FRAILTY MATTERS · A caregiver’s perspective… Frailty matters. CFN is making a difference. Mary Luk was a caregiver to her mother and benefited from

FRAILTY MATTERS:Every Canadian is affected by frailty

ANNUAL REPORT 2016–2017

#FRAILTYMATTERS

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Table of ContentsFrailty matters 2

CFN is dedicated to frailty 6

IMPACT: Improving evidence through research 12

IMPACT: Mobilizing evidence into policy and practice 21

IMPACT: Training the next generation 27

INCREASING IMPACT: Awareness and partnerships 32

SUPPORTING IMPACT: Strong management and governance 35

The CFN Community 37

Our Research Portfolio 48

Frailty matters 60

FRAILTY MATTERS. 1.2 million older Canadians live with frailty.

Every Canadian is touched by frailty – personal aging and life course, caregivers, care providers, family members, friends, co-workers, older adults living with frailty.

Improving frailty care benefits every Canadian.

2 CFN ANNUAL REPORT 2016–17

FRAILTY IS a state of increased vulnerability, with reduced physiological reserve and loss of function across multiple body systems. Older Canadians with frailty have a markedly reduced ability to cope with normal or minor stresses, which can cause rapid and dramatic changes in health.

FRAILTY IS A SIGNIFICANT AND GROWING ISSUE IN CANADA

Canadians living with frailty

2.0M+ Canadians will be living with frailty

(projected 67% increase since 2017)

1.2M

2017

20172025

2025

46%2017

76%2025

CANADA’S HEALTHCARE SPENDING FOR PEOPLE OVER 65

$105 billion $175 billion (estimated)

Canadians are caregivers

(projected 67% increase since 2017)

to family members because of age-related needs

2.25M+Canadians will be caregivers

3.75M

3CFN ANNUAL REPORT 2016–17

A caregiver’s perspective…

Frailty matters. CFN is making a difference.

Mary Luk was a caregiver to her mother and benefited from the Quality of Life Assessment Practice Support System (QPSS) in British Columbia. QPSS is a tablet-based system that enables the care team to get patients’ and family caregivers’ perspectives about their quality of life (QOL) concerns and care needs. This tool was developed and tested through a CFN funded project led by Dr. Richard Sawatzky, Trinity Western University.

More than 2.25 million Canadians like Mary are caregivers to family members because of age-related needs (2012 Stats Can).

‘‘I was a family caregiver of my mother, who passed away two months ago, before her 83rd birthday. Between 2012 and 2015, my mother had been in and out of hospital undergoing various examinations and receiving different treatments for kidney cancer and other illnesses. She was also being visited and seen by multiple specialists, community nurses, physiotherapists, occupational therapists, and home health workers.

Being her sole caregiver, my days were so busy and my life, and my husband’s, had become very hectic. Doctors’ appointments and incidental visits to hospitals were our new routine. Not to mention the phone calls to book appointments or liaise with various community home health offices. As my mother did not speak or read English, all these communication tasks, including interpretation duties, became my caregiving responsibility.

With the implementation of the Quality of Life Assessment Practice Support System (QPSS), the key information about my mother’s health and quality of life status was promptly available to the healthcare providers to address my mother’s immediate needs. Such a system greatly supports the family’s role as partner with the healthcare team in giving the best care for the patient.

No one could fully understand how hard it could be to take care of a senior with life-limiting illness, the frustration, the fear, and the “don’t- knows”. Therefore, an intervention that facilitates clear communication of the patient’s medical and quality of life needs, as well as upholding the family members in their pivotal role as the first-line of care provider, is paramount.

Mary Luk4 CFN ANNUAL REPORT 2016–17

THAT IS CFN’S VISION.Every Canadian is touched

by frailty in some way.

Frailty is complicated and often stressful for those concerned. Caring for someone frail is a big responsibility: difficult decisions; significant time commitment; expense; providing the right care to meet with values, wishes, quality of life; and legal/financial issues.

But everyone involved with an older person living with frailty wants the same thing: the best possible care and quality of life for their loved one, friend, patient.

Caring for one older person living with frailty involves and affects many people.

BETTER EVIDENCE•

BETTER CARE•

BETTER CARE BENEFITS EVERY CANADIAN


CFN IS Canada’s only network dedicated to older Canadians living with frailty and the people responsible for their well-being. A one-of-a-kind community comprised of:

45 400

8403,500

universities and teaching hospitals across Canada

researchers

students and trainees who will form the next generation of researchers, academics and care professionals and decisionmakers

individual stakeholders such as researchers, trainees, partners, partner institutions and industry associates (60% growth in two years)

CFN Stats


On March 1, 2017, The Honourable Kirsty Duncan, Minister of Science, announced nearly $24 million in funding from the Networks of Centres of Excellence (NCE) Program to the Canadian Frailty Network (CFN) for a second five-year term (2017–2022). This historic investment by the Government of Canada allows CFN to continue its mission of empowering Canadians from all walks of life to provide the best possible care for older citizens living with frailty.

The NCE is a joint program of the Natural Sciences and Engineering Research Council, the Social Sciences and Humanities Research Council, the Canadian Institutes of Health Research and Industry Canada. Since its creation in 1989, the NCE Program has successfully brought together the best minds in many disciplines and sectors to find solutions to major social, economic or health issues of critical concern to Canadians.

CFN receives strong network and administrative support from our Network hosts: Queen’s University and Kingston General Hospital.

THE HONOURABLE KIRSTY DUNCAN,MINISTER OF SCIENCE

CFN awarded $23.9 million in renewed funding

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‘‘By bringing together partners from academia, industry, government and not-for- profit organizations, these networks [NCEs] are tackling two key issues for Canadians from a variety of angles… In Kingston, the network [Canadian Frailty Network] helps improve end-of-life care for all Canadians. Innovations made through these two networks will improve the quality of life of all Canadians.


CFN Vision, Mission and Strategic Objectives

OUR VISION:Canada provides the highest quality of care for its older citizens living with frailty throughout

the country.

OUR MISSION:Improve care of older Canadians

living with frailty.

OUR STRATEGIC OBJECTIVES:

MATCH CARE TO VALUES

Empower, engage & support patients and families/caregivers

Improve clinical outcomes

Improve care across the continuum


Systematic assessment of frailty within the Canadian healthcare system

Improve evidence for the prevention/treatment of frailty

Move evidence into policy and practice

Train the next generation

Care plan appropriate for degree of frailty

Development of care guidelines/tools

Quality metrics for patients living with frailty

Public measurement and reporting

OUR APPROACH:

Guiding Framework and ApproachCanadian Frailty Network will improve the care of older adults living with frailty and support their families and caregivers by increasing frailty recognition and assessment within Canadian health and social care systems, by increasing evidence for decision making including citizen engagement, and by advocating for change in health and social care systems to ensure that the needs of this vulnerable population are met.

As a result of our efforts, we will become the go-to resource on issues of frailty – for the general public, partners, the clinical community and deliverers of care, government and policy makers.


From the Board Chair

Many Canadians are likely aware that our society is aging and with it there is a growing number of people living longer with chronic health conditions. However, most Canadians probably have less understanding of the very complex/significant needs and costs to our healthcare systems involved with caring for 1.2 million (and

rising) older citizens who live with frailty.

This needs to change, because every Canadian is touched by frailty: whether through personal aging and life course; or as a care-giver/care provider; or, family member, friend or co-worker. Frailty matters in Canada, and the good news is – Canadian Frailty Network is making a difference.

As you will see described in this report, our achievements include expanding the network to comprise more than 3,500 talented and brilliant people and organizations (60% expansion in two years). Almost 200 commitments from 150 partners were secured for our renewal application through our aligned partnership and communications strategies totaling almost $34 million (and growing). During the past year CFN also secured nearly $3.5 million in direct contributions from 39 partners (non-NCE sources).

To fuel a sea change in the care of older Canadians living with frailty: Canadians must be part of the solution. In the past year CFN has strengthened the embedding of citizens in every aspect of the organization. I was very pleased to have the CFN Board of Directors establish a formal citizen engagement committee; requiring citizens on all governance bodies, ensuring all CFN funded projects must include citizen engagement, and adding a stand-alone citizen engagement module to all HQP training programs.

CFN governance has evolved in parallel with the network, with the Board of Directors committed to a sustained focus on planning and strategic priorities along with oversight and

stewardship to ensuring the NCE’s investment in frailty achieves the maximum impact possible. In addition to the Citizen Engagement Committee, the Board established a Working Group on Board Recruitment, formalized a policy on intellectual property, and updated terms of reference for all committees to better reflect the voices of CFN’s receptor community, including policy makers, health professionals, other knowledge users, industry, patients and their family/friend caregivers.

The efforts of the Network community in the past year have positioned and equipped CFN to have a substantial and meaningful impact over the next five years. We feel very privileged to have this opportunity to leverage and mobilize the NCE’s investment and enable Canada to provide the best possible care for older Canadians living with frailty, their families, caregivers and care providers, and to have Canada be recognized as an international leader in caring for this population.

I would like to express my deep thanks to my fellow Board members, to the committee leaders and volunteers; to our dedicated administrative leadership and team; and to our many network partners. I want to especially highlight the great leadership of John Muscedere, our Scientific Director and CEO, without him we would not be creating such exciting momentum. Ultimately, our renewal and successes as a network would never be possible without the contributions of this dedicated and outstanding community.

Russell Williams Chair, Board of Directors Canadian Frailty Network

Russell Williams


From the Scientific Director & Chief Executive Officer

We are grateful to the Government of Canada and the Networks of Centres of Excellence (NCE) program. Renewing the Canadian Frailty Network (CFN) for a second term is a powerful statement recognizing the need to transform how 14 healthcare systems in this

country care for older Canadians living with frailty. This investment also affirms that CFN is the one organization in Canada that can marshal the expertise, advocates and citizens to fulfill this need.

Thanks to the NCE, CFN has built the largest and most comprehensive research portfolio and knowledge base on frailty that has ever existed in Canada; one that is being recognized internationally. Our second term will extend the impact of the NCE’s investment by testing the implementation of new tools and methods to improve care for older Canadians living with frailty. This will fuel significant longer-term impact by building the needed evidence to support the wide scale and spread of meaningful practice change across Canada.

For example, CFN-funded projects are leading the development of innovative tools and approaches to transform care, such as: examining an online toolkit for family caregivers; the role of strength training to mitigate early symptoms of frailty, and an ICU discharge to improve transitions of care. This adds to the inventory of tools that have been tested and developed through CFN research and knowledge transfer and exchange, because of the NCE’s investment. CFN funded research has brought forward emerging themes from our first term, such as: nutrition, medication optimization, and frailty assessment. These themes and will be strengthened and mobilized in Term 2.

Following an open call and rigorous scientific review, CFN is funding four transformative studies will advance first-term pilot studies and leverage existing frailty evidence to potentially alter the landscape for older Canadians living with frailty, their families, their caregivers and care providers. Other new knowledge partnerships will establish common data elements that can be used to aggregate study results and inform new studies and evidence worldwide, and examine potential biomarkers of frailty creating a repository of knowledge unique in the world.

CFN continues to make strides in integrating knowledge translation in research studies and corporate knowledge translation partnerships. Last year’s implementation of the Acute Care for Elders (ACE) Collaborative with Canadian Foundation for Healthcare Improvement (CFHI) and Mt. Sinai Hospital has laid the foundation for three new national collaborations in our second term.

Engaging policy makers with the issue of frailty is a priority for CFN. In May 2016, we held our second CFN National Forum, which assembled more than 100 participants voicing the perspectives of all stakeholders involved with frailty. This dialogue has informed five papers on frailty from working groups established after the 2015 Forum. CFN in partnership with Research Canada brought together more 70 MPs, Deputy Minister, Senators and their senior staff to hear from and meet with CFN member researchers and leadership on Parliament Hill.

CFN’s leads Canada in preparing the next generation to care for older Canadians living with frailty. In 2016–17, CFN’s highly qualified personnel (HQP) program included trainees from diverse disciplines, including: Biostatistics, Engineering, Nursing, Social Work/Psychology, Psychiatry, Geriatrics, Public Health, Rehabilitation, Medicine, Community Health, Epidemiology/Life Sciences, Health Studies, Medical Anthropology, and Health Research.

Our successes are built from the dedication and passion of a very special community: our Network. I am incredibly thankful to the investigators, corporate and non-profit partners, sponsors, public sector agencies, members of the Research Management Committee and other advisory committees, CFN Theme Leads and Working Group Leaders, HQP, supervisors, mentors, volunteers, our dedicated staff, and, of course, energy and counsel of the CFN Board of Directors.

Together, with the visionary investment by the NCE and the strength of this community, we will improve the care and quality of life for our older citizens living with frailty. I invite you to join us in making a difference.

John Muscedere Scientific Director and Chief Executive Officer Canadian Frailty Network

John Muscedere


‘‘When an older patient who is frail has an acute health crisis in Canada, our health system usually delivers excellent service. That’s good news. But health – and quality healthcare – is determined by more than just response to medical emergencies. The truth is, our health system often fails when it comes to addressing the complex care needs of older patients living with frailty between urgent health events.

JOHN MUSCEDERESCIENTIFIC DIRECTOR AND CHIEF EXECUTIVE OFFICER CANADIAN FRAILTY NETWORK

CANADA’S MOST SIGNIFICANT PORTFOLIO OF KNOWLEDGE ON FRAILTY – EVER

Additional partnership contributions from

public and private sector organizations adding up to:

With 1.2 million Canadians deemed to be medically frail the issue of improving care and quality of life for everyone involved with older Canadians living with frailty has never been more urgent. Frailty matters, but it has been an under-appreciated health state leading to poor health outcomes, significant stress on families and care providers and disproportionate consumption of healthcare resources.

Canada’s investment in CFN has allowed us to fund landmark research studies, and become a national hub for a network engaging and mobilizing the finest investigators, research organizations and knowledge users, in Canada (and internationally). This has led to an unprecedented body of knowledge and practice, and moreover, the increased recognition of frailty as a healthcare priority for Canada.

CFN has invested in these projects:

Total number of projects:

92 PROJECTS $15,000,000 $9,800,000

IMPACT: IMPROVING EVIDENCE THROUGH RESEARCH


Older adults living with

frailty and their family/friend

caregivers

■ KNOWLEDGE USERS: ■ HQP:

■ MULTI-DISCIPLINARY RESEARCHERS: • Engineering• Social Work • Epidemiology • Rehabilitation • Palliative Care• Nursing• Pharmacology

• Nutrition• Ethics, Law• Medicine• Biostatistics• Gerontology• Health Policy,

Economics

• Health and social care policy decision makers• Clinicians and healthcare professionals• Care providers• Care facility administrators

• Undergraduate students

• Graduate students

• Postdocs

• Working professionals

■ PARTNERS: • Universities and teaching hospitals

• Research institutes

• Industry and business partners

• Community and government agencies

• Not-for-profit organizations

OUR RESEARCH APPROACHCFN funds research that demonstrates potential for widespread adoption of frailty screening and transforming clinical practices involving care for older adults living with frailty.

