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Enhancing Aging Research Capacity in Canada

© Her Majesty The Queen in Right of Canada (2003)
Cat. number : MR21-46/2003E-PDF
ISBN 0-662-34969-5

Table of Contents

Message from the Federal Minister of Health
Message from the Scientific Director of the Institute of Aging

NET - New Emerging Teams

Training - Strategic Training Programs

IHRT - Interdisciplinary Health Research Teams

Appendix on Team Members and Contacts

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Message from the Federal Minister of Health

By 2026, seniors will constitute more than one out of every five Canadians, making seniors the fastest growing age group in Canada. As the federal Minister of Health responsible for seniors, I am pleased to convey that the Government of Canada is committed to providing our aging population with the support needed to live healthy, independent lives and to maintain quality of life in all states of health. This commitment is supported with rigorous health research aimed at meeting the challenges of our aging population.

We cannot ensure that our programs and policies meet the diverse needs of seniors without a solid foundation of knowledge on which to base our actions; knowledge based firmly in research. Through the Canadian Institutes of Health Research at the Institute of Aging, the federal government is investing more than $27 million towards bold new initiatives to increase research capacity in health and aging by supporting unique teams.

Scientific teams are training our young Canadians, breaking new ground and generating the knowledge needed to inform not only policy-makers at all levels of government, but also practitioners, service organizations and the public. The teams are also sharing their best strategies on training and knowledge transfer to the wider health community both domestically and internationally.

Congratulations to the CIHR Institute of Aging for its leadership in addressing national health research priorities for seniors and setting an aggressive agenda that is not only generating essential knowledge, but also building teamwork and providing the necessary training to sustain and expand this important area of research.

The Honourable Anne McLellan
Minister of Health

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Message from the Scientific Director of the Institute of Aging

Since its beginning in December 2000, The Institute of Aging has undertaken strategic planning activities steered by consultation with the scientific community and stakeholders in aging research in Canada. The need to develop Canadian research capacity emerged from discussions as a top priority, as aging research, unlike other areas, must appeal to more investigators in order to address the rising challenges of our aging population. Accordingly, the Institute particularly provides for initiatives aiming to first, foster the development of research teams, and second, train and establish new investigators in emerging fields of aging research.

In line with its strategic plan, the Institute has thus far successfully contributed to the Canadian aging research capacity. It assumed the funding of a few Interdisciplinary Health Research Teams, part of the transition programs stemming from the launch of the Canadian Institutes of Health Research. The Institute also contributed to the establishment of the Strategic Training Programs. Finally, the Institute developed the New Emerging Team program that is tailored to the specific needs of aging research, as it provides small scientific teams with stable funding to train and establish new investigators, allowing them to build a critical mass to become more competitive.

Together, the Institute of Aging and the Canadian Institutes for Health Research put forward an investment of 27 million dollars to support activities undertaken by 18 teams across Canada. These teams display research interests relevant to the five research priorities of the Institute: healthy and successful aging, biological mechanisms of aging, aging and maintenance of functional autonomy, cognitive impairments in aging, and health services and policy relating to older people. The Institute considers these teams as pillars in the development of aging research in Canada and a solid foundation to nurture and establish new investigators. These lines of action will likely lead to innovative solutions that in turn, will improve the quality of life and health of older Canadians.

Dr. Réjean Hébert

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NET New Emerging Teams

The purpose of the New Emerging Team (NET) grant is to build capacity in new and developing areas of research, develop new research teams, and give researchers the building blocks required to successfully apply for future funding. It provides, over a period of five years, support for the growth of small existing teams or the formation of new and non-existent teams of independent researchers undertaking multidisciplinary research in Canadian research institutions. The objectives of the New Emerging Team grant program are to:

  • Create or develop new competitive research teams which show potential for successfully applying for other infrastructure team funding in the future;
  • Foster multidisciplinary and cross-theme research in areas of focus, such as aging;
  • Train and establish new investigators in these areas;
  • Create a team environment that favours the development of new fundable research projects.
  1. Optimising End-of-Life Care for Seniors
  2. Helping Seniors and Primary Care Professionals Optimise the Use of Drugs to Improve Health
  3. Transitions and Dementia: Bridging Gaps in Service Provision
  4. Implementation and Evaluation of a Comprehensive Pain Assessment and Treatment Program for Seniors
  5. Development of Biological Implants for Joint Repair
  6. Innovative Approaches to Optimising Balance and Mobility in Older Adults
  7. Health Impacts of Violence Across the Lifespan: A Multidisciplinary Approach
  8. The Canadian Driving Research Initiative for Vehicular Safety in the Elderly (CanDRIVE)
  9. Genomics, Genetics and Gerontology (G3): A Multidisciplinary Team for the Study of Healthy Aging
  10. Development and Evaluation of Strategies to Improve the Care of Persons with Dementia in Rural and Remote Areas
  11. Understanding, Treating and Preventing Tinnitus
  12. Health and Aging in Rural Environments
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Optimising End-of-Life Care for Seniors

