2018

Title: The costs of Aging-in-Place for Frail Older People (Led by BRIC NS with partners in ON)
NS Research Team: Ruth Martin-Misener (Nominated Principal Investigator), Elaine Moody, Marilyn MacDonald, Lori Weeks, Lynn Shaw, Shelley McKibbon, MJ MacDonald, Ron Swan

Many countries are experiencing an aging population; there are greater numbers of older people than ever before. Older people often prefer to remain in their home and communities as they age. Some older people experience health changes that mean they need supports to live in the community. This is particularly true for frail older people, those who have multiple health conditions and who generally have a harder time recovering from illness or injury. Supports to live in the community for frail older people are often associated with out-of-pocket expenses that are not covered by health insurance. These costs have to be paid by frail older people themselves or their families or friends who care for them and can contribute to financial burden and decisions to move into long-term care facilities. This systematic scoping review will find research studies and other literature that discuss the out-of-pocket expenses for frail older people living in the community and their caregivers. This review will be supported by consultations with frail older people and their caregivers, as well as policy makers, community organizations and companies that provide support in the community. The scoping review will identify areas where further research will help to better understand the costs of aging in place, as well as summarize the types of research that have already been done. Identifying the literature that reports the out-of-pocket costs of aging-in-place for frail older people is a first step to developing better supports for addressing the costs of living in the community for frail older people and to help older people plan for staying at home as they age.

Title: Interventions to Support Transitions in Care for Children and Families with Complex Health Care Needs in the Community (Led in NB with partners in NS, PEI and NL)
Nominated Principal Investigator: Shelley Doucet (NB)
NS Research Team: Janet Curran, Ruth Martin-Misener, Sydney Breneol, Fred Burge, Jessie-Lee McIsaac, Andrew Lynk, Jocelyn Vine, Stacy Burgess

Children and youth with complex health care needs have a variety of conditions that range from less severe to life-threatening or life-limiting. For example, some children depend on medical devices and technologies whereas others require less intensive supports to live, work, and play in community settings. These children and youth experience many transitions, moving across stages of their conditions, from childhood to adulthood, between care settings, or from hospital to home/school or vice versa. Transitions are often challenging not only for children, but also for their families and care providers. In this one-year project, we will conduct a review of the literature to shed light on interventions that support transitions in care occurring from: 1) diagnosis to age 19 years; and 2) pediatric to adult care, for youth aged between 14 and 25 years of age. Findings from our project, which are in line with primary care priorities established by NB, NS, PEI, and NL, will lead to recommendations for policy and practice, and will inform future research to support transitions in care for children with complex health care needs and their families. At the heart of this proposal are patients who will have a meaningful role in the project’s design and implementation. Other members of the research team include researchers, clinicians, librarians, policy makers, and community members across the Atlantic provinces and beyond.

2016

Title: Integrating end of life care to help people stay in the community: The essentials for success (Led by BRIC NS with partners in PEI)
Research Team: Grace Warner (Nominated Principal Applicant), Fred Burge, Jessie Johnson, Beverley Lawson, George Kephart, Ruth Martin-Misener, Tanya Packer, Robin Urquhart, Lori Weeks, Cheryl Tschupruk, Erin Christian, Elaine Loney, PEI Research Team: Lisa Garland Baird (Principal Investigator), William Montelpare, Mary Sullivan

Led by BRIC NS member Dr. Grace Warner and partnered with PEI. The project focuses on understanding and supporting the complex needs of patients and their family caregivers who are dealing with multiple chronic conditions and/or life limiting illnesses. The project will synthesize the evidence for what community-based resources are critical in the last year of life for patients and their family caregivers, how a case management approach can improve the integration of these resources into innovative community-based palliative care models, and the challenges different practice settings face when trying to use a case management approach. The project will engage individuals who deliver and receive community-based palliative care to get their perspectives on what literature should be synthesize to ensure the final product addresses their needs. The final product will provide a report on findings along with recommendations for enhancing the implementation of innovative community-based palliative care models that address the complex needs of patients and family caregivers in the last year of life into bereavement.

Title: Case management in primary care to improve outcomes among frequent users of health care services with chronic conditions: a realist synthesis of what works, for whom and in what circumstances (Led by Quebec with partners in NS, SK, NL)
Research Team: Catherine Hudon (Nominated Principal Applicant), Fred Burge, Lynn Edwards, Margaret Baker, Cameron Campbell, Antoine Groulx, Kris Aubrey-Bassler, Maud-Christine Chouinard, Nazeem Muhajarine

A common reason for frequent use of health care services is the complex health care needs of individuals suffering from multiple chronic conditions, often together with mental health comorbidities and/or social vulnerability. Individuals with such complex health care needs require a variety of services across the health and social services system and community networks. This often leads to difficulties in the integration of care. Frequent users of health care services are more at risk for incapacity, loss of quality of life and mortality. Currently it would appear case management is the most promising intervention to improve care integration for Frequent Users and reduce health care costs. However, important gaps in knowledge remain: we don’t know how case management works, in what populations, and in what circumstances. Our overarching goal is to ensure that patients, practitioners and policy makers better understand case management for Frequent Users with chronic conditions, the most promising effective intervention to improve outcomes for this population with complex care needs in primary care. In order to achieve this goal, we propose to explain how case management in primary care works to improve outcomes among Frequent Users with chronic conditions, for whom, and in what circumstances.

Title: Identifying and Understanding the Health and Social Care Needs of Older Adults with Multiple Chronic Conditions and their Caregivers: A Scoping Review (Led by Ontario with partners in NS, QC, SK)
Research Team: Katherine Mcgilton (Nominated Principal Applicant), Melissa Andrew, Emily Gard Marshall, Tara Sampalli, Howard Bergman, Sheena Grimes, David McNeil, Debra Morgan, Maria Puts, Isabelle Vedel

Canadians are living longer, however, many older Canadians do not experience good health and well-being as they age. Older adults are at a high risk of having multiple chronic conditions (MCC), otherwise known as multimorbidity. Many older adults with MCC live with complex health issues that adversely affect their day-to-day functioning and overall well-being. As a result, they rely on the support of caregivers to complete daily activities. Caregiving for older adults, without the appropriate help, can negatively affect an individual’s financial and emotional well-being. Currently, not enough is known about how best to identify, understand and meet the needs of older adults with MCC, or the needs of their family caregivers. This study will contribute to minimizing the existing gap in knowledge. The project will provide much needed evidence to support current efforts to improve the Canadian healthcare system and ensure that older adults with MCC, and their caregivers, receive appropriate, equitable and cost-effective health and social care. The project team is comprised of patients, their family members, researchers, healthcare providers and policy and health system administrator decision makers, from Nova Scotia, Ontario, Québec and Saskatchewan. The research will offer an overview of the existing evidence on the health and social care needs of older adults with MCC and their caregivers, as well as evidence about how best to determine and understand these needs. Findings from the work will directly support the development and implementation of Primary & Integrated Health Care Innovations (PIHCI) tailored to meet the needs of diverse individual, and groups of, older Canadians. We take a collaborative and participatory approach to research. We aim to contribute to building a strong evidence base to support a new culture of person-centred, functioning-focused care that adds “health to years” for current and future generations of older Canadians.