Papers by Machelle Wilchesky
Canadian Geriatrics Journal, 2015
Background: Capacity building for global health issues related to dementia is necessary to bridge... more Background: Capacity building for global health issues related to dementia is necessary to bridge the generation gap in the search for global dementia solutions. It is important that all generations, including younger less established ones, are engaged to strengthen their understanding of dementia related issues. We are at a pivotal moment, the entire global population is aging and the incidences of dementia are estimated to skyrocket. Currently, the numbers are estimated at 36 million in 2010. These numbers are doubling every 20 years to 66 million by 2030 and to 135 million by 2050. We need to harness the momentum for change and impact found in the energy and innovation from younger generations. Objectives: 1. To discuss global health dementia initiatives and show the importance of younger generations leadership and understanding of dementia as a social, economic and public health issue. 2. To encourage practitioners and researchers to make room for the voices of younger, less established generations in discussions surrounding the search for global dementia solutions. Overview: The first G8 Summit on Dementia took place in London, England in December 2013. This event spurred a commitment to dementia from all attending nations and their delegates, including an obligation to participate in four subsequent G7 Legacy events (England, Canada-France, Japan, USA). These four legacy events provided an opportunity for more specific dialogue from world leaders in dementia. In parallel with these Global Action Against Dementia Legacy Events, young local leaders were given the opportunity to develop innovative ideas to support the ongoing work of the World Dementia Council, and to create a sustainable global network which will continue to address the challenges presented by dementia. Results: The 120 selected Young Leaders in Dementia met in London, Ottawa, Tokyo, and Washington D.C., to discuss innovative ideas to address dementia. Young Leaders in Dementia were also represented in Geneva at the First Ministerial Conference on Dementia where they brought their recommendations to the World Dementia Council. Conclusion: Youth are the leaders of our future, and their full participation and understanding of the global health issue surrounding dementia is required to support the aging population. Capacity building, sustainability and innovation will guide the next generation in its solutions for public health issue of dementia.
JMIR Research Protocols
Background The latest global figures show that 55 million persons lived with major neurocognitive... more Background The latest global figures show that 55 million persons lived with major neurocognitive disorders (MNCDs) worldwide in 2021. In Quebec, Canada, most of these older adults are cared for by family physicians in interdisciplinary primary care clinics such as family medicine groups (FMG). When a person has a MNCD, taking potentially inappropriate medications or polypharmacy (5 different medications or more) increases their vulnerability to serious adverse events. With the recent arrival of pharmacists working in FMGs and their expanded scope of practice and autonomy, new possibilities for optimizing older adults’ pharmacotherapy are opening. Objective This project aims to evaluate the impact of involving these pharmacists in the care trajectory of older adults living with MNCD, in an interdisciplinary collaboration with the FMG team, as well as home care nurses and physicians. Pharmacists will provide medication reviews, interventions, and recommendations to improve the pharma...
Background: Nursing home (NH) residents with severe dementia use many medications, sometimes inap... more Background: Nursing home (NH) residents with severe dementia use many medications, sometimes inappropriately within a comfort care approach. Medications should be regularly reviewed and eventually deprescribed. This pragmatic, controlled trial assessed the effect of an interprofessional knowledge exchange (KE) intervention to decrease medication load and the use of medications of questionable benefit among these residents. Methods: A 6-month intervention was performed in 4 NHs in the Quebec City area, while 3 NHs, with comparable admissions criteria, served as controls. Published lists of “mostly”, “sometimes” or “exceptionally” appropriate medications, tailored for NH residents with severe dementia, were used. The intervention included 1) information for participants’ families about medication use in severe dementia; 2) a 90-minute KE session for NH nurses, pharmacists, and physicians; 3) medication reviews by NH pharmacists using the lists; 4) discussions on recommended changes wi...
Objective: To establish a robust understanding of the state of the evidence on the effectiveness ... more Objective: To establish a robust understanding of the state of the evidence on the effectiveness and/or efficacy of art therapy (AT) as a non-pharmacological treatment (NPT) modality for persons living with dementia (PLWD). Introduction: Over the past decade, AT has received increased attention from health care professionals and researchers as having a potential role to play within treatment plans for PLWD.(1-4) Inclusion criteria: This scoping review will include systematic reviews from health-related disciplines conducted within the last 20 years that report the effectiveness and/or efficacy of AT as an NPT modality for PLWD and Mild Cognitive Impairment (MCI) as their primary outcome. Study outcomes must include cognition, quality of life, emotional and psychological well-being, and/or neuropsychiatric symptoms (NPS). Methods: A scoping review of systematic reviews was selected to outline different types of evidence and to identify gaps in the literature. The proposed review will...