End-of-life care for seniors is an important, but until recently neglected area of research because of the limited collaboration between specialists in geriatrics and palliative care. On average each year, 75% of deceased Canadians are aged 65 and above and less than 10% of these people received interdisciplinary palliative care, validating the need for immediate investigative action. Co-ordinated and integrated end-of-life care for seniors, however, remains a daunting task; it is multifaceted and involves a variety of care settings and service providers. Hence, this research project aims to consider the quality of end-of-life care for seniors in terms of structure, process of care, quality of care and life and outcome of care across residential, institutional and long-term care settings.

The research plan includes five broad initiatives. The first component addresses the end-of-life care needs of rural seniors through a series of community-based studies in three rural communities in Ontario. The second component aims to examine quality of end-of-life care for seniors in home settings and in long-term care facilities. For home settings, the objective is to determine how family caregiving affects the choices of end-of-life strategies, and how to best support family caregivers. In long-term care settings, investigators aim to identify factors affecting palliative care and determine and evaluate strategies to improve them. The third component includes a qualitative investigation on the sense of burden seniors experience during end-of-life care. The goal is to develop a set of guiding principles to strengthen the relationship between seniors and their support system. In the fourth component, investigators plan to focus on the role of volunteers in palliative care for seniors, and attempt to clarify the most appropriate volunteer programs. The fifth component consists of an examination of delirium in seniors at the end-of-life. This component will address the impact of delirium on decision-making regarding care and the difficulties delirium presents for families and service providers.

The objective of this NET initiative is to establish a diversified research program focusing on end-of-life care for seniors. Developing research capability and guiding principles in this increasingly important domain will result in improved quality of care for seniors who are approaching death and support and guidance for their caregivers.

Dr. Pierre Allard heads this multi-disciplinary team of researchers from the University of Ottawa, McMaster University, and Lakehead University. Dr. Allard offers expertise in palliative care, epidemiology and delirium. Dr. Brazil contributes extensive epidemiological research experience on care of the elderly and palliative health services delivery. Dr. Guirguis-Younger brings her knowledge of gerontology and community psychology to the study of the role of volunteers in integrated end-of-life care for seniors. Dr. Legault contributes expertise in the role of nurses in providing palliative care for marginalised and underserved populations. Professor Mary Lou Kelley brings extensive experience in palliative care delivery in rural areas. Dr. Wilson's expertise is in psychological assessment and the epidemiology of mental disorders. Dr. McPherson brings expertise in health psychology and nursing to palliative home care research, and Dr. Brajtman in palliative care nursing.

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Helping Seniors and Primary Care Professionals Optimise the Use of Drugs to Improve Health

Appropriate use of medication is a key strategy for healthy aging; regrettably, it is a strategy that still needs to be encouraged and put into practice. Evidence points to significant incidences of under-prescribing, unneeded prescribing, misuse of medication, and communication and information gaps between physicians, patients and pharmacists. In turn, these incidences lead to drug-related morbidity and mortality, as well as unnecessary health care expenditure. As seniors account for 28 to 40% of prescription drug use, it is imperative to develop and evaluate strategies to improve medication use by seniors. In response, the research project taken on by Dr. Dolovich and her team aims for the following:

  • Determine the clinical, psychological, sociological and epidemiological factors affecting medication use by seniors (including over the counter and alternative medications).
  • Determine the role of primary care physicians and pharmacists in assisting or hindering optimal medication use.
  • Examine the role of cognitive, psychological, sociological and behavioural factors in treatment's comprehension and adherence.
  • Develop and evaluate evidence-based messages directed at patients, physicians and pharmacists to optimise use of medication.
  • Identify and evaluate strategies to enhance patient participation, dialogue between patient-pharmacist-physician and effective use of information technology.
  • Disseminate information and translate findings into clinical practice and health policies.