Research teams are multi-sectoral and multi-disciplinary.

CFN-supported research teams engage patients, families and knowledge users, and involve trainees directly in the research. Research investigators also seek support from external partners to accelerate the adoption and implementation of project results.


!"#$%&'(CFN Research Themes CFN Goal

Improved outcomes for older

Canadians living with

frailty, their families and

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Improved EOL Care/ACPTheme lead: John You, MD, MSc, FRCPC, McMaster University

Theme Lead: Paul Hébert, MD, Centre de recherche du CHUM

Theme Lead: George Heckman, MD, MSc, FRCP(C) University of Waterloo

Theme Lead: Marilyn Macdonald, PhD, MSN, BN, Dalhousie University

Improved Acute Care/Critical Care

Optimization of Community Care/ Residential Care

Optimization of Transitions of Care

OUR RESEARCH PORTFOLIOCFN’s research portfolio is designed around four overarching themes.

In Term 1 we concentrated on increasing the available evidence on frailty and creating opportunities for further research.

For details on the projects funded, please see pages 48 to 59.

8 types of grant programs

15 competitions

92 research projects


http://www.cfn-nce.ca/research-evidence/our-research-portfolio/

>7x $99,983 è$735,139

>16x $99,923 $1,670,000

Drs. Wendy Duggleby & Barbara Pesut: Study volunteer pa�ent navigator protocol. Grants from Province of Alberta and CIHR to >5x expand the study.>5x $99,547 è

$518,847

Dr. Michelle Kho: Pilot study of in-bed cycling as rehabilita�on modality for cri�cally ill, older adults living with frailty. Grant from CIHR grant to expand the study.

->3x $99,988 è

$332,994

Dr. Sharon Kaasalainen: Improve pallia�ve care for older adults living with frailty in long-term care homes. Co-funding from CIHR; Alberta Innovates Health Solu�ons; Manitoba Health Research Council; Ontario Ministry of Health and Long Term Care; Saskatchewan Health Research Founda�on.

>1x

Drs. Anik Giguère & France Légaré: Improve shared decision making for older adults living with frailty and caregivers re. loca�on of care. Grant from Ministère de l’enseignement supérieur, Recherche, Science et Technologie.

>1x $599,400 è$667,909

$600,000 è$760,000

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Dr. Richard Sawatzky: Pilot study of a prac�ce support system in home care for older adults with life-limi�ng illnesses. Upon comple�on, received CIHR eHIPP grant to conduct the defini�ve study.

Drs. Todd Lee & Emily MacDonald: A pilot study to develop and test MedSafer, an electronic deprescribing tool on the reduc�on of poten�ally inappropriate medica�ons. The preliminary results from this CFN project were a springboard to a $1.67 million three-year CIHR grant.

LEVERAGING CANADA’S INVESTMENTS IN RESEARCH – BUILDING MOMENTUM AND CATALYZING KNOWLEDGE CREATIONThe funding of pilot and early phase studies by CFN has allowed researchers to be successful at other funding agencies for larger-scale studies thereby leveraging CFN/NCE contributions for a total amount of $12.14 million from other funding sources. Obtaining early phase funding is difficult and these studies would likely not have occurred without initial CFN investment. Some prime examples of how CFN Investigators have leveraged their funding appear below.

DR. MICHELLE KHOMcMASTER UNIVERSITY

‘‘It’s time to change the way we view exercise for critically ill patients who are living with frailty. As soon as we resuscitate, we need to think of starting rehabilitation interventions, even in the ICU, to optimize their recovery. People may think that ICU patients are too sick for physical activity, but we know that if patients start in-bed cycling two weeks into their ICU stay, they will walk farther at hospital discharge.


IMPROVING ADVANCE CARE PLANNING (ACP) FOR FRAIL ELDERLY CANADIANS

Investigators: John You, McMaster University (project lead); Doris Barwich, University of British Columbia; Gloria Gutman, Simon Fraser University; Michelle Howard, McMaster University; Dev Jayaraman, Research Institute of the McGill University Health Centre; Sharon Kaasalainen, McMaster University; Amy Tan, University of Calgary; Daniel Kobewka, Ottawa Hospital Research Institute; Jessica Simon, University of Calgary; Tamara Sussman, McGill University; Robin Urquhart, Dalhousie University

The vision for this project is to eliminate the gap for older Canadians living with frailty between the care they prefer and the care they receive as they near the end of life through advanced care planning (ACP). ACP has been shown to increase the quality of life of dying patients, improve the experience of family members, and decrease healthcare costs. The goal of ACP is to prepare people, and their substitute decision-maker(s), for future “in-the-moment” treatment decisions so that people get medical care that is consistent with their values, goals and preferences during serious illness. This project brings together a team of 32 pre-eminent investigators from 16 universities, five international collaborators, 42 partner organizations and a growing team of patient advisors to develop, tailor, implement, and evaluate a multi-faceted suite of ACP tools. Special attention will be paid to the needs of marginalized groups (i.e. ethnic and gender minority groups).

CFN Transformative Grants: An investment to revolutionize careCFN is funding four large transformative research projects in its second term with the potential to revolutionize the care of older Canadians living with frailty, and have a major economic and social impact on the current Canadian healthcare system. Last year, CFN funded pilot work for the project teams to expedite the launch of these major studies in 2017–18.

EQUIP EVERY CANADIAN TO COMMUNICATE THEIR WISHES TO ALL INVOLVED WITH THEIR CARE

96% of Canadians believe it is important to have a conversation with their loved ones about their wishes for care;

Only 34% have had this discussion;

Only 13% have completed an advanced care plan to communicate their wishes;

73% want more information from their doctors to begin an advance care plan.


TRANSFORMING PRIMARY HEALTHCARE FOR FRAIL ELDERLY CANADIANS

Investigators: Paul Stolee, University of Waterloo (project lead); Anik Giguère, Université Laval; Kenneth Rockwood, Nova Scotia Health Authority; Joanie Sims-Gould, University of British Columbia; Sara Mallinson, University of Calgary

This landmark study seeks to establish an effective, feasible and sustainable model of primary care for older adults living with frailty leading to improved outcomes for patients and a decreased burden on the healthcare system. This will include: a new healthcare screening system that can screen and assess older adults at earlier stages of risk and frailty, and coordinate appropriate care plans; stronger patient and family caregiver partnerships at both the clinical level and in research; and an enhanced role for primary care in addressing frailty that is more closely integrated with other parts of our healthcare system.

Nine primary care clinics in three provinces (Québec, Ontario, Alberta) will use a quick screening tool to identify older patients who are at risk of becoming frail. This will help initiate referral to healthcare or support services where necessary. Innovative technology will be used to streamline the referral process and help assist older adults in decision- making about their care. A new app (My Care Mapp), is also being developed that will enable patients and care delivery personnel to monitor and share information on treatment. The project team will work in partnership with a variety of stakeholders including older adults, healthcare providers, health administrators and policy makers.

IMPROVED HEALTH OUTCOMES: DECREASED COST TO CANADA’S HEALTHCARE SYSTEM

More than one in 10 community-dwelling older persons

are living with frailty.

One in 20 were found to be at high risk

requiring more comprehensive assessment or specialist referral.

Previous CFN-funded research found that

one in four older persons screened in primary care were found to be at risk.


PROSPECT: PROBIOTICS TO PREVENT SEVERE PNEUMONIA AND ENDOTRACHEAL COLONIZATION TRIAL

Investigator: Deborah Cook, McMaster University

Canada’s more than one million older adults living with frailty are especially vulnerable to hospital acquired infections. Lung infections, particularly ventilator-associated pneumonia can have a detrimental effect on the health outcomes of this population and dramatically increase the cost of their care, including greater risk of re-hospitalization and one-year mortality.

The large-scale PROSPECT study is a key in the search for better ways to prevent serious infection during critical illness in older patients. The study will involve 33 centres in 5 provinces (BC, Alberta, Ontario, Quebec and Nova Scotia), with 88 Research Coordinators working with 2,650 patients. Using probiotics could provide an easy-to-use, readily available and inexpensive solution help reduce infections in older critically ill patients, especially living with frailty.

ADDRESSING INFECTION IN HOSPITALS

Ventilator associated pneumonia (VAP) is the most common hospital acquired infection

in the ICU and associated with a two-fold risk of death, additional costs of $13,000–16,000

per patient and costs the Canadian healthcare

system $46 million annually.

Past probiotic ICU studies found that patients who

receive probiotics experience a 25% reduction

in lung infection, known as ventilator‐associated

pneumonia (VAP). There is also an 18% reduction

in the chance of developing any infection in the ICU.

PROSPECT will rigorously test this approach with

older patients living with frailty.


A MEANS TO IMPLEMENT EFFECTIVE SYSTEM-WIDE MULTI-FACETED INTERVENTIONS FOR FRAIL OLDER CANADIANS CALLED BETTER TARGETING, BETTER OUTCOMES FOR FRAIL ELDERLY PATIENTS (BABEL)

Investigators: Paul Hébert, Centre de recherche du Centre hospitalier de l’Université de Montréal (project lead); Allan Garland, University of Manitoba; John Hirdes, PhD, University of Waterloo

The Better tArgetting, Better outcomes for frail ELderly patients (BABEL) study will use an internationally proven system (interRAI – Resident Assessment Instrument) and apply it to frailty in homecare and long-term care settings to develop a common approach to chronic disease management care across Canada based on a common understanding of clients’ needs and the necessary resources to meet those needs.

The BABEL project includes two major studies: the first pilot study of the interRAI Long Term Care Facility assessment system in 10 Quebec homes; and, use of interRAI assessments to improved advanced care planning in 24 LTC homes in Ontario and Manitoba.

Increasing knowledge on the chronic disease management needs and resources available to home care agencies will enable implementation of a feasible intervention viability across Canada. Provincial governments and regional health authorities can use this to invest in or reorganize community programs to help vulnerable older adults avoid unnecessary ED visits and hospital admissions. Ultimately this will help older adults in the community to maintain their independence and engagement.

ENABLING CANADA TO BETTER CARE FOR OLDER ADULTS AT RISK OF FRAILTY

ANDRÉ PICARDTHE GLOBE AND MAIL, FEBRUARY 16, 2017‘‘What distinguishes the countries that have markedly better results than Canada – like the

Netherlands and the Nordic countries – is the cohesiveness of the system, and the emphasis on primary care.

Many older adults remain independent while others become frail, experiencing more and more health issues, progressive disability, complications of care and premature death.

Previous CFN funded research indicates over 75% of LTC residents could be classified as frail. Within 90 days of assessment, the most frail (compared to the least frail) residents of long term care facilities are:

Multi-faceted interventions targeted to frailty are needed

Use of effective system-wide interventions

have been limited by

inefficient targeting of “at-risk” patients,

healthcare system fragmentation and a

lack of information on patient needs

and preferences.

2.5 times more likely to be discharged to hospital

12 times more likely to die in hospital

27 times more likely to die in hospital or LTC home


CFN PROJECT SPOTLIGHT: OPTIMIZING MEDICATION TO IMPROVE CARE AND OUTCOMES FOR OLDER CANADIANS

Reducing post-discharge potentially inappropriate medications amongst the elderly: a multi-centre electronic deprescribing intervention, Todd Lee, McGill University Health Centre.

Older adults living with multiple chronic conditions are often prescribed many medicines, which by design address these conditions individually, but cumulatively may have a quite negative impact on health and outcomes – even more so with frailty. Investigators on this CFN funded pilot study developed an electronic deprescribing tool (EDT), MedSafer to identify de-prescribing opportunities for older patients (aged 65 and older) when hospitalized. The tool cross-references patient conditions with established sources (Beers, STOPP and Choosing Wisely Canada) to flag potentially inappropriate medications (PIM’s).

MedSafer provides treating teams in the hospital a prioritized list of deprescribing opportunities using three criteria: likelihood of causing harm; potential to reduce the risk of future illness; and, the potential for a drug to improve symptoms. Using MedSafer enables better use of medications in this vulnerable population which can contribute to more effective treatment and better outcomes and potential cost savings from decreased re-admissions.

This pilot study developed and tested the EDT, at four sites in Montreal, Toronto and Ottawa on over 1000, hospitalized older adults living with frailty. The preliminary results from the CFN grant were very promising and have led to a $1.67 million CIHR grant over 3 years to run a national clinical trial using MedSafer in 9 hospitals in 4 provinces.

MEDICATION OPTIMIZATION MATTERS WITH FRAILTY

Older people living with frailty are at the highest risk of adverse events from polypharmacy

(taking more than 5 medications).

More than 50% of patients aged 65 and older are admitted to

hospitals with more than 10 daily medications and

10% with more than 20 daily medications.

35% of community-dwelling older adults experience

at least one adverse drug event (ADE), each year.

Severe ADEs are responsible for 27,000 hospital admissions annually in Canada and up to

20% of return visits to the hospital within

30 days of discharge.


IMPACT: MOBILIZING EVIDENCE INTO POLICY AND PRACTICE

Because frailty impacts all Canadians, CFN is committed to putting Canada’s best knowledge in the hands of all people involved with the care of older adults living with frailty: from family/friend caregivers and healthcare providers to policy makers and interested citizens. As CFN begins a second term, the focus of the network is shifting from building our research portfolio and knowledge base to directly impacting the quality of care for older Canadians living with frailty. New evidence, tools and methods piloted through CFN funded studies will be ramped up to larger definitive trials to support the scale and spread of meaningful practice change across Canada.

For example, 75% of the projects funded through CFN’s 2016 Catalyst Grant competition will lead to larger definitive trials which will transform care, such as: examining an online toolkit for family caregivers; the role of strength training to mitigate early symptoms of frailty and an ICU discharge to improve the transitions of care. This adds to the inventory of novel tools aimed at improving the lives of Canadians living with frailty and their family/friend caregivers. With supporting evidence, many of these tools can be implemented regionally in a relatively short period of time in different care settings. For some tools expanded feasibility testing and implementation will lead to nation-wide use.

Putting knowledge on the front line of care is embedded to every aspect of our network. All CFN-funded Research results are reviewed for knowledge translation potential by our Knowledge Translation Committee, and impact summaries targeted to specific stakeholder audiences are disseminated and discussed via our website, events, webinars and publications.

PUTTING CANADA’S BEST KNOWLEDGE TO WORK TO ADDRESS FRAILTY

Substantial strides continue to be made by the Network with direct impacts on practice, such as:• CFN funding supported Dr. Richard Sawatzky (Trinity

Western University) in determining the feasibility of an electronic (tablet-based) Quality of Life Assessment and Practice Support System (QPSS). The tool can aid clinicians in hospital-based care settings to assess health-related concerns relevant to the quality of life of older people with chronic life-limiting illnesses, and that of their family caregivers. See Mary Luk’s letter at on page 4.