Medication appropriateness list. (DOCX 37 kb)
Canadian Geriatrics Journal, 2013
To identify primary care doctors knowledge, practices, and obstacles with regard to the diagnosis... more To identify primary care doctors knowledge, practices, and obstacles with regard to the diagnosis and management of dementia. Methods: Standardized questionnaires covering knowledge, practices, and obstacles were distributed among a random sample of primary care doctors in Kathmandu, Nepal. 380 physicians responded (response rate = 89%). Results: Knowledge of practitioners with regard to the diagnosis and management of dementia was unsatisfactory. Diagnosis and management barriers are presented with regard to GP factors, patient factors, systemic factors, and carer factors. Discussion: Specifically, the results address the following issues: time, communicating the diagnosis, negative views of dementia, difficulty diagnosing early stage dementia, acceptability of specialists and responsibility for extra issues, knowledge of dementia and ageing, less awareness of declining abilities and diminished resources to handle care, not specified guidelines, poor awareness of epidemiology, and less confidence to advise. Conclusions: Demographic changes mean that dementia will represent a significant problem in the future. The following paper outlines the problems and solutions that the Nepalese Abstracts from the 7 th Canadian Conference on Dementia (CCD) held in Vancouver, October 2013
Palliative and Supportive Care
Objective Symptoms present at the end of life and the quality of communication with the healthcar... more Objective Symptoms present at the end of life and the quality of communication with the healthcare team have both been shown to impact family assessments of the quality of dying of their loved one with dementia. However, the relative contributions of these two factors to family assessments have not yet been investigated. To address this knowledge gap, we explored which of these two factors has more influence on family assessments of the quality of dying of long-term care (LTC) residents with dementia. Method This is a secondary analysis of a mortality follow-back study. Ninety-four family members of LTC residents who had died with dementia assessed the quality of dying (very good or not very good), the frequency of symptoms, and the quality of communication with the healthcare team using a self-administered questionnaire mailed 1 month after the resident's death. Logistic regression analyses were performed to determine the relative contributions of the two independent variables ...
Canadian Journal on Aging / La Revue canadienne du vieillissement, 2022
Most Canadians with dementia die in long-term care (LTC) facilities. No data are routinely collec... more Most Canadians with dementia die in long-term care (LTC) facilities. No data are routinely collected in Canada on the quality of end-of-life care provided to this vulnerable population, leading to significant knowledge gaps. The Quebec Observatory on End-of-Life Care for People with Dementia was created to address these gaps. The Observatory is a research infrastructure designed to support the collection of data needed to better understand, and subsequently enhance, care quality for residents dying with dementia. This article reports on the main steps involved in setting up the Observatory, as well as a pilot study that involved 172 residents with dementia who died between 2016 and 2018 in one of 13 participating facilities. It describes the data gathered, methodological changes that were made along the way, feedback from participating facilities, and future developments of the Observatory.
Databases for Pharmacoepidemiological Research, 2021
Number of all regular medications, according to the medication appropriateness list [1] and the W... more Number of all regular medications, according to the medication appropriateness list [1] and the WHO-ATC classes. (DOCX 30 kb)
The Author(s) 2015. This article is published with open access at Springerlink.com Introduction: ... more The Author(s) 2015. This article is published with open access at Springerlink.com Introduction: Aging of the population results in an increase in senior drivers. Elderly are frequently treated with benzodiazepines and antidepressants. The objective of this study was to determine whether the concurrent use of
C-reactive protein (CRP) is one of the most commonly used markers of acute phase reaction in clin... more C-reactive protein (CRP) is one of the most commonly used markers of acute phase reaction in clinical settings and predictors of cardiovascular risk in healthy women; however, data on its physiologic regulation in premenopausal women are sparse. The objective of this study was to evaluate the association between endogenous reproductive hormones and CRP in the BioCycle Study (2005–2007). Women aged 18–44 years from western New York were followed prospectively for up to 2menstrual cycles (n 259). Serum levels of CRP, estradiol, progesterone, luteinizing hormone, and follicle-stimulating hormone were measured up to 8 times per cycle, timed by fertility monitors. CRP levels varied significantly across the cycle (P < 0.001). More women were classified as being at elevated risk of cardiovascular disease (CRP,>3 mg/L) during menses compared with other phases (12.3 % vs. 7.4%; P < 0.001). A 10-fold increase in estradiol was associated with a 24.3 % decrease in CRP (95 % confidence ...