The research plan is two-fold; first, develop a network of primary care physicians, pharmacists and patients to work in partnership with the research team, and second, examine a set of pertinent research questions through various projects. Research activities evolve around four specific themes: patients and policy needs, production of evidence-based therapeutic messaging, integration of health care system and improvement of patient outcomes. Projects include a randomised control trial investigating the effect of a shared decision making model of communication during consultation on antibiotic prescription rate. Investigators also plan to evaluate an electronic shared care model that involves patients, health providers, labs and pharmacies and aims to improve medication use in seniors.

The intended outcomes of this project are to first, find the best solution to the problems relevant to medication use in seniors; more specifically to make a case for patient involvement in decision making and physician-pharmacist co-operation, and find effective interventions improving medication use. Second, look across all projects to see how they resonate together to build a reliable foundation that will transcend new pharmacological technologies. As not one treatment fits all in primary care and medication use, this research project aims to provide insight on how to assess patients, tailor therapies, and ensure their appropriate fit.

Dr. Lisa Dolovich leads this multi-disciplinary group of investigators based at McMaster University. Her research background includes patient-pharmacist-physician collaboration, evidence-based communications with patients, and skill building interventions for physicians and pharmacists.

While adding an international dimension to the team, UK-based Dr. Butler commits his knowledge of health behaviour change and optimisation of antibiotic prescribing. Dr. Holbrook provides expertise on evidence-based therapies and evaluation of electronic integrated delivery systems. Dr. Kaczorowski puts forward his knowledge of clinical practice, socio-demographic correlates of health, information technology and medical education. Dr. Levine offers knowledge of value systems that influence physician prescribing behaviours, and his experience in developing therapeutic guidelines and text materials for physicians and patients. Dr. Kaasalainen provides her perspective as a nurse and offers her knowledge as a researcher in gerontological issues including pain management. Dr. Agarwal puts forward the perspective of a family physician and her knowledge of diabetes management in primary care.

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Transitions and Dementia: Bridging Gaps in Service Provision

Examination into the continuum of care for seniors suffering from dementia reveals that transitions between care providers or agencies are likely to cause gaps in provision of care. Since a variety of health professionals and agencies are involved in the treatment of dementia, co-ordination between services is necessary to make transitions as smooth as possible. Clinical, social, organisational and economic aspects of transitions must be examined and understood to develop best practices of dementia care addressing the realities and needs of patients and their families. As 250 000 Canadians are currently diagnosed with dementia, with the prevalence expected to rise to 750 000 by 2031, it is important to act now to uncover, understand and bridge these gaps, and thus ensure an effective continuum of care for dementia sufferers. In response, this research aims to:

  • Examine the circumstances in which transitions take place;
  • Investigate transitions management;
  • Evaluate new approaches aiming to bridge the gaps during transitions.

The research plan includes six research projects. In the first project, investigators look into the very first transition, which is recognising the symptoms and seeking help, and the response from health and social service providers. Second, both generic and specialised case management methods for dementia are compared, and then examined in term of their effectiveness at managing transitions. Third, investigators intend to explore how behavioural problems triggered by dementia affect care processes and outcomes, patients' social network, and social and personal transitions though the continuum of care. The fourth project focuses on the expectations of patients, families and professionals towards new dementia medications, and how the latter affect provision of care. The fifth project involves inter-provincial data linkage to examine patterns of transitions and assess their effects on morbidity, mortality, function and quality of life. Finally, investigators mean to assess the value of an electronic community dementia care registry from an ethical, economic, social, and clinical standpoint.

Demographics and health statistics point to a massive wave of dementia cases that will soon fall onto our communities and health care system. Evidence pertaining to the best practices to ensure efficient continuum of care for dementia patients is critical in preparation for the upcoming increase in dementia prevalence. Members of this team consider this research as building a solid foundation; outcomes are expected to provide valuable and timely information on dementia care, but most important, inspiration for new lines of investigations for future research.

This multidisciplinary team, under the direction of Dr. Neil Drummond , emerged from the union of three community dementia networks in Calgary, Toronto and Ottawa. After identifying their research agenda, the team embarked on their path to develop and strengthen evidence pertaining to dementia care. More specifically, they aim to resolve problems associated with co-ordinated delivery of care for dementia, particularly throughout zones of transitions. Each member deeply values the solid foundation provided by the three net-works and insists on including all three geographic areas in each component of the research project, thus ensuring their national agenda.