• ICU patients in Alberta are now screened for frailty thanks to a CFN-funded project, “Province-Wide Implementation of the Clinical Frailty Scale in a Electronic Medical Record System (eCritical) in Alberta”, led by Dr. Sean Bagshaw, University of Alberta.

• A project to guide the implementation of the acute care interRAI tool in ten hospitals, in three provinces led by CFN researcher, Dr. John Hirdes, addresses a growing need for an integrated health information system to be used in community, institutional and hospital-based settings. The tool fosters an integrated health information system with consistent terminology, common core items, and a common conceptual basis in clinical approach.

• Staying at home or moving to a care facility is one of the toughest decisions faced by older Canadians and their care providers. A CFN-funded project by led by Dr. France Légaré supported the development and testing of a training program/tool that teaches doctors and inter-professional teams how to share decisions with their older patients living with frailty.

• A CFN Implementation Grant supported Dr. Paige Moorhouse (Nova Scotia Health Authority) in assessing the feasibility of a web-based “frailty portal” utilizing the Frailty Assessment for Care planning Tool (FACT) that would improve the identification, raising awareness of, care planning and delivery of appropriate care for the frail in community primary care practice.

CANADIAN FOUNDATION FOR HEALTHCARE IMPROVEMENT (CFHI)

‘‘Our partnership with the Canadian Frailty Network to spread the Acute Care for Elders (ACE) Strategy from Toronto’s Sinai Health System to 18 sites has already led to 58 elder friendly interventions and five new ACE Units across the country. Just as importantly, together we have strengthened the capacity of these leaders and organizations to provide high quality care for older adults in the most appropriate setting.


CFN PROJECT SPOTLIGHT: FOOD IS MEDICINE FOR FRAILTY

More-2-Eat: Nutrition care pathway and optimized protein supplementation for malnourished elderly patients – Heather Keller, University of Waterloo, and Adam Rahman, Western University.

Dr. Heather Keller’s CFN funded pilot study led to this multi-year SIG project. Malnutrition is strongly associated with frailty, and many patients can leave the hospital in a frailer state than when admitted. While treatable, many malnourished patients are not identified. This innovative project implemented nutrition care best practices in medical units, which are dominated by older, frail individuals in five diverse acute care hospitals in four provinces.

Among the very promising findings, Dr. Keller found that: improved nutrition care is feasible within current hospital resources. A virtual toolkit (http://nutritioncareincanada.ca/) has been developed to translate key learnings to other hospitals. International partners have also adopted the pathway and are studying implementation in their hospitals.

For the first time, an evidence-based pathway developed by multi-disciplinary consensus within a uniquely Canadian context was created that has the potential to radically change nutrition care.

By 2035 one in four Canadians will

be 65 years old or older, an age group

prone to malnutrition and frailty.

Older adults living with frailty struggle with everyday activities such as cooking and eating, putting them

at risk for malnourishment, exacerbating their

condition and causing further weakness.

Increased hospital stays of malnourished patients

cost Canada $2 billion a year.

45% of people admitted to hospital are malnourished;

75% of the time this goes unnoticed;

meaning 1 in 3 people in hospital are

at risk of poorer health outcomes.

FOOD IS MEDICINE FOR FRAILTY

HEATHER KELLER,UNIVERSITY OF WATERLOO

‘‘Simple tools for screening and processes for detecting and treating these conditions together need to be developed across the continuum of care. Frailty and malnutrition should be considered simultaneously due to the high likelihood that a patient will have both conditions together.


CFN PROJECT SPOTLIGHT: ACE COLLABORATIVE

CFN and the Canadian Foundation for Healthcare Improvement (CFHI) partnered in the ACE (Acute Care for Elders) Collaborative which rolled out a successful innovation from Mount Sinai Hospital to seventeen healthcare organizations from Ontario, Quebec, New Brunswick, Nova Scotia and Yukon and an international team based in Iceland.

Many hospitals across Canada (and internationally) struggle with the issue of understanding and addressing the complex healthcare needs of older adults in a proactive manner. The result is doubly negative – care delivered at great expense to our system with poor outcomes. Many of these adverse outcomes are preventable.

Led by Dr. Samir Sinha, director of geriatrics for the Sinai Health System and a respected clinician and researcher ACE is a seamless model of care for older adults that spans the continuum of the emergency department, inpatient, outpatient and community care. Interprofessional teams of specialist physicians – particularly geriatricians and geriatric psychiatrists – advanced practice nurses, social workers, therapists, pharmacists, dieticians and volunteers work together to provide better, more coordinated care for patients.

At Mount Sinai Hospital, the ACE Strategy demonstrated significant improvements in overall quality of care outcomes, as well as reduced lengths of stay, admissions, readmissions and inappropriate resource utilization. The scale up of this innovative approach through one year pilot studies at the ACE Collaborative sites was completed last year. The results are being evaluated to eventually be spread nationally to improve acute care for all older Canadians.

THE ISSUEOlder adults, particularly those living with frailty who have complex inter-related chronic and acute care issues.

Individuals 65 and older comprise 16% of the population

represent 42% of all acute care hospitalizations and

58% of all hospital days across Canada.

30% of seniors are discharged at a significantly

reduced level of functional ability and most

will never recover to their previous level of independence.

Acute Care for Elders (ACE) impact at Mount Sinai Hospital (Toronto)

reduced total lengths of stay

(12 days – 8 days – 25% reduction)

reduced alternate level of care days (20% reduction)

reduced re-admissions within 30 days (15% –13%)improved rate of returning patients home as opposed to

other institutional settings (71%–79%)

$6.7 million in net acute care savings to the healthcare system in 2014 alone


New knowledge, tools and treatments are just part of the equation to fuel improved care: healthcare system change driven by change in policy is needed and Canadians need to be engaged. Progress is being made: frailty is now in the national conversation about healthcare and care for Canada’s aging population and being increasingly recognized as playing a key role in sustaining the Canadian healthcare system.

FRAILTY MATTERS: BUILDING AWARENESS AND UNDERSTANDING

CFN and our research partners were successful in positioning well-received articles on frailty research themes in mainstream Canadian media CBC’s The National, Global News and National Post canoe.ca

CFN’s newsletter has a circulation of over 3,500 and above-average open rates of nearly 30% of recipients.

CFN social media presence grew in 2016–17 with a 66% increase in Twitter impressions; a 61% increase in profile visits; a 12% increase in mentions and nearly a 38% increase in followers.

CFN Webinars continues to disseminate CFN research findings by showcasing the research and insights of Canadian and international experts on advancements in assessing and caring for older Canadians living with frailty. To date, CFN has attracted an average webinar audience of 200 attendees, for a total audience participation of 4,000 in 2016–17.

CFN ON PARLIAMENT HILL

2016 CFN NATIONAL FORUM

In October 2016, CFN partnered with the Health Research Caucus, Research Canada to host an event (Frailty Among the Aged in Canada) in the Speaker’s Lounge in the Centre Block on Parliament Hill. This brought together MP’s, Deputy Minister, Senators and other senior officials, to hear from and meet with CFN member researchers and leadership to strengthen relationships and understanding among Canada’s elected officials and policy makers on the importance of frailty in Canada.

More than 100 participants including government officials, representatives of national groups like the Canadian Medical Association (CMA), Canadian Institute for Health Information (CIHI) and Canadian

Foundation for Healthcare Improvement (CFHI), interested citizens and caregivers came together for CFN second National Forum in May 2016. Forum participants included high-profile experts and advocates, such as: André Picard, Health and Public Policy Reporter and Columnist, The Globe and Mail; Hazel McCallion, Chancellor, Sheridan College and Former Mississauga Mayor; and The Hon. Hugh D. Segal, CM, Master, Massey College.

The dialogue from the meeting formed the background for five papers on frailty from working groups established after CFN’s 2015 Forum, which will be published in a special supplement to the Canadian Journal of Aging. The 2016 Forum has catalyzed the awareness of frailty with healthcare leadership across the country, including government, healthcare and other organizations.


BRINGING CANADIAN CITIZENS TOGETHER TO ADDRESS FRAILTY

RESEARCH TO BENEFIT PATIENTS – DRIVEN BY PATIENTSA CFN Research Priority Setting Competition funded a special initiative to determine patient-centred research priorities

relating to healthcare of older Canadians living with frailty.

The research team led by Drs. Katherine McGilton and Martine Puts from the University of Toronto is using a consultative process aligned with the internationally established James Lind Protocol that calls for equal input from the perspectives of older adults living with frailty and their caregivers, clinicians and allied health

professionals. Using this process research priorities will be identified and developed in a fair, transparent, and meaningful manner.

A survey is now complete, and a short list of research priorities will be presented on September 26, 2017 in Toronto. A group will prioritize research questions which will form the basis of a CFN competition focused on patient-centred care management for older adults living with frailty.

Having citizens engaged in every aspect of our work adds to the quality and relevance of every aspect of our work. Citizen engagement results in more relevant research and practice, improves dissemination of new evidence that supports the

values and needs of older Canadians living with frailty, and addresses the impact on families; and increases the likelihood of better policy and design of our healthcare systems.

The CFN Board of Directors reinforced the Network commitment to citizen engagement by formally establishing a Citizen Engagement Committee. Chaired by CFN Board member Joyce Resin, the Committee assists CFN in ensuring patients and family and friend caregivers, as well as the broader community, is involved in CFN

strategic and operations planning, and in improving the patient and family experience in the work CFN undertakes and funds. This includes citizens participating as knowledge users on the CFN Board of Directors, Research Management Committee and most advisory Committees, and in all CFN-funded research or KT projects, in a meaningful way, as knowledge users.


CFN PROJECT SPOTLIGHT: NCARE: NAVIGATING, CONNECTING, ACCESSING, RESOURCING, ENGAGING

One year pilot testing the feasibility of a volunteer/healthcare provider navigation partnership to support rural-dwelling older adults – Barbara Pesut (University of British Columbia), Wendy Duggleby (University of Alberta)

Assisting rural seniors living with frailty to age in place is essential to quality of life at end-of-life. This CFN-funded study piloted a volunteer/healthcare provider partnership to provide chronic illness navigation for older adults

living with frailty in the community in rural British Columbia.

The NCARE approach uses a three-day training program of community volunteers to assist older adults with their healthcare journey to ensure they leverage the resources available to them, and also seeks to further develop those resources in the rural community.

The NCARE volunteers, provide regular in-home visits for older adults with serious illnesses. The volunteers help make connections with the supports available in their community that improve quality of life. They can also mitigate issues such as a lack of social support, loneliness and isolation, poor information about available resources, and feeling overwhelmed with decision-making.

The success of the NCARE service trial funded by CFN has led to nine additional sites agreeing to implement the program in British Columbia, Alberta and Nova Scotia. The ultimate goal is to develop policy recommendations for NCARE, and a toolkit for hospice societies across Canada to implement volunteer navigation in their communities. “This has the potential to assist thousands of aging Canadians,” says Dr. Pesut. “We believe NCARE holds promise for improving the lives of adults with serious illness through a compassionate community approach.”

‘‘Everything comes at you so fast, and there are so many decisions to make. When your volunteers come out we can sit and talk about this, and it helps us to understand a little more why [healthcare providers] are doing this or that. And oh, what a difference that makes.

(NCARE PARTICIPANT)


‘‘

IMPACT: TRAINING THE NEXT GENERATION

In 2016–17, CFN recruited

218 Project HQP,

21 Summer Students, and

23 Interdisciplinary Fellows

from across Canada.

In 2016–17, CFN trainees delivered

89 academic products including

journal articles, book chapters, specialized

publications, conference presentations/

proceedings and workshops.

CFN trainee disciplines/professions:

Biostatistics, Engineering, Nursing, Social

Work/Psychology, Geriatrics, Public Health,

Rehabilitation, Medicine, Epidemiology/

Life Sciences, Community Health Science,

Health Studies, Medical Anthropology,

and Health Research, Gerontology, Clinical

Medicine, Psychiatry, Paramedicine.

The [Interdisciplinary Training Program] offers opportunity for meeting people from different disciplines, sharing ideas and expectations about providing the best quality and most effective care for older adults living with frailty.

(CFN TRAINEE)


‘‘

If Canada is to provide the best possible care for its older citizens living with frailty, more than just knowledge is needed. In addition to producing and spreading new evidence and innovative treatments across Canada, CFN is equally committed to training the next generation of care providers and researchers. To date, 840 highly qualified personnel (HQP), including graduate students, post-doctorates, and working professionals have learned to develop, evaluate, and implement innovative healthcare models (largely based on CFN funded knowledge) to improve care for older adults living with frailty. This program, the only one in Canada dedicated to frailty, provides interdisciplinary training on research, ethics, knowledge translation and citizen engagement while connecting HQP with leaders in healthcare, government and industry.

CFN TRAINING STREAMS

Trainees on research projects: Undergraduate, graduate students and post-doctoral fellows and in some cases professional trainees on CFN projects receive valuable training and experience in research organization, experimental design, clinical trial procedures, data analysis and interpretation and knowledge translation. This provides experience and guidance from diverse disciplines.

Interdisciplinary Fellowship Program: Sponsored Fellows work on supervised research and complete common training modules, while also engaging in experiential interdisciplinary training activities.

Summer Student Program: This is the training entry point for undergraduate students to nurture their interest in frailty early in their education. These trainees are funded for 14 weeks of full-time participation on a research project working with a supervisor, and complete common training modules.

CFN Trainees develop skills touching on every aspect of frailty, including:

• The complexities and unique challenges of caring for older Canadians living with frailty;

• Mobilizing research into policy and practice;

• Working productively within a multi-disciplinary, multi-sectoral academic and professional network;

• Applying for project funding;

• Interdisciplinary thinking and collaborative practice.

I expect big things from this student in terms of practice change, and as a result of this CFN experience her knowledge of frailty will have grown exponentially over the period of the SSA project; she now knows much more about the importance of frailty assessment, and would not have known this at all without the assistance of this grant.

(CFN SUMMER STUDENT SUPERVISOR)


FLEXIBLE LEARNING

All HQP participating in the Canadian Frailty Network Interdisciplinary Training Program must complete a number of modules and activities in addition to any research project work with their supervisors:

• CFN Orientation: HQP will learn more about CFN, our target audience, and our objectives.

• Frailty Assessment: HQP will be able to recognize frailty to improve care for older Canadians with evidence-based interventions.

• Citizen Engagement: HQP will be able to identify and apply best practices for patient/citizen engagement to incorporate their needs and concerns into research, practice and policy.

