REPORT 2 0 1 5

The Labarge Optimal Aging Initiative has invested in the growing research strength in optimal aging at McMaster University. The Initiative has supported fourteen research projects over the last three years focused on “mitigating risk, maximizing resilience”, with themes including maintaining mobility, managing chronic disease and

fighting infection. Investments from the Initiative have also supported our efforts in knowledge translation and evidence-based decision-making, particularly through the creation of the McMaster Optimal Aging Portal, which provides older adults with access to evidence-based information about healthy aging that they can trust.

About the Labarge Optimal Aging Initiative

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Patrick DeaneThe vision and leadership of Suzanne Labarge have given us the opportunity to capitalize on our emerging research strengths in aging, and have made a critical difference in moving forward both our research agenda and positioning in this field. Our cadre of researchers with an interest in aging is growing, and the Labarge Optimal Aging Initiative has provided the stimulus for new collaborations, which has led to both an impressive accumulation of knowledge and expertise and a deeper commitment by the institution to supporting these efforts. The new McMaster Institute of Geroscience is built upon this foundation and is poised to enable broader impact on a global scale.

I invite you to review the progress of the work resulting from the generosity of Suzanne Labarge. Researchers funded through the Initiative are contributing to a critical mass of expertise in optimal aging that will position McMaster as a leader in this field of growing importance.

John KeltonIt has been exciting to watch the momentum grow. The Labarge Optimal Aging Initiative has stimulated increasing collaboration and innovation at McMaster over the last three years, and this trend promises to continue. Researchers have been inspired to turn their attention to an aging population and gather results with the potential for tangible impacts on older adults. The McMaster Optimal Aging Portal has begun to accumulate an audience among multiple stakeholders. Our Knowledge Translation Enterprise has brought world-class speakers and important topics to a public audience, and has inspired conversations about optimal aging across the country and around the world.

Captured within these pages are highlights from our world-class teams who, with the support of the Labarge Optimal Aging Initiative, are confronting the challenges of Canada’s older adults head-on. It is through these efforts that we will continue to build our reputation for excellence in this area, while helping older adults progress towards the goal of optimal aging.

Susan DenburgIt has been a pleasure to witness the growing enthusiasm for aging research and knowledge translation at McMaster University. The Labarge Optimal Aging Initiative has enabled us to build upon our existing strengths in aging research, and propel our impact to a new level. The robust network of researchers that has been established through the Initiative continues to grow, as has the breadth of content and reach of the McMaster Optimal Aging Portal. I continue to be amazed by the innovative ways that these teams are addressing one of the most pressing health challenges of our time.

This year’s report illustrates the commitment of McMaster researchers to improving the lives of aging Canadians. The progress this year has been inspiring, and I look forward with anticipation to continued momentum and evidence of sustained impact from the work of the Labarge Optimal Aging Initiative.

Dr. Susan DenburgActing Provost and Vice-President Academic

Dr. Patrick DeanePresident and Vice-Chancellor

Dr. John KeltonDean and Vice-President, Faculty of Health Sciences

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Drs. Julie Richardson and Lori Letts of the School of Rehabilitation Science continue their study of the assessment of preclinical disability. The expected completion date is June 2016. Participants will complete self-assessments of their physical functioning 6 times over an 18-month period and will receive tailored therapeutic recommendations to address activity goals from an occupational therapist or a physiotherapist through their electronic personal health record (MyOSCAR). The team has completed

recruitment and have enrolled a total of 147 participants to the study from the Stonechurch Family Health Centre. Fifty participants are ≥ 50 years of age without a chronic condition and the remaining participants are ≥44 years of age with at least 1 chronic disease at varying stages of functional decline. Approximately 25% of participants have completed their final assessment. Early results from this project have indicated a significant improvement in functional abilities for participants who have identified pre-clinical mobility issues.

Detecting and Addressing Preclinical Disability

INVESTIGATORS:

Julie Richardson

Lori Letts

David Chan

Lehana Thabane

Henry Siu

“A patient rated his ability to crouch at 2/10, and was then provided with a tailored recommendation from a physiotherapist. Six months later he reported

“…the hip pain has gone. I am doing squats as part of my routine now, it’s fantastic…” and rated his ability to perform crouching activities at 8/10.”