This multi-sited and multidisciplinary initiative brings together investigators with various backgrounds including social sciences, geriatric medicine, psychiatry, health economics, management and policies for senior care, nursing care of the elderly, and biostatistics. Dr. Drummond appreciates and praises his team's democratic nature, devotion, efficiency, and values this complimentary and unique combination of expertise and experience.

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Implementation and Evaluation of a Comprehensive Pain Assessment and Treatment Program for Seniors

Many pieces of evidence demonstrate the importance of the study of pain in seniors. The burden of pain accompanies most age-related conditions, and is a common preoccupation among seniors. Also, under-management of pain is a serious public health problem at all ages, and becomes a significant threat in populations with limited abilities to communicate. To address these issues, this research project has three objectives:

  • Systematically assess pain in seniors with normal to severe cognitive impairment, and in seniors receiving palliative home care service.
  • Develop, implement and evaluate psychosocial interventions aiming to prevent and treat pain in seniors.
  • Develop ethical guidelines relating to the assessment and management of pain, and study ethical issues associated with under-treatment of pain in seniors.

To fulfil these objectives, a large multidimensional research plan was designed. First, the Regina Qu'Appelle Health Region case co-ordinators and home care nurses plan to administer an assessment battery, which includes recognised pain assessment strategies. Second, the team proposes to adapt a 12-session pain psycho-educational program for the project; one version tailored to the specific needs of seniors, and another version guiding caregivers of cognitively impaired patients in helping them deal with the patients' pain. The program involves a wait-list control group and four types of delivery: group sessions for seniors in the community, group sessions for professional and informal caregivers of seniors with dementia, individual sessions for seniors in the community and individual sessions for professional and informal caregivers of seniors with dementia. Lastly, various focus groups are planned to discuss and study ethical issues surrounding pain assessment and management in seniors.

Pain is a challenging opponent to battle. It is the primary symptom of many chronic diseases afflicting seniors, dictates visits with health care professionals, and is reported to be under-managed in cognitively impaired seniors. Combined with the fact that pain can be a silent burden in the latter population, the need to effectively assess and manage pain in seniors becomes irrefutable. This research project is expected to lead to interesting insights on building and improving systematic pain assessment approaches for seniors, improving plans for routine care of dementia patients, and enhancing patients' environment and quality of life. It will likely lead the way to future courses of action, such as the development and evaluation of tailored pain assessment tools for specific types of dementia, and the matching of patients with specific types of dementia to specific interventions.

Dr. Thomas Hadjistavropoulos heads this Regina-based team and brings expertise in assessment of dementia and pain, and of issues related to unremitting pain in late life. He speaks very highly of his team, and particularly affectionately of his colleague and wife, Dr. Heather Hadjistavropoulos, of her creativity and the notable impact of her work in psychosocial interventions for pain.

While adding a philosophical spin to the relationship between pain and dementia, Dr. Malloy often suggests new perspectives and ideas, along with his expertise of ethical issues in health care. Dr. MacLean and Dr. McCulloch both provide strong leadership to the group and expertise in palliative and end-of-life care and in physical activity for seniors respectively. Dr. Craig offers his knowledge of pain assessment in populations with limited ability to communicate (children and seniors with dementia) and his many international connections with pain experts. Recently, a variety of collaborators and trainees have joined the team: Dr. Beattie, Dr. Gallagher, Dr. LeFort, Dr. Lix, Dr. Martin, Dr. Ferrell, Dr. Harrison, Dr. Paluck, Shannon Fuchs-Lacelle, and Sheryl Green.

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Development of Biological Implants for Joint Repair

The incidence of joint damage caused by either degenerative diseases or injuries is escalating. Add the phenomenon of an aging population, and the development of new treatment strategies becomes a compelling research avenue. Interesting advances have been made in biological joint repair methods, but they bear serious limitations. Concerned with the latter, Dr. Kandel and her team devised an innovative method that, once fine-tuned and proven feasible, will likely revolutionise the treatment of joint diseases. Imagine a bi-phasic implant (cartilage-covered plug) that can be of any shape and size, and consists of a bone substitute and cartilage grown in vitro from a person's own cartilage cells. A plug that, once placed in the defective joint, will fuse with the intended surface cartilage and allow bone in-growth through its pores as it gradually biodegrades. This method addresses the limitations of other methods, which include donor site morbidity and the movement associated with the use of a mosaic-like arrangement of multiple plugs. It also allows for treatment at earlier stages of disease, involves biodegradable synthetic material, and should result in shorter periods of disability and limited movement. Although bi-phasic implants show great potential, the team must concentrate on a few challenges, as indicated in the following research objectives:

  • Determine the optimal bone substitute, i.e. porous Calcium Polyphosphate (CPP). More specifically, find the perfect chemical composition and physical parameter (pore size) to allow for optimal bone in-growth, the best CPP grain size for appropriate degradation rate, and the best technique for shaping custom-made implants.
  • Develop the best method to form cartilage in vitro with a composition closest to person's own cartilage, that is, a cartilage tissue with calcified zone characteristics and ratio of proteoglycans to collagen similar to native cartilage.
  • Develop appropriate surgical instrumentation for the placement of the bi-phasic implants.
  • Evaluate the bi-phasic implants with the optimal characteristics in vivo, using a sheep model.

In their efforts to find methods to improve joint healing in the elderly from a clinical, mechanical and biological standpoint, this team of investigator aims to reduce or delay the need for joint replacement with a metal prosthesis and treat joint diseases at earlier stages. The advantages of such an approach are compelling: shorter periods of disability and limited movement, less risk of morbidity and mortality that is associated with implant surgery and revision surgery, and less medication use, which means less drug-related side effects. After this project, Dr. Kandel and her team are looking forward to examining the use of stem cells to form cartilage tissue, ways to stimulate cartilage repair, and to identify cell signalling mechanisms activated following cartilage cell attachment to biomaterials.

Dr. Rita Kandel brings together an innovative team of researchers combining their expertise towards the development of biological implants for joint repair. She describes the team as cohesive and committed to working together to attempt to solve this complex problem. She appreciates the close working relationships and communication amongst the investigators.

Since it is necessary to assemble an interdisciplinary group of investigators to appropriately examine biological joint repair, the team includes representation from several disciplines. Dr. Pillar, an engineer, gives attention to synthetic implant formation and generation of biodegradable calcium phosphate structures, and Dr. Grynpas, a biophysicist, to analysis of hard tissue and biomaterials. Dr. Hurtig, a veterinarian, offers his expertise in veterinary surgery and animal models for joint resurfacing, and Dr. Kandel, a clinician-scientist, in engineering of both cartilage tissue and intervertebral disc tissue.

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Health Impacts of Violence Across the Lifespan: A Multidisciplinary Approach

Although current literature provides a substantial body of evidence on violence, many relevant questions are yet to be examined. Existing evidence fails to clarify the role of individual and situational factors in the impact of violence on subsequent quality of life. Also, it barely provides information related to effective interventions to prevent violence, modify its impact, and treat its negative consequences. In light of these limitations, this research aims to create new knowledge on the occurrence, meaning and impact of violence on women, children and seniors through various investigations. One of these focuses on an unrecognised problem of great magnitude: elder abuse. To make a case for elder abuse prevention and intervention strategies requires a clear definition of elder abuse, an estimate of its prevalence, as well as reliable and valid measurement tools, all of which are yet to be ascertained. In response, the initiative aims to:

  • Clarify what is abuse or violence towards seniors;
  • Develop a valid and reliable questionnaire that reflects seniors' concept of elder abuse and is appropriate for seniors in institutions and communities;
  • Determine elder abuse prevalence.

The research approach includes two phases. First, the investigators plan to clarify and define the concept of elder abuse, and develop a questionnaire to measure its prevalence. To accomplish this, investigators propose a systematic literature review pertaining to prevention, treatment and risk factors associated with elder abuse, and focus groups to gain insights into how seniors define and comprehend elder abuse. Based on the literature review and the outcomes of the focus groups, the investigators intend to develop a survey instrument to measure elder abuse, and then evaluate its validity and reliability. The second phase consists of establishing elder abuse prevalence. The investigators propose to pilot the survey in a sample of seniors from the Seniors Health Investigation Network, and include it in the next wave of survey to take place in two to three years. They also hope that their survey items will be included in the Canadian Longitudinal Aging Study.

The tasks taken up in this initiative are the first steps towards developing much needed strategies to prevent, treat and detect elder abuse. Current forms of checklists used to identify seniors at risk of abuse and caregivers at risk of committing abuse are lacking, and there is no reliable evidence that management strategies are effective. Likewise for prevention strategies, existing evidence fails to provide grounds to incorporate prevention and screening tools for elder abuse in routine health examinations.

This team led by Dr. MacMillan draws upon a wide range of disciplines as varied as they are complementary. The team comprises numerous established and new investigators, and is characterised by Dr. MacMillan as extremely resourceful and co-operative. The sub-group of researchers looking into elder abuse is dynamic and full of enthusiasm, she comments.