• CFN Webinars: HQP will expand their learning through participating in the CFN Frailty Research Webinar Series and other webinar offerings.

• Networking and Knowledge Translation: HQP will have the opportunity to attend, submit an abstract and present a poster at the annual CFN Conference, where they will interact with researchers, citizens and other knowledge users. Funding is also available through a bursary honouring the Hon. Sharon Carstairs, P.C., the Founding Chair of the CFN Board.

KNOWLEDGE TRANSLATION OPPORTUNITIES FOR HQPCFN supports participants in the Interdisciplinary Training Program by providing funding to cover expenses incurred in participating in knowledge translation or other activities furthering CFN’s commitment to improving care of older adults living with frailty. This typically includes speaking at or presenting a poster at a Conference, or making a presentation at a meeting or event.

Support is provided through a bursary recognizing the work of The Honourable Sharon Carstairs, P.C., the Founding Chair of the Board for Canadian Frailty Network. She retired from the Senate of Canada in 2011 after a political career spanning four decades which including Chairing Senate Committees examining the issues of hospice palliative care and aging, and authoring two special reports on palliative care and aging in Canada. Her work is widely recognized as seminal in bringing the Compassionate Care Benefit to Canadians, and in making palliative care part of the core curriculum in Canadian medical schools.

Flexible, Dedicated Learning through CFN Training Modules

Frailty AssessmentCitizen Engagement

CFN Webinars

Orientation

External PlacementMentorship

Online Collaborative Project

Networking and Knowledge Translation

(CFN SUMMER STUDENT SUPERVISOR)


BEST PRACTICES FOR PATIENT/CITIZEN ENGAGEMENT Canadian Frailty Network values the meaningful and appropriate involvement of citizens (patients and their family and friend caregivers, and the interested general public) in everything we do. We believe – and evidence suggests – that when citizens are engaged in decision making, it improves the patient experience, contributes to more cost-effective services and enhances the overall quality of our health and social care systems.

Dr. Jacobi Elliott, part of our 2015–16 Fellowship cohort, and a member of the CFN Citizen Engagement Committee, worked in partnership with the CFN Citizen Engagement Committee to develop a citizen engagement training module for HQPs, based on the CFN-funded Knowledge Synthesis work completed by Dr. Paul Stolee and his team at the University of Waterloo.

The module is presented in two parts. Part 1 examines patient and family engagement; and provides a review of patient

engagement frameworks. Part 2 focuses on specific strategies for patient and family engagement in healthcare research, planning and clinical decision- making; and the specific challenges and opportunities experienced when engaging frail older adults. In groups, trainees work through different case scenarios using the information provided from the modules.

CFN INTERDISCIPLINARY FELLOWSHIPIn their 12-month terms in addition to common training modules, Fellows also must complete additional experiential learning activities:• Online Collaborative Project: Working in small groups of Fellows at different levels and from different disciplines,

Fellows will work collaboratively on a small research project. • Mentorship: Fellows meet regularly with citizen mentors to gain insight.• External Placement: Fellows have the opportunity to complete a placement outside their discipline or scope of work.

ONLINE COLLABORATIVE PROJECTSIn this module, Fellows collaborate to identify and minimize barriers to the effective, ethical, and economically viable care of older adults living with frailty. The goal is to cross-pollinate research, knowledge translation, policy, and mobilization efforts across disciplines. The project also prepares Fellows with the proclivity and skills to make ethical and equitable interdisciplinary decisions about practice, policy, prevention, and advocacy.

For example, a collaboration on the current state of research on LGBT aging and stigma in the areas of sexuality and dementia within the context of long-term care by CFN-funded Fellows Arne Stinchcombe, Joseph Enright, Katherine Kortes-Miller, Kimberly Wilson has been very successful. Drs. Stinchcombe, Wilson and Kortes-Miller have since expanded this work and have submitted or had published a number

of articles, and presented at the 2016 Annual Meeting of the Gerontological Society of America, having received the Honourable Sharon Carstairs Bursary from CFN to attend. They also presented at the International World Congress of Gerontology and Geriatrics (IAGG) in San Francisco in July 2017.

These emerging investigators leveraged their CFN fellowship funding by obtaining two grants for further research delving into this area: a Social Sciences and Humanities Research Council (SSHRC) Insight Development Grant, and funding from the Law Commission of Ontario.

NETWORKING OPPORTUNITIES FOR HQPTrainees have an opportunity to network with researchers and knowledge users at the CFN Annual Conference, and participate in face-to-face sessions designed to meet their learning needs. They also gain valuable experience preparing abstracts for peer review and then presenting posters at the Conference. The 2016–17 abstracts will be published in the September issue of Canadian Geriatrics Journal.


Matthew Leyenaar is a PhD candidate in the Health Research Methodology program at McMaster

University, supervised by Dr. Andrew Costa. He began his career working as a paramedic in Eastern Ontario. His research sought to improve patient outcomes and

service provision through the integration of health data in order to identify risk factors and

patient trajectories as elderly patients navigate through multiple health services. His placement was at the Hamilton Niagara Haldimand Brant Community Care Access Centre in Hamilton, Ontario. The home assessments he conducted through the Community Access Centre provided an increased understanding of identified risk factors at home causing seniors who are frail to use emergency medical services, particularly following a fall. This new knowledge was immediately applicable to his work experience as a paramedic.

Jennifer Gibson is a PhD candidate in the School of Nursing at the University of British Columbia, supervised by Dr. Paddy Rodney. Her research focused on the palliative approach, end-of-life care, frailty and older adults. She has a

particular interest around understanding clinical practice contexts. Her external placement was at the Supportive Care Clinic in the Heart Function Clinic at St. Paul’s Hospital in Vancouver. This placement provided Jennifer with skills in multidisciplinary palliative-oriented care to patients with heart failure, especially in the form of outpatient care using a

multidisciplinary palliative approach.

Dr. Marian Krawczyk recently finished her PhD in the Department of Sociology and

Anthropology at Simon Fraser University, and was supervised in the CFN Interdisciplinary Fellowship Program by Dr. Richard Sawatzky of Trinity Western University. Her

research examined how clinical practice change in tertiary settings shape relations of care,

particularly within palliative care. For her external placement, she was accepted as a visiting scholar within the University of Glasgow’s End-of-Life Studies Group, led by Dr. David Clark, who is a preeminient scholar in palliative care. The overall aim of the placement was to promote global improvement in palliative and end-of-life care; and to build on her understanding of hospital palliative care provision globally, including the clinical, economic, cultural and ethical considerations specific to different cultural and resource settings.

‘‘Hearing my [patient mentor’s] experiences about ACP reminds me that this research is about real people and real families and that there are real problems out there that need improvement.

(CFN TRAINEE)

EXTERNAL PLACEMENTS

A key component of CFN interdisciplinary training is external placements, which provide a unique learning experience to obtain practical experience outside of their primary disciplines and sectors. This experience encourages Fellows to further consider clinical, economic, social, and ethical interdisciplinary implications in moving from knowledge creation into policy and practice, and offers opportunities to collaborate with others in new care settings, sectors and disciplines.


INCREASING IMPACT: AWARENESS AND PARTNERSHIPS

CFN is Canada’s hub for bringing brilliant, talented people and organizations together from academia, care delivery, communities, government, NGOs, advocacy groups, other non-profits and industry to address frailty. As Canada’s only national network dedicated to older Canadians living with frailty, CFN provides a unique opportunity to reach out and make a difference on this issue that impacts every Canadian.

Partnerships are at the core of CFN’s network model. Our partners are integral to every aspect of CFN: research, knowledge translation, exchange and exploitation, HQP, events, thought leadership, policy and ultimately system transformation. CFN’s partnership strategy also dictates that partners are screened and selected based on the potential to advance the CFN’s strategic priorities and second term research/KTEE objectives.

The Network has recruited and engaged a diverse cadre of hundreds of partners touching on critical aspect of frailty. In 2016–17, CFN focused on securing a foundational partner base to advance every facet of the Network’s activity for its second term, to ultimately have a material impact on Canada’s ability to care for older adults living with frailty.

CFN’s second term will begin with many significant collaborations, including:

• IBM and Indoc Consortium to create a centralized data management platform (DMP) to support CFN’s primary goal of creating a set of common data elements and outcome measures to be recorded during frailty-related research studies in Canada and internationally.

• The Canadian Longitudinal Study on Aging (CLSA) accessing the largest platform for aging research in the world to determine the biological markers of frailty, potentially radically improving the identification of frailty and understanding of responses to therapy, and allow for research that cannot be conducted anywhere else in the world.

• The Canadian Agency for Drugs and Technologies in Health (CADTH) has made a major commitment to support the evaluation of completed CFN research to help determine the potential impact on the Canadian healthcare system thereby, providing better evidence to inform best practices and the development of policy.

CFN is committed to maximizing the impact of the NCE (and Canada’s) investment in our network by collaborating with organizations that are interested in frailty. Looking ahead, the Network is expanding its international reach by discussing partnerships with global leaders such as the Commonwealth Fund and World Health Organization. Our philosophy is: that by sharing our knowledge and collaborating with other organizations and nations will lead to improved care and quality of life for those living with frailty, everywhere.


‘‘It has become clear that we have a tremendous opportunity to leverage our [CFN/CADTH] collective strengths in order to bring about real and sustained evidence-informed change that will improve the care of Canada’s older adults living with frailty.

CADTH – CANADIAN AGENCY FOR DRUGS AND TECHNOLOGY IN HEALTH (CADTH)

During the past year CFN also secured $3,434,938 in direct partner contributions (non-NCE sources). This included $881,139 in cash contributions from

39 partners and $2,553,779 of in-kind contributions.

For CFN’s second term renewal application, the network secured commitments totalling $33,767,382

for our second term, via nearly 200 commitments from 150 partners, comprising:

$6,773,778 from the university sector

$5,264,045 from provincial and federal agencies

$5,935,674 from industry

$15,793,885 from other sources (mainly care delivery and associations)

CIHI – CANADIAN INSTITUTE FOR HEALTH INFORMATION

‘‘CIHI and CFN have complementary skills, information resources and stakeholders – all of which need to be mobilized to more effectively and efficiently care for frail persons across care sectors and across the country

Nunavik Regional Board of Health and Social Services, Inuulitsivik Health Centre and Tulattavik Health Centre CFN is committed to advancing care for particularly vulnerable populations in remote locations. These CFN partners contributed to a study led by Dr. Serge Dumont, Université Laval on implementing a 24/7 on‐call consultation service offered by southern healthcare professionals who specialize in palliative care and of delivering palliative care training to Nunavik healthcare professionals. The knowledge generated by this study contributes to improving the supply of services in palliative care in Nunavik’s communities, and thereby maintaining Inuit patients living with frailty in their community during end of life care. This work also supports new strategies to enhance palliative care capacity in all remote areas of Canada.


Canadian Foundation for Health Improvement (CFHI) The CFN- CFHI partnership has grown significantly. For the Acute Care in the Elderly (ACE) Collaborate, CFN tapped into the collective expertise of its partner network to bring together the necessary collaborators to help develop curriculum, programming, and adjudication leading to the selection of 17 sites across Canada and one in Iceland, establishing 58 new interventions. In addition to strategic guidance, CFN also promoted the initiative internationally through its database of 3,500 plus involved with the care of older adults living with frailty. CFN-CFHI have committed to developing three more national collaboratives during CFN’s second term to test and scale up innovative practices across Canada.

Institut national de santé publique du Québec and ministère de la Santé et des Services sociaux du Québec These two government agencies partnered on a CFN-funded project led by Dr. France Légaré, Université Laval. A training program was developed and tested which improves how doctors and interprofessional teams involve their older patients living with frailty in decision making (for transitions in their care), thus improving their quality of care and satisfaction. This work will lay the foundations for a national strategy to ensure that difficult decision of whether to stay at home or move to a care facility are shared among all concerned.

Long Term Care Facilities Partnering with long term care facilities is a priority for CFN to access residents who live with frailty to support Network research and knowledge translation. Long Term Care partners who made contributions in 2016–17 include: Comox Valley Hospice Society, Extendicare – Hamilton Continuing Care, Integrated Long-term Care Program – East Toronto Health Link, Sienna Senior Living and Whitehorn Retirement Village. CFN has also received commitments from Ontario Ministry of Health and Long-term Care and Government of New Brunswick to designate LTC facilities as incubators for CFN projects.

CFN Training CFN’s HQP training program has been a significant success in attracting interest from our partner community to support the development of a next generation specifically equipped to care for frail older Canadians living with frailty. In 2016–17, CFN’s HQP program generated $535,667 in matching funds, for 21 Summer Student Awards (SSA) and 23 Interdisciplinary Fellows (IFP). The funders represent a broad spectrum of stakeholders across Canada, for example: British Columbia Ministry of Health, Providence Healthcare (BC), Alberta Health Services, Seven Oaks Hospital (MB) Hamilton-Niagara-Haldimand, Brant CCAC (ON).

New Brunswick Health Research Foundation (NBHRF) The CFN HQP program has proved to be an effective “gateway” source for non-NCE funds by engaging new partners, which the Network then expands to a longer-term relationship/agreement. NBHRF was on-boarded in 2016–17, funding three SSA’s and two IFP’s. The initial partnership has been leveraged into a significant collaboration for CFN’s second term, to advance frailty research province-wide in New Brunswick and provide a foundation for national scale and spread.

Long Term Care


The CFN Board of Directors has evolved from operations management to policy governance, allowing for a sustained focus on active leadership of planning and strategic priorities for the network. Significant policy, knowledge translation and networking expertise was added in 2016–17 as the Board welcomed new members Jeff Blackmer, Jean Gray, Fred Horne, and Sharon Straus.

In preparation for our second term, Terms of Reference for the Board and its committees, the Research Management Committee, and advisory committees were updated to reflect evolving priorities and to formally include demographic membership requirements, in particular the inclusion of citizens and trainees.

Board membership recruitment has been guided by the Executive Committee of the Board, but with significant numbers of terms ending in 2017 and 2018, in January of 2017, the Board established a Working Group on Board Recruitment to act as a dedicated nominating group. The Working Group was charged with reviewing Board membership needs to first ensure that the Board has the necessary skills and expertise required to

effectively govern, and second, reflects the CFN community and is appropriately diverse in terms of geographic, disciplinary, sector, gender and other demographic balance as we move into our second term. In May of 2017 the Board converted the working group to a Standing Nominating Committee of the Board to continue recruitment activities, and also to guide staff in conducting a skills and experience audit of existing and new members, updating orientation materials, considering Board member evaluation, and succession planning.

In 2016–17, CFN formalized a policy on intellectual property that is now structured to promote and facilitate the wide use and dissemination of knowledge created from CFN investments. CFN will be reviewing all existing policies to ensure that they meet emerging needs as CFN enters Term 2 (governance processes, executive limitations, board-staff relations, protection of privacy, network or committee membership, environmental review, citizen engagement, and conflict of interest).