Obstetrics and gynecology, Feb 1, 2018
To evaluate the association of cesarean deliveries on the incidence of small bowel obstruction. W... more To evaluate the association of cesarean deliveries on the incidence of small bowel obstruction. We formed a population-based cohort of all women with a first live birth between 1998 and 2007 using the U.K. Clinical Practice Research Datalink. Women were followed until 2015, the occurrence of a small bowel obstruction, or loss to follow-up. Cesarean delivery was identified from the Hospital Episode Statistics and small bowel obstruction events were identified using the Classification of Interventions and Procedures and International Classification of Diseases, 10th Revision codes. Cox proportional hazard models, with cesarean delivery defined as a time-dependent exposure, estimated the adjusted hazard ratios and 95% CIs of small bowel obstruction associated with cesarean delivery. The cohort included 81,480 women with a median follow-up of 8.0 years (range 6 months to 16.6 years), during which 575 new small bowel obstructions occurred (incidence 9.1/10,000 person-years). Risk of smal...
Geriatric Nursing
Although specialized communication tools can effectively reduce acute care transfers, few studies... more Although specialized communication tools can effectively reduce acute care transfers, few studies have assessed the factors that may influence the use of such tools by nursing staff at the individual level. We evaluated the associations between years of experience, tool-related training, nursing attitudes, and intensity of use of a communication tool developed to reduce transfers in a long-term care facility. We employed a mixed methods design using data from medical charts, electronic records, and semi-structured interviews. Experienced nurses used the tool significantly less than inexperienced nurses, and training had a significant positive impact on tool use. Nurses found the purpose of the tool to be confusing. No significant differences in attitude were observed based on years of experience or intensity of use. Project findings indicate that focused efforts to enrich training may increase intervention adherence. Experienced nurses in particular should be made aware of the benefits of utilizing communication tools.
Wound Repair and Regeneration, 2015
Pressure ulcer prevention is an important long-term care (LTC) quality indicator. While the Brade... more Pressure ulcer prevention is an important long-term care (LTC) quality indicator. While the Braden Scale is a recommended risk assessment tool, there is a paucity of information specifically pertaining to its validity within the LTC setting. We therefore undertook a systematic review and meta-analysis comparing Braden Scale predictive and concurrent validity within this context. We searched the Medline, EMBASE, PsychINFO and PubMed databases from 1985-2014 for studies containing the requisite information to analyze tool validity. Our initial search yielded 3,773 articles. Eleven datasets emanating from 9 published studies describing 40,361 residents met all meta-analysis inclusion criteria and were analyzed using random effects models. Pooled sensitivity, specificity, positive predictive value (PPV) and negative predictive values (NPV) were 86%, 38%, 28% and 93%, respectively. Specificity was poorer in concurrent samples as compared to predictive samples (38% vs 72%), while PPV was low in both sample types (25% and 37%). Though random effects model results showed that the scale had good overall predictive ability [RR, 4.33; 95% CI, 3.28-5.72], none of the concurrent samples were found to have &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;optimal&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; sensitivity and specificity. In conclusion, the appropriateness of the Braden Scale in LTC is questionable given its low specificity and PPV, in particular in concurrent validity studies. Future studies should further explore the extent to which the apparent low validity of the scale in LTC is due to the choice of cut-off point and/or preventive strategies implemented by LTC staff as a matter of course. This article is protected by copyright. All rights reserved.
CJEM, Jan 17, 2018
CLINICIAN'S CAPSULE What is known about the topic? Delirium is frequent in older inpatients b... more CLINICIAN'S CAPSULE What is known about the topic? Delirium is frequent in older inpatients but often goes undetected. A short tool, the 4 A's Test (4AT), was created and validated for the detection of delirium. What did this study ask? This study compared the performance of the French version of the 4AT (4AT-F) with the Confusion Assessment Method (CAM) for the screening of delirium. What did this study find? The 4AT-F was a fast and reliable screening tool for delirium in the emergency department (ED). Why does this study matter to clinicians? Because of its quick administration time, it allows for systematic screening of patients at risk of delirium and cognitive impairment.
Pharmacoepidemiology and Drug Safety, 2015
Uploads
Papers by Machelle Wilchesky