Julie RichardsonJulie Richardson (standing) and Lori Letts (right)

P R O J E C T U P D A T E S 3

This Labarge-funded team has continued the momentum of moving the original intent of the project forward: to develop a user-centred design process that consider the needs of older people. Using the automobile as its focus and building on their success in terms in both research and education (aging, health, driving, engineering design), Drs. Vrkljan and Fleisig completed their first collaboration with Ontario College of Art and Design (OCAD) this past spring using an evidence-based design approach. As well, discussions continue with the Faculty of Engineering in their development of ‘smart’ home technologies and how these advancements can be linked with supporting the community

mobility of older people, including the ‘smart’ automobile. Dr. Fleisig was given the 2015 President’s Award for Outstanding Contributions to Teaching and Learning based on a partnership with Dr. Vrkljan in which over 1000 1st year engineering students work with students from the occupational therapy program to design a product based on a need identified by a community partner with a specific focus on aging. Dr. Vrkljan’s growing research team has had early success with funding support from the Canadian Occupational Therapy Foundation (COTF) that will examine driving after stroke as well as the newly established AGE-WELL, a Network Centre of Excellence (NCE) funded by the Government of Canada.

Innovations in Vehicle Design that Promote Safety and Usability in an Aging Society

INVESTIGATORS:

Brenda Vrkljan

Robert Fleisig

“The Labarge funding continues to support the best and brightest students and research trainees – our Canadian leaders and innovators of tomorrow – to develop the expertise needed when it comes to enabling all of us, young and old, to stay healthy and mobile in our homes and communities for as long as possible.”

Brenda VrkljanPhD, O.T. Reg. (Ont).

Brenda Vrkljan (left) and Robert Fleisig (right)

P R O J E C T U P D A T E S4

People with knee osteoarthritis may benefit from exercise prescriptions that minimize damaging knee loads. The research team designed a strengthening program to minimize exposure to knee loads known to worsen the disease. The team also showed that this strengthening program improved self-reported symptoms and physical function, and strength among women with clinical knee osteoarthritis. It seems reasonable that an exercise program designed for knee osteoarthritis may aid in disease management while improving self-reported outcomes, strength, and mobility. Further investigation using a randomized

controlled trial design is needed to make conclusions regarding the efficacy of this osteoarthritis-specific strengthening program in people with knee osteoarthritis.

This work was presented at the American Society of Biomechanics 2015 conference. Also, 2 peer-reviewed manuscripts have been published, with another currently under review. Finally, knowledge translation activities include advising the Canadian Society for Exercise Physiology of the ideal curriculum and evaluation criteria for exercise specialists around arthritis, and an invited article to a knowledge translation magazine.

Promoting Physical Activity in Older Adults with Arthritis

INVESTIGATOR:

Monica Maly

“Funding from the Labarge Optimal Aging Initiative has enabled us to establish a strengthening program designed specifically to avoid overloading an arthritic joint, and test the efficacy of this program in older women. This work is an essential step to enable older Canadians with osteoarthritis to enjoy the health and productivity benefits of exercise without worsening their condition.”

Monica Maly

P R O J E C T U P D A T E S 5

The research team has been able to identify an optimal exercise intervention strategy to improve muscle stem cell function and protein synthesis in older men. These results have been presented at multiple conferences and published in two papers in scientific journals. The team has also begun a large, double-blind, placebo-controlled intervention trial to determine the efficacy of a newly developed nutritional supplement specifically designed for older adults to be taken in conjunction with exercise. All participants take part in an extensive battery of tests at the beginning, middle and the

end of the study to evaluate the intervention. Testing includes muscle biopsies and blood sampling for molecular analysis as well as body composition measurements, strength and performance on activities of daily living. Furthermore, the team is performing health psychology tests/cognitive tests, measures of cardiovascular health, measures of performance on motor control tasks and balance related skills. This part of the study is particularly exciting as the results may help to bring a nutritional supplement to market designed to support optimal muscle health in older adults.

Defining the Optimal Combination of Exercise and Nutrition for Maximizing Muscle Mass and Mobility in Aging

INVESTIGATORS:

Gianni Parise

Stuart Phillips

“Under the Labarge Optimal Aging Initiative our project will allow the establishment of guidelines that will maximize strength gains in older adults following an exercise intervention program to improve mobility, independence and ultimately quality of life. Heathy aging is not only a concept to strive for but an absolute societal necessity.”