Partnerships

Manager, Partnerships& DevelopmentJackie St. Pierre

Research

Research & IP ManagerPerry Kim

Knowledge Translation (KT)

KT / Intelligence ManagerTo be determined

Communications

Manager, CommunicationsTo be determined

Network Management

Finance & AdministrationJeremy Boers

Administrative AssistantLois Breadner

HQP CoordinatorDoug Jarrell

Board of DirectorsChair: Russell Williams

Scienti�c Director & CEOJohn Muscedere

Research ManagementCommittee (RMC)Chair: John Muscedere

International Scienti�cAdvisory CommitteeChair: John Muscedere

Citizen Engagement CommitteeChair: Joyce Resin

Executive Director & COOCarol Barrie

Board Committees

Executive CommitteeChair: Russell WilliamsAudit & Finance CommitteeChair: Dan CiuriakBoard NominatingChair: Deborah Thorlakson

Education & Training CommitteeChair: Denise Stockley

Scienti�c Review CommitteeChair: Richard Hall

Knowledge Translation CommitteeChair: Jayna Holroyd-Leduc

SUPPORTING IMPACT: STRONG MANAGEMENT AND GOVERNANCE


REVENUE AND DEFERRED REVENUE

NCE grant dollars 2016–17 $ 3,660,769Deferred Revenue $ 3,483,608Interest Income $ 53,041Other Income $ 45,256

$ 7,242,674

EXPENDITURES AND COMMITMENTS

Research Programs $ 5,217,901 76.91%Training Program $ 446,667 6.58%Admin Centre $ 668,740 9.86%Knowledge Translation $ 356,118 5.25%Networking and Partnerships $ 14,771 0.22%Communications $ 80,293 1.18%

$ 6,784,490 100.00%

Commitments for Future Research and Fellowships $ 8,863,304

ALL SOURCES OF REVENUE 2016–17Source Cash In-kind Total Revenues Percentage

■ NCE $ 3,660,769 $ – $ 3,660,769 51.59%■ University $ 357,115 $ 204,345 $ 561,460 7.91%■ Industry $ 28,621 $ 108,666 $ 137,287 1.93%■ Provincial $ 132,850 $ 408,330 $ 541,180 7.63%■ Other Sources:

Hospital, NPO, etc.

$

362,553 $

1,832,458

$

2,195,011

30.93%

Total $ 4,541,908 $ 2,553,799 $ 7,095,707 100.00%

$2.5M$2.0M$1.5M$1.0M$0.5M$0M

$ 561,460

$ 137,287

$ 541,180

$ 2,195,011

University

Industry

Provincial

Other Sources

EXTERNAL REVENUES 2016–17

FINANCIAL OVERVIEWYear ending March 31, 2017


The CFN Community

Table of ContentsBOARD OF DIRECTORS 38COMMITTEES 40MEMBER INSTITUTIONS 42NETWORK INVESTIGATORS 43PARTNERS 45INTERDISCIPLINARY FELLOWS 46SUMMER STUDENTS 47


Board of Directors

Russell Williams 1 2 3

Chair of the Board Vice-President, Government Relations and Public PolicyCanadian Diabetes Association

David Crane 2

Journalist and Author

John Fisher 1

Interim Vice Principal (Research)Queen’s University

Jean GrayProfessor Emeritus, Medical Education, Medicine, and Pharmacology; Former Associate Dean of Postgraduate Medical Education and Associate Dean of Continuing Medical Education; Dalhousie University

Fred Horne 3

Health Policy ConsultantFormer Alberta Minister of HealthAdjunct Professor, School of Public Health, University of Alberta

Yolande James(to January 6, 2017)Political analyst, Radio-Canada Television (RDI TV)Former Québec Minister of Family and Minister of Immigration and Cultural Communities

Brian Gray 1

Vice Chair Senior PartnerNorton Rose Fulbright Canada LLP

Richard Birtwhistle(to September 14, 2017)Professor, Departments of Family Medicine and Community Health and Epidemiology, and Director, Centre for Studies in Primary Care, Queen’s University

Jeff BlackmerVice President, Medical ProfessionalismCanadian Medical AssociationAssociate Professor of Medicine, University of Ottawa

Dan Ciuriak 2 (to September 14, 2017)Consultant and EconomistResearch Fellow with CD Howe Institute Associate with BKP Development Research & Consulting GmbH, Munich

Angus Campbell(from September 14, 2017)Executive Director, Caregivers Nova Scotia Association

Debbie DeLancey(from September 14, 2017)Deputy Minister of Health and Social Services, Government of Northwest Territories


1 Member, Executive Committee2 Member, Audit and Finance Committee3 Member, Nominating Committeeº Chair, CFN Citizen Engagement Advisory Committee

Andreas Laupacis 1

(to January 12, 2017)Executive Director of Li Ka Shing Knowledge Institute, St. Michael’s HospitalProfessor in Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto

Duncan SinclairEmeritus Professor of Physiology, Fellow of School of Policy Studies, Queen’s UniversityFormer Vice-Principal (Health Sciences), Past Dean, Faculty of Medicine, Queen’s University

Sharon StrausDirector, Knowledge Translation Program, Li Ka Shing Knowledge Institute and Deputy Physician-in-Chief, St. Michael’s HospitalVice Chair, Medicine (Mentorship, Equity, Diversity) and Division Director for Geriatric Medicine, University of Toronto

Deborah Thorlakson 2 3

Member of numerous foundations and boards including the International Centre for Dignity and Palliative Care, the Manitoba Foundation for the Arts, and the Headingley Library

Carol Barrie 1 2 3

CFN Executive Director and Chief Operating Officer (non-voting)

Steven Liss 1

(to March 1, 2017)Vice-Principal (Research) Queen’s University

John Muscedere 1 2 3

CFN Scientific Director and Chief Executive OfficerProfessor and Research Director, Department of Critical Care Medicine, Queen’s University

Tom Noseworthy 1

Professor, Health Policy and Management, Department of Community Health Sciences and Institute for Public Health, University of Calgary

Joyce Resin º 3

Public Engagement ConsultantFormer Journalist and BroadcasterFormer Executive Director Impact BC

Shirlee Sharkey(from September 14, 2017)President and Chief Executive Officer, Saint Elizabeth


Committees

RESEARCH MANAGEMENT COMMITTEEChair: John Muscedere

Canadian Frailty Network (CFN Scientific Director)

Josef AmannCitizen/caregiver

Allan GarlandUniversity of Manitoba

Gloria GutmanSimon Fraser University

Richard HallDalhousie University (Chair, Scientific Review Committee)

Paul HébertCentre Hospitalier de l’Université de Montréal (CHUM) (Theme Lead, Acute/Critical Care)

George HeckmanUniversity of Waterloo (Theme Lead, Optimization of Community and Residential Care)

Jayna Holroyd-LeducUniversity of Calgary (Chair, Knowledge Translation Committee)

Marilyn MacdonaldDalhousie University (Theme Lead, Optimizations of Transitions of Care)

Ruth Martin-MisenerDalhousie University

Daryl PullmanMemorial University

Joyce SandercockCitizen/caregiver

Samir SinhaMount Sinai Hospital

Denise StockleyQueen’s University (Chair, Education and Training Committee)

Josie VisentiniPfizer Canada Inc.

John YouMcMaster University (Theme Lead, End-of-Life Care (EOL)/Advance Care Planning (ACP))

SCIENTIFIC REVIEW COMMITTEEChair: Richard Hall

Dalhousie UniversitySean Bagshaw

University of AlbertaGrace Johnston

Dalhousie UniversityJean-François Kozak

University of British ColumbiaJim Kutsogiannis

University of AlbertaFrance Légaré

Centre de recherche du CHU de QuébecPaul Stolee

University of Waterloo

Carol Barrie, CFN Executive Director and Chief Operating Officer, as well as a representative of the NCE, are non-voting members of all Committees. John Muscedere, CFN Scientific Director and Chief Executive Officer, is a non-voting member of the Education and Training, Knowledge Translation, and Scientific Review Committees. Information as of September 30, 2017.

To guide, manage and monitor its research and other programs, the CFN Board of Directors relies on its Research Management Committee (RMC). Other committees provide input to the Board through the RMC or the Scientific Director and CEO. Committee membership reflects the multi-sectoral and multi-disciplinary nature of CFN activities, and we thank these volunteers for their commitment, time and talent.


EDUCATION AND TRAINING COMMITTEEChair: Denise Stockley

Queen’s UniversityPaula Chidwick

William Osler Health SystemKathryn Downer

Pallium CanadaBrenda Gamble

University of Ontario Institute of Technology

Margaret McKeeLakehead University

Aaron McKimEastern Health

Patricia StrachanMcMaster University

Kevin WooQueen’s University

KNOWLEDGE TRANSLATION COMMITTEEChair: Jayna Holroyd-Leduc

University of CalgaryDoris Barwich

BC Centre for Palliative CareCarlota Basualdo-Hammond

Alberta Health ServicesSharon Baxter

Canadian Hospice Palliative Care Association (CHPCA)

Carole EstabrooksUniversity of Alberta

Anik GiguèreCHU de Québec (Centre hospitalier universitaire de Québec)

Paige MoorhouseDalhousie University

Stephen VailCanadian Medical Association

CITIZEN ENGAGEMENT COMMITTEEChair: Joyce Resin

Public Engagement ConsultantLucy Barylak

Citizen/caregiverAngus Campbell

(to September 14, 2017) Caregivers Nova Scotia Association

Jacobi ElliottUniversity of Waterloo

Jerold HodgeCitizen/caregiver

Kelly KaySeniors Care Network

Barb MacLeanFamily Caregivers of British Columbia

Alies MaybeeCitizen/caregiver

John MuscedereCanadian Frailty Network

Kelli StajduharUniversity of Victoria

INTERNATIONAL SCIENTIFIC ADVISORY COMMITTEEChair: John Muscedere

Canadian Frailty NetworkMatteo Cesari

Centre Hospitalier Universitaire de Toulouse, France

Hans Erik HenriksenHealthcare DENMARK, Denmark

Fabian Chin Leong LimNanyang Technological University, Singapore

Joanne LynnAltarum Institute, U.S.A.

Imogen MitchellAustralian National University/Canberra Hospital, Australia

Kathy RowanICNARC (Intensive Care National Audit & Research Centre), U.K.

John YoungBradford Institute for Health Research, U.K.

PREVIOUS COMMITTEE MEMBERSJoan Almost

Queen’s UniversityLana Bistritz

University of AlbertaAna Johnson

Queen’s UniversityAriella Lang

McGill UniversityDuncan Robertson

Alberta Health ServicesPaddy Rodney

University of British ColumbiaTom Stelfox

University of Calgary

CFN STAFFJohn Muscedere

Scientific Director and Chief Executive Officer

Carol Barrie Executive Director and Chief Operating Officer

Peter Aitken Manager, Partnerships, Development and Government Relations

Kate Cooke Manager, Communications and Corporate Initiatives

Perry Kim Manager, Research and IP

Mat LaBranche Finance and HQP Coordinator

Danielle McGolrick Research and KT Officer

Claire Notman Administrative Assistant

Committees


Universities and other Member Institutions CFN is directly affiliated with 45 Canadian universities, colleges and other institutions that have a mandate to undertake frailty research. These Network Members include teaching hospitals, research institutes and other organizations eligible to receive funding from the Government of Canada through the Tri-Council funding agencies (NSERC, SSHRC, CIHR), and that provide academic/researcher status to CFN Network Investigators.


Network Investigators

Jonathan Afilalo, Jewish General Hospital

Patrick Michel Archambault, Université Laval

Rakesh Arora, University of Manitoba

Mylène Aubertin-Leheudre, Université du Québec à Montréal

Sean Bagshaw, University of Alberta

Ian Ball, University of Western Ontario

Nick Bansback, University of British Columbia

Susan Baptiste, McMaster University

Michael Barnett-Cowan, University of Waterloo

Doris Barwich, University of British Columbia

Jennifer Baumbusch, University of British Columbia

Michel Bédard, Lakehead University

Chaim Bell, Mount Sinai Hospital/University of Toronto

Luc Bissonnette, Université Laval

Veronique Boscart, Conestoga College Institute of Technology and Advanced Learning

Danielle Bouchard, University of New Brunswick

Susan Bronskill, Institute for Clinical Evaluative Sciences (ICES)

Stirling Bryan, University of British Columbia

Fred Burge, Dalhousie University

Karen Burns, St. Michael’s Hospital/University of Toronto

Lisa Burry, Mount Sinai Hospital

David Chan, McMaster University

Vicky Chau, University Health Network

Mark Chignell, University of Toronto

Robin Cohen, Jewish General Hospital

Kiska Colwill, Hamilton Health Sciences

Deborah Cook, McMaster University

Andrew Costa, McMaster University

Don Cowan, University of Waterloo

Greta Cummings, University of Alberta

Vanina dal Bello-Haas, McMaster University

Raoul Daoust, Hôpital du Sacré-Coeur de Montréal

Sara Davison, University of Alberta

Shelly Dev, Sunnybrook Research Institute

Brian de Vries, Simon Fraser University

Peter Dodek, University of British Columbia

James Downar, University Health Network

Wendy Duggleby, University of Alberta

Serge Dumont, Université Laval

Tilak Dutta, Toronto Rehabilitation Institute, University Health Network

Marcel Émond, Université Laval

Carole Estabrooks, University of Alberta

Deborah Fels, Ryerson University

Geoff Fernie, Toronto Rehabilitation Institute, University Health Network

Cheryl Forchuk, Lawson Health Research Institute

Alan Forster, Ottawa Hospital Research Institute

Robert Fowler, Sunnybrook Research Institute

Brenda Gamble, University of Ontario Institute of Technology

Allan Garland, University of Manitoba

Rose Geist, Trillium Health Partners

Lora Giangregorio, University of Waterloo

Anik Giguère, Université Laval

Judah Goldstein, Dalhousie University

Christopher Gordon, McMaster University

Leah Gramlich, University of Alberta

Michelle Grinman, University of Calgary

Andrea Gruneir, University of Alberta

Gloria Gutman, Simon Fraser University

Cindy Hamielec, Hamilton Health Sciences

Matthew Heath, University of Western Ontario

Paul Hébert, Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM)

George Heckman, University of Waterloo

Daren Heyland, Queen’s University/Kingston General Hospital

Neil Hilliard, Fraser Health Authority

John Hirdes, University of Waterloo

Greg Hirsch, Nova Scotia Health Authority

Andy Hoffer, Simon Fraser University

Jayna Holroyd-Leduc, University of Calgary

Michelle Howard, McMaster University

Sandra Hundza, University of Victoria

Andrea Iaboni, University Health Network

Susan Jaglal, University of Toronto

Dev Jayaraman, Research Institute of the McGill University Health Centre

Lianne Jeffs, St. Michael’s Hospital

Ana Johnson, Queen’s University

Jeffrey Jutai, University of Ottawa

Sharon Kaasalainen, McMaster University

Heather Keller, University of Waterloo/Schlegel-UW Research Institute for Aging

Mary Lou Kelley, Lakehead University

Rachel Khadaroo, University of Alberta

Michelle Kho, McMaster University

Joan Kingston, University of New Brunswick

Doug Klein, University of Alberta

Daniel Kobewka, Ottawa Hospital Research Institute

Anand Kumar, Health Sciences Centre, Winnipeg

Andrew Laing, University of Waterloo

CFN has 183 Network Investigators at 45 host institutions.


