Canadian Geriatrics Journal

FI-CGA and eFI-CGA in Frailty Care: a Scoping Review

Xiaowei Song — 2026-06-03

Background

Comprehensive geriatric assessment (CGA) is the reference standard for diagnosing and managing frailty. By evaluating a broad range of health, functional, cognitive, and social problems, the CGA enables the construction of a deficit accumulation Frailty Index (FI-CGA). Recent advances have integrated the electronic CGA (eCGA) into electronic health/medical records and other digital platforms, allowing auto-mated coding and summarization of CGA data to generate an electronic Frailty Index (eFI-CGA).

Methods

We reviewed over two decades of research on the develop-ment, validation, and application of the FI-CGA, eCGA, and eFI-CGA in health-care contexts, conducted following the PRISMA-ScR guidelines. A comprehensive search was performed in MEADLINE and CINAHL databases, including English language publications from 2004 to July 1, 2025. The 38 studies that met all criteria are included in the final review. Data were synthesized descriptively and analyzed thematically.

Results

The evidence suggests that the FI-CGA is a robust, adaptable predictor of adverse outcomes including mortality, hospitalization, and functional decline. Digital adaptations improve feasibility, accuracy, and workflow, supporting wider application in acute, long-term, primary, and community care. The transition from manual to eCGA-based frailty measurements marks a significant advance toward scalable, integrated frailty care. Emerging implementations are targeting earlier detection, risk stratification, and personalized interventions.

Conclusion

The digital eCGA and eFI-CGA tools hold potential to enhance (“geriatrize”) capacity to identify and manage frailty across care settings. Further research is needed to validate them across populations, and leverage innovative technologies to advance frailty care, in these ways promoting healthy aging.

Augmented Reality for Balance Rehabilitation in Older Persons: A Scoping Review

Afeef Vehra — 2026-06-03

Background

Falls are a leading cause of injury and loss of independence in older adults. Impaired balance is a modifiable risk factor yet traditional rehabilitation approaches may not fully address balance control. Augmented reality (AR) provides an interactive method to support balance training and fall prevention. This scoping review summarizes key characteristics of AR interventions for balance rehabilitation in older adults, as well as associated outcome measures.

Methods

Literature searches were performed across CENTRAL, CINAHL, EMBASE, Medline, PubMed, ScienceDirect, SCOPUS, and Web of Science from inception to July 2024. Using Arksey and O’Malley’s framework, we included studies meeting the following criteria: (i) older adults (65+), (ii) AR-based balance rehabilitation, (iii) randomized control trials (RCTs) or observational studies, and (iv) outcomes related to balance, balance confidence, or fear of falling, categorized using the Balance Evaluation Systems Test (BESTest) framework. Two reviewers independently screened and extracted data.

Results

Ten studies (six RCTs, four observational) involving 235 participants (ages 64.70-75.8 yrs) met inclusion. AR interventions were delivered 1–5 times/week over 4 to 12 weeks (4–36 total hr), with adherence rates of 83.3% to 100%. The most frequently assessed balance systems were stability in gait (100%) and anticipatory postural adjustments (90%), which improved with AR. Only one study evaluated all balance systems. RCTs showed statistically significant improvements in balance, while observational studies mainly reported associations and trends.

Conclusions
This review highlights AR as a complementary tool for fall prevention, supporting tailored interventions across balance domains. Clinicians may find AR useful for engaging older adults in targeted, functional rehabilitation.

Caregiver Attitudes, Motivations and Care Quality in Residential Memory Care: a Scoping Review Protocol

Sarah Maat — 2026-06-03

Background

The motivations and attitudes of caregivers strongly influence the care they provide. Motivation is also a central component in staff retention and care consistency, whereas attitude shapes delivery and degree of person-centeredness in care. Although caregiver attitudes and motivations have been examined separ-ately in dementia care research, these constructs have not been comprehensively mapped together within residential memory care settings or explicitly linked to care quality.

Objective

This review aims to assess literature pertaining to attitudes and motivations of formal caregivers in residential dementia care facilities and to examine how these constructs are associated with care quality. This review seeks to generate practical insights to inform workforce training and recruitment strat-egies to support high-quality, person-centered dementia care.