Gianni Parise

P R O J E C T U P D A T E S6

The purpose of this study was to understand the role diet may play in “turning off” genes which may increase the risk of heart attack in susceptible people. Study volunteers were randomly assigned to consume either a healthy diet rich in fruits, vegetables, healthy fats and whole-grains or a “typical” unhealthy Canadian diet for two weeks. After 2 weeks, participants receiving the prudent diet tended to have lower blood pressure and total cholesterol, compared to individuals assigned the Western diet.

No changes in overall methylation were observed within genomic region 9p21 (the “high risk” region), although changes in methylation were observed in other regions among those on the Western diet. No changes in gene expression were observed and the patterns of gene expression did not differ by age group. Data from this pilot study suggests the epigenome may be more flexible in response to dietary changes among younger participants. Future larger trials are required to test this hypothesis.

A Dietary Intervention Trial to Understand the Mechanism Underlying the 9p21 Variant Interaction with High Fruits and Vegetable Consumption

INVESTIGATORS:

Sonia Anand

Russell de Souza

“The Labarge gift provided us with an exceptional opportunity to examine how a short term change in diet might affect aspects of gene expression and methylation. This study provided an excellent training opportunity for our postdoctoral fellow, and has helped to generate new theories about how diet may influence changes in body processes that are not typically measured in a clinical setting.”

Russell de Souza

P R O J E C T U P D A T E S 7

Older adults with type 2 diabetes mellitus (T2DM) and multiple chronic conditions have poorer diabetes self-management, a lower quality of life, a higher risk for diabetes-related complications, and increased use of health services compared to those with diabetes alone. With funding from the Labarge Optimal Aging Initiative, the research team conducted a pilot study of a newly designed 6-month community-based intervention. The aim was to support both older adults with T2DM and multiple chronic conditions and their family caregivers. Results from the

pilot suggested that intervention was feasible, acceptable, and effective, while feedback from participants and the care providers who delivered the intervention identified elements that needed further refinement. Presently, the team is conducting a pragmatic randomized controlled trial which is a scaled-up version of the Labarge funded pilot. Already there are reports from the older adult participants that this type of community research is valuable. Thanks to the Labarge Optimal Aging Initiative, the team was able to embark on this promising course of research.

A Pilot Study of a Nurse-Led, Community-Based Diabetes Intervention for Frail Older Adults with Type 2 Diabetes and Comorbid Chronic Conditions

INVESTIGATOR:

Maureen Markle-Reid

“By participating in the diabetes study I felt I was making a contribution to the welfare of older adults with diabetes. Through participation in the [study] groups I discovered I was still able to not only contribute, but to also make a meaningful difference in my life.”

Project Participant

P R O J E C T U P D A T E S8

The research team has completed a feasibility study testing whether probiotics would be an acceptable preventative treatment for respiratory infections in a cohort of nursing home elderly. Residents were randomly assigned to either probiotic or placebo controls and monitored for respiratory infections. Placebos were manufactured and found to be indistinguishable from probiotics. The ability to swallow the pills varied amongst residents but mixing with food was found to be an acceptable alternative. Although

enrollment was lower than anticipated, compliance was high, and in conjunction with nursing staff and nursing home administrators, we have developed procedures and addressed concerns that should increase uptake in future studies. Nasal swabs were collected at the beginning of study, whenever patients had symptoms and at the endpoint. Screens for common viral infections were performed and the microbial communities were quantitated. Results are currently being written up for publication.

Probiotics to Prevent Respiratory Infections in the Elderly

INVESTIGATORS:

Dawn Bowdish

Param Nair

Mark Loeb

Jennie Johnstone

Mike Surette

Jonathan Bramson

“There were a number of surprising finds in this study. For example a bacterial species, Mycoplasma, was found in the majority of patients who had symptoms of a respiratory infection. Whether it caused the infections or simply correlated with them, is not clear but we do know that clinicians rarely test for this pathogen. Future studies will focus on understanding if this bacteria causes infections in the elderly.”

Dawn Bowdish

P R O J E C T U P D A T E S 9

Unique Adult Day Services (ADS) models have the potential to become important components in the health care continuum, mitigating the susceptible period of time of discontinuity and potential adverse events for older adults during the transition period from hospital to home. This project aims to better understand how a unique ADS program targets the needs of older adults and improves older adults’ function, mobility, resiliency and quality of life. Phase 1 of the study has now been

completed. Focus groups and semi-structured interviews have explored the experiences, including barriers and facilitators, of Goldies2Home (G2H) participants and their caregivers, G2H staff, and Community Care Access Centre coordinators. System- and participant-level challenges were identified, as were many positive and valuable aspects of the G2H program. Phase 1 results have been used to inform and refine Phase 2, a 6-month mixed methods study which will begin enrolling participants in October 2015.