François Lamontagne, Université de Sherbrooke

Eddy Lang, University of Calgary

Joel Lanovaz, University of Saskatchewan

Francis Lau, University of Victoria

Sandra Lauck, University of British Columbia

Constance LeBlanc, Dalhousie University

Jacques Lee, Sunnybrook Research Institute

Todd Campbell Lee, McGill University Health Centre

France Légaré, Université Laval

Stuart MacDonald, University of Victoria

Laurie Mallery, Dalhousie University

Sara Mallinson, University of Calgary

Muhammad Mamdani, St. Michael’s Hospital

Dee Mangin, McMaster University

Avril Mansfield, Toronto Rehabilitation Institute, University Health Network

Doug Manuel, The Ottawa Hospital

Isabelle Marcoux, University of Ottawa

Lori Schindel Martin, Ryerson University

Melanie Martin, University of Winnipeg

Colleen Maxwell, University of Waterloo

Nancy Mayo, McGill University Health Centre Research Institute

Rose McCloskey, University of New Brunswick

Mary Ann McColl, Queen’s University

Emily McDonald, McGill University Health Centre

Lynn McDonald, University of Toronto

Katherine McGilton, Toronto Rehabilitation Institute, University Health Network/University of Toronto

William McIlroy, University of Waterloo

Daniel McIsaac, Ottawa Hospital Research Institute

Sangeeta Mehta, University of Toronto

Alex Mihailidis, University of Toronto

Paige Moorhouse, Nova Scotia Health Authority

José Morais, McGill University Health Centre Research Institute

Andrew Morris, Mount Sinai Hospital

Benoit Mulsant, Trillium Health Partners

John Muscedere, Queen’s University/Kingston General Hospital

Goldie Nejat, University of Toronto

Ian Newhouse, Lakehead University

Megan O’Connell, University of Saskatchewan

Donna Ouchterlony, St. Michael’s Hospital

Hélène Ouellette-Kuntz, Queen’s University

Sarah Pakzad, University of Moncton

Alexandra Papiaoannou, McMaster University

Tejal Patel, University of Waterloo

José Pereira, University of Ottawa

Jeffrey Perry, Ottawa Hospital Research Institute

Barbara Pesut, University of British Columbia

Robert Petrella, University of Western Ontario

David Price, McMaster University

Martine Puts, University of Toronto

Adam Rahman, University of Western Ontario

Clare Ramsey, University of Manitoba

Linda Read Paul, University of Calgary

Carla Rice, University of Guelph

Stephen Robinovitch, Simon Fraser University

Kenneth Rockwood, Nova Scotia Health Authority

Paddy Rodney, Providence Health Care Research Institute (BC)

Daryl Rolfson, University of Alberta

Brian Rowe, University of Alberta

Tara Sampalli, Nova Scotia Health Authority

Richard Sawatzky, Trinity Western University

Dallas Seitz, Queen’s University

Debra Sheets, University of Victoria

Jessica Simon, University of Calgary

Joanie Sims-Gould, University of British Columbia

Lianne Singer, University Health Network

Samir Sinha, Mount Sinai Hospital

Marie-Josée Sirois, Université Laval/CHU de Québec

Henry Siu, McMaster University

Andrew Sixsmith, Simon Fraser University

Jeff Small, University of British Columbia

Christine Soong, Mount Sinai Hospital

Dawn Stacey, University of Ottawa

Kelli Stajduhar, University of Victoria

Henry Thomas Stelfox, University of Calgary

Paul Stolee, University of Waterloo

Tamara Sussman, McGill University

Esther Suter, University of Calgary

Amy Tan, University of Calgary

Ada Tang, McMaster University

Navdeep Tangri, University of Manitoba

Olga Theou, Nova Scotia Health Authority

Patricia Trbovich, University of Toronto

Deborah Tregunno, Queen’s University

Holly Tuokko, University of Victoria

Alexis Turgeon, Université Laval

Robin Urquhart, Dalhousie University

Cara Vaccarino, Trillium Health Partners

Kathleen Valentine, University of New Brunswick

Paula van Wyk, University of Windsor

Adrian Wagg, Alberta Centre on Aging

Ron Wald, St. Michael’s Hospital/University of Toronto

Kimberley Wilson, University of Guelph

Kevin Woo, Queen’s University

Feng Xie, McMaster University

John You, McMaster University

Dan Zuege, University of Calgary

David Zygun, University of Alberta


Partners


Interdisciplinary FellowsUniversity of AlbertaShannon Cunningham (Supervisor: Sara Davison) – 2013Elizabeth Dogherty (Supervisor: Carole Estabrooks) – 2014 Gilgamesh Eamer (Supervisor: Rachel Khadaroo) – 2016Joshua Hathaway (Supervisor: Andrea Gruneir) – 2016

University of British ColumbiaJennifer Gibson (Supervisor: Paddy Rodney) – 2016

University of CalgaryChelsia Gillis (Supervisor: Leah Gramlich) – 2016

University of GuelphKimberley Wilson (Supervisor: Carla Rice) – 2014

Lakehead UniversityKatherine Kortes-Miller (Supervisor: Mary Lou Kelley) – 2014Lana Ozen (Supervisor: Michel Bédard) – 2014

Université LavalNoémie Roy (Supervisor: France Légaré) – 2016

University of ManitobaReid Whitlock (Supervisor: Navdeep Tangri) – 2016

McGill UniversityZahra Bagheri (Supervisor: Tilak Dutta) – 2016

McMaster UniversityAbigail Wickson-Griffiths (Supervisor: Sharon Kaasalainen) – 2013Matt Leyenaar (Supervisor: Andrew Costa) – 2016Melody Maximos (Supervisor: Vanina dal Bello-Haas) – 2016

University of MonctonMylène Michaud (Supervisor: Sarah Pakzad) – 2016

University of New BrunswickEmily MacDonald (Supervisor: Rose McCloskey) – 2016

University of Ontario Institute of TechnologyKelly Kay (Supervisor: Brenda Gamble) – 2013

University of OttawaAyah Nayfeh (Supervisor: Isabelle Marcoux) – 2013Arne Stinchcombe (Supervisor: Michel Bédard) – 2015

Ottawa HospitalAmy Hsu (Supervisor: Doug Manuel) – 2016

Queen’s UniversityChristine Knott (Supervisor: Mary Ann McColl) – 2013Idevania Geraldina Costa (Supervisor: Deborah Tregunno) – 2016Julia Kirkham (Supervisor: Dallas Seitz) – 2016Clive Velkers (Supervisor: Dallas Seitz) – 2016

University of SaskatchewanJoseph Enright (Supervisor: Megan O’Connell) – 2014

Simon Fraser UniversityLaura Booi (Supervisor: Andrew Sixsmith) – 2014

University of TorontoLaura Tamblyn Watts (Supervisor: Lynn McDonald) – 2014Amol Verma (Supervisor: Muhammad Mamdani) – 2016

Trinity Western UniversityEric Chan (Supervisor: Richard Sawatzky) – 2013Joyce Lee (Supervisor: Richard Sawatzky) – 2013Marian Krawczyk (Supervisor: Richard Sawatzky) – 2016Larry Mroz (Supervisor: Richard Sawatzky) – 2016 Rozanne Wilson (Supervisor: Richard Sawatzky) – 2016

University Health Network (Toronto Rehabilitation Institute)Zahra Bagheri (Supervisor: Tilak Dutta) – 2016Reza Rizvi (Supervisor: Tilak Dutta) – 2014Alison Schinkel-Ivy (Supervisor: Avril Mansfield) – 2016

University of VictoriaAnna Jeznach (Supervisor: Holly Tuokko) – 2013Drew Commandeur (Supervisor: Sandra Hundza) – 2016

University of WaterlooJacobi Elliott (Supervisor: Paul Stolee) – 2015Celia Laur (Supervisor: Heather Keller) – 2016

CFN has funded 41 Interdisciplinary Fellows supervised by 34 network investigators at 22 Host Institutions.


Summer Students

University of AlbertaLeo Akioyamen (Supervisor: Carole Estabrooks) – 2015Diana Bark (Supervisor: Adrian Wagg) – 2015Veronica Bergstrom (Supervisor: Carole Estabrooks) – 2016Samantha Kuchera (Supervisor: Wendy Duggleby) – 2014Muhammad Moolla (Supervisor: Carole Estabrooks) – 2017Madison Riddell (Supervisor: Jayna Holroyd-Leduc) – 2014Kaitlyn Tate (Supervisor: Greta Cummings) – 2016

University of British ColumbiaBilly Zhao (Supervisor: Jennifer Baumbusch) – 2016

University of GuelphJeffrey Smallbone (Supervisor: Kimberley Wilson) – 2017

Lakehead UniversityDaphne Haggarty (Supervisor: Ian Newhouse) – 2013

Université LavalAntoine Laguë (Supervisor: Marcel Émond) – 2016

University of ManitobaRyan Henrie (Supervisor: Anand Kumar) – 2013

McMaster UniversityKelsey Ambrose (Supervisor: Andrew Costa) – 2017Nicole Babin (Supervisor: Vanina Dal Bello-Haas) – 2016Andrew Lagrotteria (Supervisor: Cindy Hamielec) – 2016Melissa Shears (Supervisor: Michelle Kho) – 2014Lavan Sivarajah (Supervisor: Alexandra Papiaoannou) – 2017

University of MonctonMathilde Thériault (Supervisor: Sarah Pakzad) – 2016

Mount Sinai HospitalManpreet Bansuita (Supervisor: Christine Soong) – 2017Ksenia Chezar (Supervisor: Christine Soong) – 2014Brittany Marinelli (Supervisor: Sangeeta Mehata) – 2013Andrew Perrella (Supervisor: Vicky Chau) – 2016Cassandra Turchet (Supervisor: Lisa Burry) – 2014Kathleen Wheeler (Supervisor: Sangeeta Mehta) – 2014

University of New BrunswickCourtney Busson (Supervisor: Kathleen Valentine) – 2016Dominique Hibbert (Supervisor: Kathleen Valentine) – 2017Alexa Kolyvas (Supervisor: Rose McCloskey) – 2017Amanda Lee (Supervisor: Danielle Bouchard) – 2017Karen Philpott (Supervisor: Joan Kingston) – 2016

North York General HospitalBridgett Hyland (Supervisor: Patricia Trbovich) – 2017

Nova Scotia Health AuthorityJessica Shannon (Gregory Hirsch) – 2016

University of OttawaJamal Alkadri (Supervisor: Jeffrey Jutai) – 2013Joseph Aziz (Supervisor: Jeffrey Jutai) – 2015Patrique Bégin (Supervisor: Jeffrey Jutai) – 2013Alison Knapp (Supervisor: José Pereira) – 2015Jasmine Mah (Supervisor: Jeffrey Jutai) – 2013

Queen’s UniversityHeather Johnson (Supervisor: John Muscedere) – 2013Ryan Pardy (Supervisor: Hélène Ouellette-Kuntz) – 2014Simon Parlow (Supervisor: Ana Johnson) – 2013Molly Steer (Supervisor: Kevin Woo) – 2016Kaylin Woods (Supervisor: John Muscedere) – 2014

Ryerson UniversityPatricia Julian (Supervisor: Lori Schindel Martin) – 2016

University of SaskatchewanCody Weiler (Supervisor: Joel Lanovaz) – 2016

Simon Fraser UniversityCherlene Chang (Supervisor: Stephen Robinovitch) – 2016Kate Meffen (Supervisor: Andy Hoffer) – 2015

Sunnybrook Research InstituteBannuya Balasubramanaiam (Supervisor: Jacques Lee) – 2016Tomas Saun (Supervisor: Shelly Dev) – 2013

University of TorontoKaren Chiu (Supervisor: Andrea Iaboni) – 2016

Trinity Western UniversityWilliam Harding (Supervisor: Richard Sawatzky) – 2013Dawson McCann (Supervisor: Richard Sawatzky) – 2016

University of VictoriaChen Ya (Cynthia) Chao (Supervisor: Debra Sheets) – 2017Alayna Payne (Supervisor: Debra Sheets) – 2015Richelle Stanley (Supervisor: Debra Sheets) – 2014

University of WaterlooSarah Brubacher (Supervisor: Heather Keller) – 2017Kamayu Duggan (Supervisor: Michael Barnett-Cowan) – 2015Chao Dong Hu (Supervisor: Tejal Patel) – 2016Michelle Tanel (Supervisor: Andrew Laing) – 2015Ruchit Patel (Supervisor: Lora Giangregorio) – 2015

Western UniversitySpencer Chambers (Supervisor: Ian Ball) – 2015Tina Felfeli (Supervisor: Robert Petrella) – 2014Andrea Petrella (Supervisor: Matthew Heath) – 2016

University of WinnipegThalia Magyar (Supervisor: Melanie Martin) – 2016

CFN has funded 62 undergraduate students at 24 host institutions in five cohorts of Summer Student Awards.


End-of-Life (EOL) Care/Advance Care Planning (ACP)Theme Lead: John You, MD, MSc, FRCPC McMaster University

Acute/Critical CareTheme Lead: Paul Hébert, MD Centre hospitalier de l’Université de Montréal (CHUM)

CFN has funded 92 research projects through 15 research competitions under seven grant categories.

CFN’s research portfolio is designed around four overarching themes.