Among the 11 NET members, five give attention to elder abuse. Dr. MacMillan puts forward her expertise in epidemiology and violence research. Dr. Boyle offers remarkable skills in sampling efficiency, evaluation and adjustment for sample loss, generalisability of findings, and statistical analysis. Dr. Patterson commits his expertise in preventative health care, cognitive disorders, and elder abuse. The team includes two doctoral students; Christine Walsh in social work, with emphasis on violence, and Nadine Wathen in information sciences, with a focus on systematic review methods.

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Innovative Approaches to Optimising Balance and Mobility in Older Adults

Falling and immobility are ever-increasing concerns in light of the greying of baby boomers. Falling is the leading cause of accidental death and injury admission to acute care hospitals, and often brings about social withdrawal, inactivity and immobility. Furthermore, problems related to falling, such as hip fractures, are expected to quadruple over the next 40 years, which will likely place severe demands on our health care system. Evidence also indicates that attentional and cognitive deficits, and not only sensory and musculoskeletal impairments, significantly contribute to the risk of falling. Accordingly, appropriate and cost-effective approaches to optimise balance and encourage safe mobility and independence are not only necessary, but timely as well. Hence, this research team aims for these three objectives:

  • Develop innovative interventions to prevent falls and promote safe mobility using research on biomechanics and neural control of postural stability and movement.
  • Evaluate the developed methods in clinical and community settings.
  • Transfer new technologies and information to homes, institutions and the market place.

The research plan includes five projects aiming to examine various aspects of balance and mobility. Projects include the development and evaluation of (i) balance training systems that improve compensatory stepping and grasping balancing reactions; (ii) a new design of walker with enhanced lateral stability; (iii) a closed-loop neuro-orthosis that compensates for balance deficits in seniors. In another project, investigators propose to examine the long-term effectiveness of a balance-enhancing footwear insole and evaluate its potential to reduce risk of falling. The insole facilitates cutaneous sensation from the sole of the feet to improve control of compensatory stepping. Finally, another project sets to evaluate an auto-alerting handrail that eliminates delays and errors in initiating compensatory grasping reactions of the rail.

Preliminary testing with young subjects has already yielded interesting results. For instance, findings suggest an adverse effect of mobility aids in risk of falling; walkers created problems in terms of lateral balance, and subjects tended to rely too much on canes when losing balance, persisting in holding it instead of reaching for the rail. Such findings have direct clinical implications and suggest to primary physicians vigilant prescribing of assistive devices and necessary training for appropriate use. Such research outcomes are not only encouraging but also inspiring. Dr. Maki and his team are pondering future research projects in which they plan to expand their focus on grasping reactions, and investigate the effects of climate on balancing and mobility. Particularly the effects of breathing cold air, psychological issues and design of handrails, footwear, clothing and mobility aids to promote safe mobility in cold weather.

Under the direction of Dr. Brian Maki , this team brings together investigators with compelling experience and backgrounds. Dr. Fernie has an unrivalled profile in technology transfer; with over 17 issued patents, he excels in the development and commercialisation of assistive devices. Dr. Maki and Dr. McIlroy are well-established investigators in balance and fall research, and in balance and movement control respectively. Dr. Liu and Dr. Fisher put forward their clinical expertise, and extend their access to various resources, clinical populations and fall prevention programs. Dr. Popovic, a new member, commits his expertise in electrical stimulation to increase balance control, and brings his background in electrical and biomedical engineering, as well as his experience in mobility and balance training.

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The Canadian Driving Research Initiative for Vehicular Safety in the Elderly (CanDRIVE)

Together, the steady increase in the number of cars on the road and the aging population has led to seniors becoming the fastest growing segment of the driving population. While seniors are among the most experienced and safe drivers on our roads, they are also at increased risk of developing cognitive and physical problems that may impair their driving ability. As evidence pertaining to the health-related factors influencing vehicular safety in seniors is limited, research efforts are important and pressing. Consequently, the CanDRIVE research program aims for the following:

  • Identify, analyse and address health-related issues associated with vehicular safety in seniors with functional and medical impairments.
  • Develop a screening tool to assess seniors' ability to continue operating a motor vehicle.
  • Investigate relevant health factors (psychosocial, cultural, language and medical/legal issues) to ensure the safety of seniors and other drivers.