Enhancing Optimal Aging: An Examination of a Unique Adult Day Service Model for Older Adults

INVESTIGATORS:

Vanina Dal Bello-Haas

Sharon Kaasalainen

“We are so excited to have Goldies2Home formally evaluated by researchers from McMaster. We know it is a great program that has tremendous impacts on our healthcare system, as do our participants

…. It has been a pleasure being involved in Phase 1 of the research. We look forward to the evaluation results of Phase 2.”

Krista SheppardShalom Village

Vanina Dal Bello-Haas (left) and Sharon Kaasalainen (right)

P R O J E C T U P D A T E S10

The Canadian workforce is aging. The purpose of this study is to examine the impact of an exercise program, delivered within the workplace, on work ability and resilience among older workers. After developing new protocols to capture hip joint strength and health and securing ethics approval, the research team is currently recruiting sedentary workers at McMaster University into a randomized controlled trial. They are also collaborating with the Technical

Leader for Vehicle Operations at Ford Motor Company in Dearborn, Michigan to pilot a trial of exercise among older workers. Finally, the researchers have completed the 12-week intervention period for a randomized controlled trial evaluating the impact of exercise on systemic inflammatory markers in women with knee osteoarthritis. The aim is to establish the first workplace exercise program designed to minimize damaging knee and hip loads among older workers with this disease.

Resistance and Longevity for Older Workers with Arthritis through Exercise

INVESTIGATORS:

Monica Maly

Peter Keir

Jim Potvin

“[I] enjoyed this study. The staff at Mac was great and very helpful. This study has improved my body, mind, and I just feel 100% better.”

Study Participant(RCT in Project 2)

Monica Maly (left), Peter Keir (center) and Jim Potvin (right)

P R O J E C T U P D A T E S 11

Individuals with higher than age-average levels of inflammatory markers in their blood are particularly susceptible to some kinds of infections. The goal of this study was to determine whether individuals with high levels of inflammatory markers would have a less robust response to vaccination than individuals with lower levels of inflammation and whether this was the result of modifications to immune genes (“epigenetics”). The results to the study have been interesting: blood samples from subjects taken before and after vaccination were used to measure levels of inflammatory markers, vaccine responsiveness and modifications in immune genes. Although some

individuals did not respond to the vaccine, there was no correlation between vaccine responsiveness and levels of inflammation. There were also no distinctive patterns in gene modification associated with vaccine responsiveness, but there were differences in gene modifications between individuals with high versus low levels of inflammation. In the next few months a larger number of samples will be tested to confirm these results. A few key genes associated with immune responsiveness will be investigated to determine if these modifications are associated with changes in gene expression and ultimately, immune cell function.

Establishing Age-Related Chronic Inflammation as a Modifiable Risk Factor for Poor Immune Function in the Elderly

INVESTIGATORS:

Dawn Bowdish

Chris Verschoor

Mark Loeb

Guillaume Parè

Alexandra Papaioannou

Jonathan Bramson

“Changes in immune function underlie so much of the ill-health that comes with age yet we know very little about how these changes occur. Through generous funding from Suzanne Labarge, we are investigating whether genetic re-programming occurs in individuals at the highest risk of developing immune dysfunction. If this is the case we can start to consider if this re-programming can be undone to restore immune function in older adults.”

Dawn BowdishDawn Bowdish (left) and Chris Verschoor (right)

P R O J E C T U P D A T E S12

Older adults with limitations in mobility present a common, costly problem to our health care system. As our population ages, it becomes increasingly important to identify those at risk for functional decline and provide interventions that will preserve physical function and independence in later life. The research team is currently undertaking

a pilot randomized controlled trial with qualitative focus groups evaluating participating in a 12-week Mobility Self-Management Program that combines self-management and dual-task training (a combination of walking and cognitive tasks). To date, the researchers have enrolled and randomized 31 participants, with the goal of recruiting a total of 60 participants by June 2016.