Inclusion Criteria

Literature focused on the attitudes and motivations of formally employed caregivers providing care to residents in a residential memory care setting. Studies published of any design, from any year, country, or language will be considered.

Method

This scoping review will follow the Joanna Briggs Institute (JBI) method. A comprehensive search will be conducted across major health, social science, and interdisciplinary databases, along with grey literature sources. Data will be extracted according to a JBI template informed by three theoretical frameworks: the Tripartite Model of Attitudes, the Empathy-Altruism Hypothesis, and Person-Centered Care. Results will be reported in accordance with the PRISMA-ScR guidelines.

Registration

Open Science Framework https://osf.io/8yrge

Effects of Exercise Order of Combined Power and Endurance Training on Arterial Stiffness and Hemodynamic Parameters in Previously Trained Hypertensive Older Adults

Bruno Bavaresco Gambassi — 2026-06-03

Background

Combining power training (PT) with endurance training (ET) offers health benefits for older adults. However, little is known about the effects of PT plus ET on arterial stiffness and hemodynamic parameters in previously trained hypertensive older adults. Additionally, the effects of exercise order—PT followed by ET versus ET followed by PT—on arterial stiffness and hemodynamic parameters remain unclear in older adults.

Objective

This study aimed to a) examine the effects of concurrent training (CT) on arterial stiffness and hemodynamic parameters in previously trained hypertensive older adults; and b) to investigate the effects of concurrent PT and ET exercise order on arterial stiffness and hemodynamic parameters in previously trained hypertensive adults.

Methods

Older adults with grade 1 hypertension were randomized into two groups: PT then ET group (DPTETG) and ET then PT group (ETDPTG). Both groups trained twice weekly for 16 weeks. Arterial stiffness and hemodynamic parameters were measured at baseline and after 16 weeks.

Results

No significant changes in arterial stiffness or hemodynamic parameters emerged after 16 weeks in either group (p > .05).

Conclusion

This study demonstrates that 16 weeks of different exercise orders of concurrent power and ET do not change arterial stiffness and hemodynamic parameters in older adults with hypertension.

Ensuring Clinical Practice Guidelines Meet the Needs of the End-User: a Prioritization Survey for Guideline Topics for Behavioural and Psychological Symptoms of Dementia

Kayla Atchison — 2026-06-03

Background

Behavioural and psychological symptoms of dementia (BPSD) are complex to assess and manage, and a lack of updated clinical practice guidelines (CPGs) leads to variation in clinical practice. When generating CPGs, involvement of end-users in developing and prioritizing topics is key to creating effective recommendations.

Methods

To inform the creation of a CPG for the management of BPSD, we completed a Canada-wide online BPSD topic prioritization survey using Qualtrics. In January-March 2023 the survey was disseminated widely to identify preferred terminology to use in the guideline and to prioritize topics to be included.

Results

Two hundred fifty-four persons responded to the survey. Participants were mostly female (88.2%), identified as women (87.0%), were aged 50-64 (37.0%), from Ontario (69.7%), and from nursing roles (n=83). BPSD was the most preferred terminology (32.1%) followed by responsive behaviours (26.2%). Seven topics were reviewed for guideline inclusion, with priority placed on prevention, non-drug management, and prodromal symptoms. Comments from participants identified concerns around validity of detection tools, possible lack of available evidence, and conflict between standardized approaches versus the need for individualized care.

Conclusions

Involvement of end-users in the determination of terminology and prioritization of topics was an effectual way to ensure CPGs represent the needs of the user.

Association Between the Japanese Version of Montreal Cognitive Assessment Tasks and Driving as the Primary Mode of Transport Among Community-Dwelling Older Adults

Yuya Nakajima — 2026-06-03

Background

Deciding whether to continue driving or transition to alternative means of transportation is a challenging issue for older adults in preventive care settings. This study aimed to identify potential associations between the Japanese version of the Montreal Cognitive Assessment (MoCA-J) and driving as the primary mode of transport among older adults.