Our Research Portfolio


Optimization of Community & Residential CareTheme Lead: George Heckman, MD, MSc, FRCP(C) University of Waterloo

Optimization of Transitions of Care Theme Lead: Marilyn Macdonald, PhD, MSN, BN Dalhousie University


End-of-Life Care (EOL)/ Advance Care Planning (ACP)

Theme Lead: John You, MD, MSc, FRCPC McMaster University

IMPROVING ADVANCE CARE PLANNING FOR FRAIL ELDERLY CANADIANS (TG2015-03 & PILOT)Principal Investigators:John You, MD, MSc, FRCPC – McMaster UniversityDoris Barwich, MD, CCFP – University of British ColumbiaGloria Gutman, PhD, FCAHS, OBC, LLD (Hon.) – Simon Fraser UniversityMichelle Howard, PhD, MSc – McMaster UniversityDev Jayaraman, MD, MPH – Research Institute of the McGill University Health CentreSharon Kaasalainen, RN, BScN, MSc, PhD – McMaster UniversityDaniel Kobewka, MD, MSc – Ottawa Hospital Research InstituteJessica Simon, MBChB, FRCPC – University of CalgaryTamara Sussman, MSW, PhD – McGill UniversityAmy Tan, MD, MSc, CCFP(PC) – University of CalgaryRobin Urquhart, PhD – Dalhousie University

INTEGRATING A QUALITY OF LIFE ASSESSMENT AND PRACTICE SUPPORT SYSTEM IN PALLIATIVE HOME CARE (CAT 2014-17)Principal Investigators:Richard Sawatzky, PhD, MSc, BSc, RN – Trinity Western UniversityRobin Cohen, PhD, MSc, BSc – Jewish General Hospital

PILOT STUDY OF AN AUTOMATED ONE-YEAR MORTALITY PREDICTION TOOL TO TRIGGER ADVANCE CARE PLANNING (CAT 2015-16)Principal Investigator:James Downar, MDCM, MHSc, FRCPC – University Health Network

TALK TO ME: SERIOUSLY ILL PATIENTS’ VIEWS ON PHYSICIAN BEHAVIOURS THAT INFLUENCE THE QUALITY OF END-OF-LIFE COMMUNICATION (CORE 2012-03)Principal Investigators:John You, MD, MSc, FRCPC – McMaster UniversityJessica Simon, MBChB, FRCPC – University of Calgary

IGAP: IMPROVING GENERAL PRACTICE ADVANCE CARE PLANNING (CORE 2013-13)Principal Investigators:Michelle Howard, PhD, MSc – McMaster UniversityDaren Heyland, MD, MSc, FRCPC – Queen’s University/Kingston General HospitalDoug Klein, MD, MSc, BSc, CCFP(PC) – University of Alberta

IMPROVING DECISION-MAKING ABOUT GOALS OF CARE FOR HOSPITALIZED ELDERLY PATIENTS: A “MULTI-INCUBATOR” STUDY (IDECIDE) (CORE 2013-30)Principal Investigators:John You, MD, MSc, FRCPC – McMaster UniversityDaren Heyland, MD, MSc, FRCPC – Queen’s University/Kingston General HospitalDev Jayaraman, MD, MPH – The Research Institute of the McGill University Health CentreJessica Simon, MBChB, FRCPC – University of Calgary

HELPING THE PRIMARY CARE SYSTEM IDENTIFY, PLAN, AND CARE FOR SERIOUSLY ILL, FRAIL ELDERLY (SIG 2014F-09)Principal Investigators:Robin Urquhart, PhD – Dalhousie UniversityFred Burge, MD, FCFP, MSc – Dalhousie University

IMPROVING PALLIATIVE CARE IN LONG-TERM CARE HOMES USING PARTICIPATORY ACTION RESEARCH (SIG 2014-IS)Principal Investigators:Sharon Kaasalainen, RN, BScN, MSc, PhD – McMaster UniversityTamara Sussman, MSW, PhD – McGill University

DECISION-MAKING ABOUT GOALS OF CARE FOR HOSPITALIZED MEDICAL PATIENTS II: A COMMUNICATION INTERVENTION (DECIDE II COMMUNICATE) – PATIENT DATA COLLECTION AND FEEDBACK PILOT (CAT 2013-18)Principal Investigator:James Downar, MDCM, MHSc, FRCPC – University Health Network

FOSTERING END-OF-LIFE CONVERSATIONS, COMMUNITY AND CARE AMONG LGBT OLDER ADULTS (CAT 2013-21)Principal Investigators:Brian de Vries, PhD – Simon Fraser UniversityGloria Gutman, PhD – Simon Fraser University


WEB-BASED VIDEOCONFERENCING (WBVC) FOR RURAL PALLIATIVE CARE CONSULTATION IN THE HOME (HTIG 2014-10)Principal Investigator:Linda Read Paul, RN, MN, CHPCN(C) – University of Calgary

SYSTEMATIC SCOPING REVIEW AND META ANALYSIS OF END-OF-LIFE DECISION MAKING TOOLS AND STRATEGIES (KS 2014-06)Principal Investigator:John You, MD, MSc, FRCPC – McMaster University

OPTIMIZING PALLIATIVE CARE IN NUNAVIK’S COMMUNITIES (CAT 2015-03)Principal Investigator:Serge Dumont, PhD – Université Laval

INTEGRATED APPROACH TO PALLIATIVE CARE IN ACUTE CARE (IPAC-AC) (CAT 2015-32)Principal Investigators:Kelli Stajduhar, PhD, MSN, BN, RN – University of VictoriaNeil Hilliard, MD – Fraser Health AuthorityRichard Sawatzky, PhD, MSc, BSc, RN – Trinity Western University

MIXED METHODS FEASIBILITY STUDY OF GROUP PEER SUPPORT INTERVENTIONS TO ENGAGE THE PUBLIC IN ACP (CAT 2015-39)Principal Investigator:Doris Barwich, MD, CCFP – University of British Columbia

A NATIONAL COMPARISON OF INTENSITY OF END-OF-LIFE CARE IN CANADA: DEFINING CHANGING PATTERNS, RISK FACTORS AND TARGETS FOR INTERVENTION (CORE 2012-12)Principal Investigator:Robert Fowler, MD, MSc – Sunnybrook Research Institute

A KNOWLEDGE TRANSLATION PROJECT ON BENCHMARK END-OF-LIFE CARE PRACTICES FOR THE ELDERLY IN PRIMARY CARE (CORE 2012-13)Principal Investigators:Francis Lau, PhD, MBA, MSc – University of VictoriaDoris Barwich, MD, CCFP – University of British Columbia

SEX DIFFERENCES IN ADMISSION TO INTENSIVE CARE UNITS: THE ROLE OF SOCIAL SUPPORT FACTORS (CORE 2012-19)Principal Investigators:Allan Garland, MD, MA, BSc – University of ManitobaClare Ramsey, MD, MSc, FRCPSC – University of Manitoba


Acute/Critical Care

PROSPECT: PROBIOTICS TO PREVENT SEVERE PNEUMONIA AND ENDOTRACHEAL COLONIZATION TRIAL (TG2015-20 & PILOT)Principal Investigator:Deborah Cook, MD, MSc (Epid), FRCPC, DABIM, CCM, CRC, CAHS, FRS – McMaster University

NUTRITION CARE PATHWAY FOR HOSPITALIZED OLDER ADULTS: CONTENT VALIDATION AND FEASIBILITY TESTING (CAT 2013-28)Principal Investigator:Heather Keller, PhD, RD, FDC – University of Waterloo

INTEGRATING QUALITY OF LIFE ASSESSMENTS INTO ACUTE CARE FOR OLDER ADULTS WITH CHRONIC LIFE-LIMITING ILLNESS (CAT 2013-51)Principal Investigators:Richard Sawatzky, PhD, MSc, BSc, RN – Trinity Western UniversityRobin Cohen, PhD, MSc, BSc – Jewish General HospitalKelli Stajduhar, PhD, MSN, BN, RN – University of Victoria

E-CYCLE: A PILOT RANDOMIZED CLINICAL TRIAL OF EARLY IN-BED CYCLING IN ELDERLY, MECHANICALLY VENTILATED PATIENTS (CAT 2014-06)Principal Investigator:Michelle Kho, PT, PhD – McMaster University

A PILOT STUDY OF A MEDICATION RATIONALIZATION (MERA) INTERVENTION (CAT 2014-29)Principal Investigator:James Downar, MDCM, MHSc, FRCPC – University Health Network

Theme Lead: Paul Hébert, MD Centre hospitalier de l’Université de Montréal (CHUM)

REDUCING POST-DISCHARGE POTENTIALLY INAPPROPRIATE MEDICATIONS AMONGST THE ELDERLY: A MULTI-CENTRE ELECTRONIC DEPRESCRIBING INTERVENTION (CAT 2015-TG2)Principal Investigators:Todd Campbell Lee, MD, MPH, FRCPC – McGill University Health CentreEmily McDonald, MD, MSc – McGill University Health Centre

ELDER-FRIENDLY APPROACHES TO THE SURGICAL ENVIRONMENT-USING BIOLOGICAL SAMPLES TO IDENTIFY & PROVIDE OPTIMIZED CARE (EASE-BIO) (CAT 2014-31)Principal Investigator:Rachel Khadaroo, MD, PhD, FRCSC – University of Alberta

PROBIOTICS: PREVENTION OF SEVERE PNEUMONIA AND ENDOTRACHEAL COLONIZATION TRIAL (PROSPECT): A FEASIBILITY PILOT TRIAL (CORE 2012-14)Principal Investigator:Deborah Cook, MD, MSc (Epid), FRCPC, DABIM, CCM, CRC, CAHS, FRS – McMaster University

REENGINEERING THE DISCHARGE OF ELDERLY PATIENTS FROM INTENSIVE CARE (CORE 2013-12) Principal Investigators:Tom Stelfox, BMSc, MD, PhD, FRCPC – University of CalgarySean Bagshaw, MD, MSc, FRCPC – University of AlbertaPeter Dodek, MD, MHSc – University of British ColumbiaAlan Forster, MD, FRCPC, MSc – University of OttawaRobert Fowler, MDCM, MSc – Sunnybrook Research InstituteFrançois Lamontagne, MD, MSc – Université de SherbrookeAlexis Turgeon, MD, MSc – Université Laval

A SCOPING REVIEW OF EVIDENCE FOR MEASURING FRAILTY IN PRE-HOSPITAL AND HOSPITAL SETTINGS (FRA 2015-A-08)Principal Investigator:Olga Theou, PhD – Nova Scotia Health Authority


FRAILTY ASSESSMENT OF OLDER CANADIANS USING EMERGENCY SERVICES WITH TABLET TECHNOLOGY (FRA 2015-B-09)Principal Investigators:Jacques Lee, MD, MSc, FRCPC – Sunnybrook Research InstituteMark Chignell, PhD – University of TorontoMarcel Émond, MD, MSc – Université LavalJudah Goldstein, PhD – Dalhousie University

THE ESSENTIAL FRAILTY TOOLSET (FRA 2015-B-11)Principal Investigators:Jonathan Afilalo, MD, MSc, FACC, FRCPC – Jewish General HospitalRakesh Arora, MD, MSC – University of ManitobaSandra Lauck, PhD, RN – University of British Columbia

PROVINCE-WIDE IMPLEMENTATION OF THE CLINICAL FRAILTY SCALE IN AN ELECTRONIC MEDICAL RECORD SYSTEM (ECRITICAL) IN ALBERTA (FRA 2015-B-20)Principal Investigators:Sean Bagshaw, MD, MSc, FRCPC – University of AlbertaDaryl Rolfson, MD – University of AlbertaTom Stelfox, BMSc, MD, PhD, FRCPC – University of CalgaryDan Zuege, MD, MSc, FRCPC – University of CalgaryDavid Zygun, MD, FRCPC – University of Alberta

PATIENT- AND FAMILY-REPORTED EXPERIENCE AND OUTCOME MEASURES FOR ELDERLY ACUTE CARE PATIENTS: A KNOWLEDGE SYNTHESIS (KS 2013-09)Principal Investigator:Richard Sawatzky, PhD, MSc, BSc, RN – Trinity Western University

ANTIPSYCHOTICS FOR MANAGEMENT OF DELIRIUM – A SYSTEMATIC REVIEW (KS 2013-10)Principal Investigator:Lisa Burry, BScPharm, PharmD – Mount Sinai Hospital

MORE-2-EAT: NUTRITION CARE PATHWAY AND OPTIMIZED PROTEIN SUPPLEMENTATION FOR MALNOURISHED ELDERLY PATIENTS (SIG 2014F-08)Principal Investigators:Heather Keller, PhD, RD, FDC – University of Waterloo/Schlegel-UW Research Institute for AgingAdam Rahman, MD – University of Western Ontario

CARE OF FRAIL, ACUTELY ILL OLDER PERSONS: MAKING HEALTHCARE WORK LIKE A SYSTEM (SIG 2014F-31)Principal Investigators:Paul Hébert, MD – Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM)John Hirdes, PhD – University of Waterloo


EXPLORING THE PREFERENCES OF FRAIL ELDERLY CANADIANS FOR ASPECTS OF INPATIENT CARE: A BEST-WORST SCALING EXPERIMENT (CAT 2015-36)Principal Investigator:Nick Bansback, PhD – University of British Columbia

SCREENING ELDERLY PATIENTS FOR INCLUSION IN A WEANING TRIAL: THE SENIOR TRIAL (CAT 2013-45)Principal Investigator:Karen Burns, MD, MSc, FRCPC – St. Michael’s Hospital/University of Toronto

EVALUATION OF A CONTEXT‐ADAPTED WIKI‐BASED DECISION AID SUPPORTING CRITICALLY ILL PATIENTS’ DECISIONS ABOUT LIFE‐SUSTAINING THERAPIES (CAT 2015-35)Principal Investigators:Patrick Michel Archambault, MD, MSc, FRCPC – Université LavalFrance Légaré, MD, PhD, CCFP, FCFP – Université Laval

PRACTICES IN END OF LIFE CARE AND IN DISCONTINUING MECHANICAL VENTILATION IN ELDERLY CRITICALLY ILL PATIENTS: A NESTED STUDY WITHIN AN INTERNATIONAL OBSERVATIONAL STUDY (CORE 2012-11)Principal Investigator:Karen Burns, MD, MSc, FRCPC – St. Michael’s Hospital/University of Toronto

OPTIMAL SELECTION FOR AND TIMING TO START RENAL REPLACEMENT IN CRITICALLY ILL OLDER PATIENTS WITH ACUTE KIDNEY INJURY (OPTIMAL-AKI) (CORE 2012-15)Principal Investigators:Sean Bagshaw, MD, MSc, FRCPC – University of AlbertaRon Wald, MDCM, MPH, FRCPC – St. Michael’s Hospital/University of Toronto

IDENTIFYING OLDER PATIENTS AT HIGH RISK OF POOR OUTCOMES AFTER JOINT REPLACEMENT SURGERY (FRA 2015-B-06)Principal Investigator:Daniel McIsaac, MD, MPH, FRCPC – Ottawa Hospital Research Institute

NEW APPROACHES TO EVALUATING FRAILTY IN SOLID ORGAN TRANSPLANTATION (FRA 2015-B-13)Principal Investigator:Lianne Singer, MD, FRCPC – University Health Network

ACUTE-CARE FRAILTY LADDER (FRA 2015-B-16)Principal Investigators:Nancy Mayo, BSc, MSc, PhD – McGill University Health Centre Research InstituteJosé Morais, MD – McGill University Health Centre Research Institute