Moving Up Stream: Preventative Approaches to Preclinical Mobility Limitation for Community-Dwelling Older Adults

INVESTIGATORS:

Sinead Dufour

Julie Richardson

Jenny Ploeg

Maureen Markle-Reid

Lehana Thabane

Carrie McAiney

Holly Reimer

“What I found interesting was that I had started to lose my balance and I had decided I just have to accept it, but I learned here that you don’t have to accept it, you can prevent it and improve. My balance has improved so much, I’m just really overwhelmed.”

A Mobility Self-Management Program participant

Sinéad Dufour (left), Jenny Ploeg (center) and Holly Reimer (right)

P R O J E C T U P D A T E S 13

This Labarge-funded interdisciplinary team is exploring how advanced vehicle technologies (e.g., back-up camera, blind spot monitor) reshape the experience of driving, as well as mobility patterns and policy responses to older drivers. Their research examines how high-tech vehicles change driving practices (e.g., how and where people drive) and offer possibilities to extend the driving life of older drivers at personal and policy levels. To explore experiential aspects of driving, in-depth interviews have been conducted with 34 drivers (20 men; 14 women) aged 60 to 85 living in the Greater Hamilton Area. Preliminary analysis of the data reveals how driving aids revise, extend, and sometimes

replace pre-existing safety checks (e.g., shoulder checks), as well as the ways in which driving aids are able to extend the capacities of the aging body. The team is also making progress on their review of policy to determine if and how older people and technology are included in public strategies in Ontario and Canada, and looking to international examples for guidance. Preliminary findings were presented at the Human-Computer Interaction conference in Los Angeles, California by Dr. Brenda Vrkljan. In upcoming months, further presentations of this work will take place at the Canadian Association on Gerontology in Alberta and the Gerontological Society of America in the United States.

Technology for Optimal Aging: An Exploratory Study of the Effects of Automobile Innovations on the Lived Experience of Older Drivers, their Mobility, and Social Policy

INVESTIGATORS:

Amanda Grenier

Jessica Gish

Brenda Vrkljan

Antonio Páez

“Thanks to the Labarge funding our team has been able to explore the empirical terrain of the high-tech automobile from the vantage point of later life and lay the groundwork for future investigation. It’s exciting to consider what research possibilities lay ahead in relation to advancements in automobile innovation.”

Jessica Gish From left to right: Amanda Grenier, Antonio Páez, Jessica Gish, and Brenda Vrkljan

P R O J E C T U P D A T E S14

Practice guidelines provide guidance to assist health care providers and patients to make health care decisions. These guidelines are typically written for health care professionals but could be an excellent source of evidence-based information for other audiences. McMaster University produces many guidelines that are directly relevant to those with an interest in healthy aging that could be made available on the McMaster Optimal Aging Portal.

The research team has had great success working with international organizations that produce clinical practice guidelines in collaboration

with faculty at McMaster University. The primary focus has been on how to share this information with patients and the public. The team has been involved in developing a toolkit to provide guidance to these organizations to produce patient information based on evidence-based guidelines. While the toolkit provides general guidance, the Labarge funding has allowed the team to concentrate primarily on information about healthy aging. The project team is currently conducting focus groups and gathering data to inform the creation of citizen-friendly guidelines related to healthy aging in a format tailored for the McMaster Optimal Aging Portal.

Providing Recommendations from Guidelines for Healthy Aging Through the McMaster Optimal Aging Portal

INVESTIGATORS:

Nancy Santesso

Holger Schunemann

“We’ve always recognised the importance of reaching patients and the public with information that can have a real impact on their health. With the funding from the Labarge Initiative, we can really move forward with this work.”

Nancy SantessoHolger Schunemann (left) and Nancy Santesso (right)

P R O J E C T U P D A T E S 15

Total users

33,611

Registered users

4,035

Sessions

53,651

Twitter

854followers

Pageviews

173,486

Twitter reach

173,486

16 M c M A S T E R O P T I M A L A G I N G P O R T A L

Celebrating its first anniversary, the McMaster Optimal Aging Portal is gaining national recognition as a valuable resource of evidence-based information about how to stay healthy, active and engaged as we grow older. Over the past year, the Portal has been endorsed by a number of health stakeholders and organizations, including Dr. Samir Sinha, the Provincial Lead, Ontario’s Seniors Strategy (he said “Check out the McMasterOptimalAging.org Portal – an AMAZING Healthy Ageing Resource!”); HomeCare Ontario; and the Canadian Association of Retired Teachers. The Portal has been further highlighted as a valuable resource by the Office of the Seniors Advocate, British Columbia;

Vancouver Island Health Authority; Finding Balance (Alberta); McMaster University Retirees Association; Grey Bruce Health Unit; and 18 others who have linked to the site.