Three major research themes are planned to move the team towards its goals. The first is the development of a standardised procedure that allows physicians to measure their older patients' physical and mental abilities to drive. To fulfil this task, investigators propose to identify the risk factors associated with unsafe driving by measuring and periodically re-measuring the medical status and driving performance of a national representative group of senior drivers over a number of years. The program also includes an examination of the medico-legal issues affecting the use of the developed standardised procedure by physicians, and an analysis of its risks/benefits and cost-effectiveness. In a second initiative, investigators set to identify and break the barriers to implementing a screening tool within routine primary care practice, keeping in mind the psychological and social issues affecting senior drivers and their support system. The third theme consists of developing a national network of CanDRIVE researchers through the creation of a progressive database for driving researchers in Canada, and organisation of various conferences. Also, the team plans to determine if the performance in driving stimulators and on-road evaluations is associated with the probability of future crash.

The CanDRIVE efforts have already yielded interesting outcomes. The Canadian Council of Motor Transportation Administrators officially approved the CanDRIVE initiative, providing them with latitude to achieve their goals. The group held their first research conference in January 2003, from which research priorities addressing clinical, psychosocial and legal concerns were established. A database is now available to all CanDRIVE members, a website is set up, and a newsletter is distributed. CanDRIVE's efforts are likely to lead to compelling outcomes: ensure that decisive factors for licensing are based on skills, not age, enlighten the general public's attitudes towards senior drivers, and obviously, increase the vehicular safety of all road users.

The CanDRIVE research program team brings in seven Ottawa-based resear-chers, with over 50 collaborators from coast to coast. Dr. Man-Son-Hing heads this interdisciplinary team of experts in various disciplines related to health. While Dr. Graham focuses on factors influencing clinicians' behaviours, Dr. Stiell concentrates on the implementation of regulations pertaining to clinical decisions. Dr. Wilson and Dr. Marshall's research interests include mental health of the elderly and vehicular safety respectively. Dr. Man-Son-Hing and Dr. Molnar both offer expertise in health care delivery to seniors.

The team displays a genuine enthusiasm towards, and dedication to the development and implementation of the CanDRIVE initiatives, comments Dr. Man-Son-Hing. He adds his team is always willing to assist anyone with an interest in vehicular safety for seniors.

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Genomics, Genetics and Gerontology (G3): A Multidisciplinary Team for the Study of Healthy Aging

In their investigation into healthy aging, this research team goes beyond environmental and lifestyle issues to examine the genetic factors underlying healthy aging. Various explanations transcending lifestyle choices and environmental factors justify long-term health beyond the age of 90; an individual may lack vulnerability to diseases, may have resistance to diseases, or may simply age more slowly than others. The team assumes that healthy aging involves both genetic and environmental factors, and that a variation in specific genes will generate a variety of processes that will in turn, result in healthy aging. They intend to:

  • Identify genes implicated in healthy aging and the genetic variants causing vulnerability to diseases;
  • Carry out combined analysis with these factors as predictors of health and diseases;
  • Generate new research questions and directions.

The research plan involves three groups of subjects: a group of healthy oldest old, one group of middle age individuals (40-50 years of age, not selected for health or functional status), and one group of patients with age-related diseases (cancer, type II diabetes, cardiovascular and pulmonary diseases). Investigators plan to draw candidate genes from: ongoing research projects at the Genome Science Centre in Vancouver using the model organism C.elegans, serial analysis of gene expression studies in cancer, and literature. A case control association study design was favoured by the investigators, and is to be performed in the three groups. The subjects in these groups are to be case and control in the analyses of both phenotypes of increased resistance to diseases and age-related diseases susceptibility. Results from these analyses are expected to indicate the presence of protective alleles in healthy oldest old group, and disease-predisposing alleles in the group of ill individuals.

The findings from this study will pertain to the prevention, screening, etiology, diagnosis, and treatment of many age-related diseases. For instance, the allele profiles discovered could be used as predictive markers. They may also lead to worthwhile pharmacological courses of action, as drugs could be develop to enhance biochemical pathways that contribute to health and hold back those that lead to disease. The outcomes of this study are expected to provide insight into why some individuals enjoy a superior quality of life and remain highly functional, while others fall prey to chronic diseases and decline in function.