Methods

The participants of this cross-sectional study were community-dwelling older adults participating in a long-term preventive care program. Participants were divided into two groups (DRIVING or OTHER) based on their questionnaire response regarding the main mode of transport used when going out, where the OTHER group included all participants who selected any other mode than a car driven by themselves. Cognitive function was measured using 13 MoCA-J tasks. Binary logistic regression analysis was used to identify associations between MoCA-J results and inclusion in the DRIVING group.

Results

Among the 199 participants, 156 were categorized into DRIVING group and 43 into OTHER group. The DRIVING group showed significantly higher task achievement rates than the OTHER group in trail-making, digit span, and phonemic verbal fluency tests. Of these, only the trail-making test results were associated with inclusion in the DRIVING group (odds ratio, 2.82; 95% confidence interval, 1.22–6.51; p =.016).

Conclusions

The trail-making task of MoCA-J may assist health-care professionals in providing driving guidance to older adults.

Decision-Making Capacity Assessment Education using Online Modules

Lesley Charles — 2026-06-03

Background/Objectives

Specialized training is necessary for health-care providers such as physicians, nurses, and social workers, to be able to accurately perform decision-making capacity assessments (DMCAs). With an increasing demand for flexible, accessible education, there is growing interest in utilizing online training modules to keep health-care providers up to date on current best practices in DMCAs. This study evaluates the effectiveness of online training modules in enhancing clinicians’ self-reported knowledge, confidence, and comfort with the core concepts necessary to conduct DMCAs.

Methods

This was a pretest/posttest study on an online DMCA training. Participants from a regional health authority (Alberta, Canada) took 13 online modules on 15 core DMCA concepts, from March to December 2021. A pretest and a posttest were completed before and after completion of the modules. Agreement to Likert-like items were collected and compared at a group level. Additionally, the ratings were compared with historical data from face-to-face DMCA workshops.

Results

A total of 683 pretests and 241 posttests were completed. All 15 posttest ratings were higher (p < .001) than pretest ratings. Compared to the historical face-to-face workshops, the self-reported ratings in the online modules tended to be higher both on pretest and posttest. However, the changes in self-reported ratings from pretest to posttest were similar between the online modules and the historical workshops.

Conclusion

Online learning of DMCA concepts can lead to higher self- reported learning posttest to pretest. Furthermore, the changes in self-reported ratings are similar to those observed in face-to-face workshops.

Geriatrician and General Internist Clinical Payments in Canada 2022–2023: Fee for Service and Alternative Payment Plan

Ashley B. Martel — 2026-06-03

A Comprehensive Geriatric Assessment (CGA) completed by a geriatrician assessing an older person living with frailty and multiple comorbidities involves longer visit durations than standard General Internal Medicine (GIM) consultations, reflecting the need for detailed evaluation. Medical trainees have little formal education about how they will be remunerated as specialists or that there are different methods of clinical payments between provinces of Canada, including Fee for Service (FFS) and Alternative Payment Plans (APP). GIM is a reasonable comparator to Geriatric Medicine because, while not using CGA, GIM residents are also trained to assess medically complex patients who often have comorbidities. The goal of this paper was to provide transparency for medical trainees about differences in the proportion of FFS or APP and the average clinical payments made to geriatricians and general internists between the provinces of Canada. Using data from the Canadian Institute for Health Information (CIHI), we show mean, mean trimmed to $100,000 and median clinical payments to geriatricians across Canada. Average payments were generally lower in provinces with predominantly an APP as the main source of payments compared to provinces with a split model of APP and FFS where payments demonstrated larger variances. The clinical payments to general internists were higher than for geriatricians. In addition to increasing transparency in specialist payments, Provincial Medical Associations and Sections or Divisions of Geriatric Medicine, could use these data to advocate for comparable remuneration between geriatricians and general internists when renegotiating clinical payments funding agreements.

Improving the Delivery of Brain Health Care to All. Keeping our Eye on the Main Prize in an Era of Emerging Anti-Amyloid Therapies

Manuel Montero-Odasso — 2026-06-03