The Portal’s @Mac_AgingNews Twitter feed, which shares the headlines about aging-related health ‘news’ from mainstream media along with related evidence drawn from the Portal, has tripled its followers since the beginning of 2015 (790 as of October 1). This engagement has been further complemented by the Portal’s Facebook page (launched at the end of 2014) and through targeted media outreach (a campaign to community publications in Ontario

resulted in 57 articles reaching a readership of over 2.5 million).

The Portal has also engaged citizens from across Canada and around the world through the Optimal Aging event series and live webcasts (more than one thousand people attended or watched the live webcasts in 2015, reaching more than 15 countries). These talks are part of the knowledge translation focus of the Portal, which has also included workshops about how to use the Portal, student events, and five citizen panels. The Portal continues to add evidence-based resources for citizens and clinical, public health and policy professionals, including Evidence Summaries (211), Web Resource Ratings (1151) and Blog Posts (70).

McMaster Optimal Aging Knowledge Translation Enterprise

“Check out the McMasterOptimalAging.org Portal – an AMAZING Healthy Ageing Resource!”

Dr. Samir SinhaProvincial Lead, Ontario’s Seniors Strategy

2015 public talks:

over 1000 participants

live or online in

15 countries

Media outreach:

57 articleswith a readership of

over 2,500,000

Facebook reach

29,524

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Knee osteoarthritis (OA) is an inflammatory condition. It is likely that chronic inflammation associated with OA is responsible for the elevated risks for heart disease, stroke, diabetes, and depression. It is unclear whether short exposures to exercise are effective in addressing the inflammatory component of knee OA, thus this emerging collaboration aims to measure inflammatory

markers in the blood and infection in the nose before and after exercise.

In order to test whether inflammation (as measured by the numbers and types of white blood cells and levels of inflammatory markers) affects function, blood was taken from 24 individuals before and after a 12 week exercise intervention. The Bowdish laboratory has finished measures of cell types and

numbers and is proceeding to measure other markers of inflammation. Preliminary analysis indicates that there may be some changes in the types and levels of white blood cells in women with osteoarthritis, which have not previously been characterized. In order to determine if this is the case, the team is currently recruiting healthy controls to include in the analysis.

Emerging Collaboration: Dawn Bowdish and Monica Maly

Dawn Bowdish (left) and Monica Maly (right)

N E W P R O J E C T S18 E M E R G I N G C O L L A B O R A T I O N

Patient decision aids are “tools that help people become involved in decision making by making explicit the decision that needs to be made, providing information about the options and outcomes, and by clarifying personal values” (source: https://decisionaid.ohri.ca/). This

project will set up a mechanism to add to the McMaster Optimal Aging Portal content from a citizen-focused evidence database of decision aids through a collaboration with University of Ottawa, and will include pilot monitoring and evaluation work on this proposed new feature of the Portal.

Helping Canadians Get More Involved in Health and Healthcare Decisions: Adding a Decision Aids Database to the McMaster Optimal Aging Portal

INVESTIGATORS:

John N. Lavis

Brian Haynes

Maureen Dobbins

Anthony Levinson

Parminder Raina

Sandra Carroll

Michael McGillion

Dawn Stacey

John N. Lavis (left) and Anthony Levinson (right)

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Osteoporosis (OP) and osteoarthritis (OA) are two of the most common health problems that affect mobility and quality of life in aging adults. The risks of these chronic conditions increase dramatically as people age. Several approaches exist for the prevention, treatment and management of complications related to these conditions. Although a wealth of scientific data, based on clinical trials, is available for pharmacological treatments, there is a lack of evidence-based studies evaluating the comparative effectiveness and safety of nonpharmacological modalities.

Network meta-analysis (NMA) has recently emerged as a powerful analytical technique that allows synthesizing evidence across multiple interventions, estimating the probability of each of the interventions to optimize outcomes. This project will undertake a comprehensive systematic review and NMA of nonpharmacological interventions for the prevention and management of complications associated with OP and OA in the elderly. Using this methodology, the project team will determine the optimal combination of these interventions for improving physical function and quality of life.