CARDIAC SURGERY AMONG THE FRAIL AND ELDERLY TOWARDS OPTIMAL DECISION MAKING (FRA 2015-B-22)Principal Investigator:Greg Hirsch, MD – Nova Scotia Health Authority

ASSESSING QUALITY OF LIFE (QOL) MEASURES FOR ELDERLY TRAUMATIC BRAIN INJURY (TBI) SURVIVORS: A SYSTEMATIC REVIEW (KS 2013-01)Principal Investigator:Donna Ouchterlony, MD, CCFP – St. Michael’s Hospital

A SCOPING REVIEW DETERMINING THE CURRENT AND FUTURE ROLE OF OCCUPATIONAL THERAPY IN THE ICU (KS 2013-13)Principal Investigators:Susan Baptiste, MSc, OT(C) – McMaster UniversityMichelle Kho, PhD, PT – McMaster University

OUTCOME PRIORITIES IN INTENSIVE CARE STUDIES (OPTICS) (SDG 2013-01)Principal Investigator:John Muscedere, MD, FRCPC – Queen’s University/Kingston General Hospital


Optimization of Community and Residential Care

Theme Lead: George Heckman, MD, MSc, FRCP(C) University of Waterloo

FEASIBILITY OF A VOLUNTEER/HEALTHCARE PROVIDER NAVIGATION PARTNERSHIP TO SUPPORT FRAIL RURAL-DWELLING OLDER ADULTS (CAT 2014-CP)Principal Investigators:Barbara Pesut, PhD, RN – University of British ColumbiaWendy Duggleby, PhD, RN, AOCN – University of Alberta

THE EDOSETTE STUDY: OPTIMIZING MEDICATION USE AND SAFETY IN COMMUNITY DWELLING SENIORS (CAT 2015-25)Principal Investigator:Henry Siu, MD, MSc, CCFP – McMaster University

A FRAILTY MEASURE FOR PERSONS WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES USING AGING CARE (FRA 2015-A-03)Principal Investigator:Hélène Ouellette-Kuntz, PhD – Queen’s University

ANTIDEPRESSANT GUIDELINES FOR LONG-TERM CARE RESIDENTS WITH ADVANCED FRAILTY (FRA 2015-A-04)Principal Investigators:Laurie Mallery, MD – Dalhousie UniversityConstance LeBlanc, DSS, MD, CCFP, FCFP, MAEd – Dalhousie University

INTERVENTIONS TO PREVENT AND TREAT FRAILTY IN COMMUNITY-DWELLING OLDER ADULTS: A SCOPING REVIEW OF THE LITERATURE AND INTERNATIONAL POLICIES (FRA 2015-A-07)Principal Investigators:Martine Puts, RN, PhD – University of TorontoKatherine McGilton, RN, PhD – University of Toronto

MODELING CHANGES IN ASSESSMENTS TO PREDICT NEEDS AND GUIDE CARE PLANNING IN HOME CARE (FRA 2015-B-07)Principal Investigators:Debra Sheets, PhD, MSN, RN, FAAN – University of VictoriaStuart MacDonald, PhD – University of Victoria

THE JINTRONIX TECHNOLOGY TO PREVENT FUNCTIONAL DECLINE IN PRE-FRAIL/FRAIL SENIORS CONSULTING EMERGENCY DEPARTMENTS (FRA 2015-B-14)Principal Investigators:Marie-Josée Sirois, OT, PhD – Université Laval/CHU de QuébecMylène Aubertin-Leheudre, PhD – Université du Québec à MontréalRaoul Daoust, MD, CSPQ, MSc – Hôpital du Sacré-Coeur de MontréalMarcel Émond, MD, MSc – Université Laval

IMPLEMENTING THE ‘FRAILTY PORTAL’ IN COMMUNITY PRIMARY CARE PRACTICE: EVALUATING FEASIBILITY, EFFECTS AND EXPANSION NEEDS (FRA 2015-B-17)Principal Investigators:Paige Moorhouse, MD, MPH, FRCPC – Nova Scotia Health AuthorityFred Burge, MD, MSc, FCFP – Dalhousie UniversityTara Sampalli, PhD, MASc – Nova Scotia Health Authority

THE EDOSETTE STUDY: OPTIMIZING MEDICATION USE AND SAFETY IN COMMUNITY DWELLING SENIORS (HTIG 2014-17)Principal Investigators:David Chan, MD, CCFP, MSc, FCFP – McMaster UniversityHenry Siu, MSc, MD, CCFP – McMaster University

FRAMING-LTC: FRAILTY AND RECOGNIZING APPROPRIATE MEDICATIONS IN GERIATRICS AND LONG-TERM CARE (SIG 2014-M1)Principal Investigators:Andrew Morris, MD, SM, FRCP(C) – Mount Sinai HospitalChaim Bell, MD, PhD – Mount Sinai HospitalSusan Bronskill, PhD – Institute for Clinical Evaluative SciencesLianne Jeffs, MScN, PhD – St. Michael’s HospitalColleen Maxwell, BSc, MA, PhD – University of Waterloo


USER STUDIES WITH INTELLIGENT ASSISTIVE ROBOTS AND ELDER RESIDENTS LIVING IN LONG-TERM CARE HOMES (CAT 2013-08)Principal Investigator:Goldie Nejat, PhD, PEng – University of Toronto

IMPROVING OUTCOMES FOR FRAIL SENIORS: IMPACT OF ASILA PROGRAM FOR LONG-TERM STAFF (CAT 2013-47)Principal Investigator:Veronique Boscart, PhD, MEd, MScN, RN – Conestoga College Institute of Technology and Advanced Learning

NEW TECHNOLOGIES TO OPTIMIZE ASSESSMENT OF MOBILITY, ACTIVITY, AND HEALTH IN THE FRAIL ELDERLY (CAT 2014-02)Principal Investigators:William McIlroy, PhD – University of WaterlooDon Cowan, PhD, BASc, MSc – University of Waterloo

INTEGRATED ETECHNOLOGY: SENIORS CARE FOR THE 21ST CENTURY (CAT 2015-02)Principal Investigator:Esther Suter, PhD, MSW – University of Calgary

SUPPORT, EDUCATION, NETWORKING & SUSTAINED ENGAGEMENT (SENSE): KNOWLEDGE-TO-ACTION WITH FAMILIES OF THE FRAIL ELDERLY LIVING IN RESIDENTIAL LONG-TERM CARE (CAT 2015-12)Principal Investigator:Jennifer Baumbusch, RN, PhD, MSN, BSN – University of British Columbia

AN OUNCE OF PREVENTION: INTENSIVE RESISTANCE TRAINING TO OPTIMIZE HEALTH IN PRE-FRAIL OLDER ADULTS (CAT 2015-19)Principal Investigators:Ada Tang, PT, PhD, MSc – McMaster UniversityChristopher Gordon, PhD – McMaster UniversityFeng Xie, PhD, MSc – McMaster University

ANTICIPATORY LONG-TERM CARE ELECTRONIC RESIDENT TRIAGE TOOL (ALERT) FOR CANADIAN LONG-TERM CARE HOMES (CAT 2015-40)Principal Investigator:Michelle Grinman, MD, FRCPC, MPH – University of Calgary

TELEPROM-G: A STUDY EVALUATING ACCESS AND CARE DELIVERY OF TELEHEALTH SERVICES AMONG COMMUNITY-BASED SENIORS (CAT 2015-TG1)Principal Investigator:Cheryl Forchuk, PhD, RN – Lawson Health Research Institute

THE CARER SUPPORT NEEDS ASSESSMENT (CSNAT) INTERVENTION: SUPPORTING FAMILY CAREGIVERS OF PALLIATIVE PATIENTS AT HOME (CORE 2013-01)Principal Investigators:Kelli Stajduhar, PhD, MSN, BN, RN – University of VictoriaRichard Sawatzky, PhD, MSc, BSc, RN – Trinity Western University

INCORPORATING A FRAILTY DIMENSION INTO LOCUS FOR SENIORS IN A MEDICAL-PSYCHIATRY POPULATION (FRA 2015-B-05)Principal Investigators:Cara Vaccarino, MSW, MHA – Trillium Health PartnersRose Geist, MD, FRCPC – Trillium Health PartnersBenoit Mulsant, MD, FRCPC – Trillium Health Partners


AN INNOVATION FOR RELOCATING A TOILET TO EASE ACCESS FOR THE FRAIL ELDERLY AT HOME (HTIG 2014-07)Principal Investigators:Tilak Dutta, PhD, PEng – Toronto Rehabilitation Institute, University Health NetworkGeoff Fernie, PhD, PEng – Toronto Rehabilitation Institute, University Health Network

WEARABLE CAREGIVER POSTURE COACHING FEEDBACK SYSTEM (HTIG 2014-11)Principal Investigator:Tilak Dutta, PhD, PEng – Toronto Rehabilitation Institute, University Health Network

USING MOBILE HEALTH APPLICATIONS (MHEALTH) TO SUPPORT COMMUNICATION WITH FRAIL ELDERLY PEOPLE IN LONG-TERM CARE (HTIG 2014-20)Principal Investigators:Jeff Small, PhD – University of British ColumbiaAlex Mihailidis, PhD, MASc, PEng – University of Toronto

POST-DISCHARGE REHABILITATION INTERVENTIONS FOR OLDER ADULTS WITH COGNITIVE IMPAIRMENT FOLLOWING A HIP FRACTURE (KS 2013-05)Principal Investigators:Katherine McGilton, PhD, RN – Toronto Rehabilitation Institute, University Health NetworkPaula van Wyk, PhD – University of Windsor

COMMUNICATION TECHNOLOGIES FOR ENGAGING PATIENTS, FAMILIES AND CAREGIVERS IN THE HEALTHCARE SYSTEM: A SCOPING REVIEW (KS 2014-07)Principal Investigator:Lynn McDonald, BA, MSW, PhD – University of Toronto

REHABILITATION FOR THE SERIOUSLY ILL ELDERLY: MODELS OF CARE AND QUALITY INDICATORS (KS 2014-08)Principal Investigator:Lora Giangregorio, PhD – University of Waterloo


Optimization of Transitions of Care

Theme Lead: Marilyn Macdonald, PhD, MSN, BN Dalhousie University

BETTER TARGETTING, BETTER OUTCOMES FOR FRAIL ELDERLY PATIENTS (BABEL) (TG2015-15 & PILOT)Principal Investigators:Paul Hébert, MD – Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM)Allan Garland, MD, MA, BS – University of ManitobaJohn Hirdes, PhD – University of Waterloo

TRANSFORMING PRIMARY HEALTHCARE FOR FRAIL ELDERLY CANADIANS (TG2015-24 & PILOT)Principal Investigators:Paul Stolee, PhD, MSc, MPA, BA – University of WaterlooAnik Giguère, PhD – Université LavalKenneth Rockwood, MD, FRCP(C) – Nova Scotia Health Authority (NSHA)Joanie Sims-Gould, PhD, BSc, MSW – University of British ColumbiaSara Mallinson, PhD – University of Calgary

CONNECTING EMERGENCY DEPARTMENTS WITH COMMUNITY SERVICES TO PREVENT MOBILITY LOSSES IN INJURED PRE-FRAIL & FRAIL SENIORS (CEDECOMS) (PILOT STUDY) (TG2015-09P)Principal Investigators:Marcel Émond, MD, MSc – Université LavalJacques Lee, MD, MSc, FRCPC – Sunnybrook Research Institute

IMPROVING THE DECISION PROCESS ABOUT LOCATION OF CARE WITH THE FRAIL ELDERLY AND THEIR CAREGIVERS (CORE 2013-56)Principal Investigator:France Légaré, MD, PhD, CCFP, FCFP – Université Laval

POST-EMERGENCY DEPARTMENT EVIDENCE-BASED INTERVENTIONS FOR THE PREVENTION OF FRAILTY AND FUNCTIONAL DECLINE IN INJURED COMMUNITY-DWELLERS (FRA 2015-A-06)Principal Investigators:Marcel Émond, MD, MSc – Université LavalMarie-Josée Sirois, OT, PhD – Université Laval/CHU de Québec

IMPLEMENTING A RISK SCREENING TOOL IN PRIMARY CARE FOR OLDER FRAIL ADULTS (FRA 2015-B-19)Principal Investigators:Paul Stolee, PhD, MSc, MPA, BA – University of WaterlooGeorge Heckman, MD, MSc, FRCP(C) – University of Waterloo


CHOOSING HEALTHCARE OPTIONS BY INVOLVING CANADA’S ELDERLY: THE CHOICE KNOWLEDGE SYNTHESIS PROJECT (KS 2013-08)Principal Investigator:Paul Stolee, PhD, MSc, MPA, BA – University of Waterloo

DEVELOPMENT AND TESTING OF A STANDARDIZED COMMUNICATION FORM TO IMPROVE TRANSITIONS FOR NURSING HOME RESIDENTS (CAT 2013-43)Principal Investigator:Greta Cummings, PhD, RN, FCAHS – University of Alberta

REENGINEERING THE DISCHARGE OF ELDERLY PATIENTS FROM INTENSIVE CARE: PRE-CLINICAL EVALUATION OF A TOOL KIT (CAT 2015-06)Principal Investigators:Tom Stelfox, BMSc, MD, PhD, FRCPC – University of CalgarySean Bagshaw, MD, MSc, FRCPC – University of Alberta

DEVELOPING PATIENT-PROVIDER PARTNERSHIPS ACROSS THE SYSTEM (CAT 2015-22)Principal Investigator:Paul Stolee, PhD, MSc, MPA, BA – University of Waterloo

TECLA SHIELD 4.0 (HTIG 2014-21)Principal Investigator:Deborah Fels, PhD, PEng – Ryerson University

HIP FRACTURE QUALITY INDICATORS: A SCOPING REVIEW (KS 2013-07)Principal Investigator:Susan Jaglal, PhD, MSc, BSc – University of Toronto


‘‘We are dealing with a topic (frailty) as important a healthcare issue since the origin of Medicare.

Duncan Sinclair, Emeritus Professor of Physiology, Fellow of School of Policy Studies,

Queen’s University Former Vice-Principal (Health Sciences),

Past Dean, Faculty of Medicine, Queen’s University

FRAILTY MATTERS.

Kidd House100 Stuart Street, Kingston ON K7L 3N6

[email protected] Twitter: @CFN_NCE www.cfn-nce.ca

™ Trademark of Technology Evaluation in the Elderly Network (Canadian Frailty Network or CFN). © Canadian Frailty Network, 2016–2022. Released 2017 09.

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Documents

ANNUAL REPORT 2016–2017 FRAILTY MATTERS · A caregiver’s perspective… Frailty matters. CFN is making a difference. Mary Luk was a caregiver to her mother and benefited from