Identifying Optimal Combinations of Nonpharmacological Interventions for the Prevention and Management of Osteoporosis and Osteoarthritis Complications in the Elderly: A Bayesian Network Meta-Analysis

INVESTIGATORS:

Joseph Beyene

Julie Richardson

Parminder Raina

Binod Neupane

Russell de Souza

Alexandra Papaioannou

Aliya Khan

Joseph Beyene

N E W P R O J E C T S20

Chronic obstructive pulmonary disease (COPD) is highly prevalent among older adults and is a leading cause of death, disability and hospitalization in Canada. There is a growing body of evidence demonstrating that older adults with COPD have important problems with their balance and a high incidence of falls compared to those of a similar age. This research will explore the feasibility and preliminary efficacy of a tailored 6-month home balance exercise program for reducing

falls in older adults with COPD. If the tailored home program is feasible and shows evidence of efficacy on intermediate outcomes linked to falls, this approach will represent a novel strategy for fostering resilience in the event of a fall and for reducing risk of future falls for the large population of older Canadians with COPD. Results of this pilot study will be used to develop a larger-scale trial of fall prevention for older adults with COPD with increased fall risk.

Pilot Study of a Tailored Home Balance Exercise Program for Reducing Falls in Older Adults with COPD

INVESTIGATORS:

Marla Beauchamp

Dina Brooks

Roger Goldstein

Stewart Pugsley

Julie Richardson

Marla Beauchamp

N E W P R O J E C T S N E W P R O J E C T S 21

Multimorbidity is the most common condition affecting older adults, who take an average of seven regular medications. Adverse drug effects requiring medical care affect 13% of Canadian seniors taking five or more medications; these include falls, cognitive impairment, poor nutrition, fatigue and poor mobility. One-third of these effects are considered preventable. The TAPER project will test a systematic approach to reducing the burden of drugs and the harmful effects of polypharmacy in older adults, while assessing the effects on patient health outcomes including quality of life and functional capacity. The aim is to enhance the quality of life in seniors by maximizing the beneficial contribution of medications to optimal aging.

TAPER-F: Team Approach to Polypharmacy Evaluation and Reduction

INVESTIGATORS:

Dee Mangin

Lisa Dolovich

Gina Agarwal

Anne Holbrook

Henry Siu

Cathy Risdon

Julie Richardson

James Gillett

Mat Savelli

James McCormack

Daria O’Reilly

Kiska Colwill

Jane Jurcic

Scott Garrison

Barbara Farrell

Peter Gøtzsche

Johanna Trimble

Alan Cassels

William Brown

Lehana Thabane

From left to right: Dee Mangin, Jenna Parascandalo, and Sherrie Orr

N E W P R O J E C T S22

Early detection of cognitive impairment is increasingly important to help optimize outcomes for older adults at risk for dementia. Current screening tools have some challenges, especially in detecting mild cognitive impairment. This project is working

to develop a new behavioural test for screening older adults for mild cognitive impairment. This test has the potential to be both easier to administer than current tests, and also much less confronting for the individuals being tested.

A New Screening Tool for Cognitive Impairment

INVESTIGATORS:

Karin R. Humphreys

L. Kathleen Oliver

Meghan McConnell

Karen Saperson

From left to right: Meghan McConnell, Karin R. Humphreys, and Karen Saperson

N E W P R O J E C T S N E W P R O J E C T S 23

Hip fractures are a significant concern for older Canadians, and their incidence can be reduced through implementation of protective measures for those most at risk. However, clinical diagnosis of osteoporosis (and corresponding fractures) is done using DXA scans, which are insufficient for accurately predicting this risk. Finite element (FE) models allow a complete investigation of a patient’s hip,

but have yet to be implemented clinically. This project will focus on developing a new technique to map a validated FE model of the hip to patient-specific parameters from DXA scans, allowing for a semi-automated clinically-relevant method to accurately predict an individual’s fracture risk. This will allow implementation of preventative interventions for those most in danger prior to sustaining a devastating fracture.

Preventing Hip Fractures in the Elderly by Mapping Subject-Specific Finite Element Models

INVESTIGATOR:

Cheryl E. Quenneville

Cheryl E. Quenneville

N E W P R O J E C T S24

N E W P R O J E C T S

Labarge Optimal Aging Initiative, McMaster UniversityHSC 2E5C, 1280 Main St. W., Hamilton ON, Canada L8S 4K1

Phone: 905-525-9140, ext. 28658

optimalaging.mcmaster.ca