This Vancouver-based team, led by Dr. Marco Marra , includes members with expertise in various domains related to genetics, genomics and gerontology. Dr. Marra puts forwards his expertise in bioinformatics and large scale DNA sequencing and mapping. As he is heading numerous large-scale studies, he entrusted the general organisation duties to Dr. Brooks-Wilson, a new investigator. She offers a solid background in industrial scale genotyping, human disease identification and the genetic features of Werner's syndrome. Dr. Le brings a global outlook to the overall aspects of the study along with expertise in data and sample collections and recruitment. Keeping the team on track and providing knowledge in gerontology, physiology of aging and assessment of function in elderly is Dr. Meneilly. By means of his remarkable creativity, Dr. Jones sets to design and customise bioinformatic tools and software for the team. Finally, Dr. Connors, characterised as a natural leader and seasoned medical professional, focuses on general gerontology, sample collection and ethical issues.

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Development and Evaluation of Strategies to Improve the Care of Persons with Dementia in Rural and Remote Areas

Current literature pertaining to dementia underlines the need to closely examine strategies to improve treatment programs and services for individuals with dementia and their caregivers in rural and remote areas. Incomplete and inadequate assessment services, lack of specialised personnel and programs, problems in personnel recruitment and retention and a growing need for caregiver education and support are all issues to address. With the prevalence of dementia expected to double in the next 30 years and the increasing proportion of seniors living in rural and remote areas, this research project accordingly aims to achieve the following:

  • Improve the availability of specialised personnel and services for assessment and management of dementia in rural and remote areas.
  • Enhance accessibility of programs supporting formal and informal caregivers of persons with dementia in rural and remote areas.
  • Improve acceptability of services for persons with dementia and their caregivers in rural and remote areas.

Four research projects aim to achieve these objectives. The first project involves the development, implementation and evaluation of an interdisciplinary distance consultation program for assessment and management of dementia. A comprehensive one-day streamlined assessment will be conducted in a tertiary care centre, with pre-assessment screening and follow-up via videoconference (telehealth). Also included is the development of a culturally sensitive method to assess cognitive impairments in aboriginal adults. Second, the team intends to evaluate a long-distance educational program designed for nursing aides from rural nursing homes and home care agencies, evaluating both the content and delivery method. Third, the team plans to examine health service utilisation by persons with Alzheimer Disease and related dementias in Saskatchewan and Canada, comparing rural, remote, and urban areas. In the fourth project, the investigators aim to generate hypothesis focusing on the triggers of aggressive behaviour by nursing home residents with dementia and nurse distress by conducting a secondary analysis of existing data from a national study of rural nurses.

Knowledge transfer, training and skill building are the ultimate goals of this initiative. Specialised training in dementia care is a critical issue in rural home care and nursing home settings. A strong majority of nursing aides who provide direct health care receive limited training in dementia care, and due to significant staffing shortages they are often hired despite a lack of relevant education and experience. Through this research, the team hopes to learn about the challenges rural caregivers face, and gain insight on more efficient approaches to providing continuity of care for rural seniors with dementia.

Dr. Debra Morgan gathers a team of investigators with expertise in all stages of dementia and from disciplines spanning psychology, neurology, nursing, medicine and sociology. She praises the complementary and unique skills each member brings to the project.

Dr. Morgan's previous work focused on assessment of physical and social environments for dementia care and formal and informal caregiving for persons with dementia in rural areas. Dr. Stewart has expertise in health services for seniors with dementia, and psychometric evaluation of clinical instruments used in dementia care. Dr. Crossley specialises in cognitive decline in dementia and interventions to improve cognitive functioning and quality of life, and Dr. D'Arcy in population health and social epidemiology. Dr. Biem offers his skills in clinical epidemiology, research translation, and health care delivery for chronically ill seniors. Dr. Kirk has a solid background in cognitive disorders and clinical care of dementia, while Dr. Forbes brings her expertise in home care use, evaluation of health services to rural seniors and research dissemination. Mary Ellen Andrews provides the team with insights on the nursing experience in rural and remote areas.

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Understanding, Treating and Preventing Tinnitus

Tinnitus is a phantom auditory sensation, similar to a continuous high frequency ringing that is experienced by 15% of the general population. In 1 to 2 % of the general population the sensation is chronic, leading to emotional distress and impairment in quality of life. Hearing loss resulting from noise exposure and aging are the leading causes of tinnitus, with drugs and hearing diseases accounting for a minority of cases. While effective treatments for tinnitus are yet to emerge, neuroscience research is providing important insights into the question of how tinnitus is generated when the auditory cortex is deprived of neural input by damage to the cochlea. Through this NET initiative, investigators want to understand how cochlear injuries alter auditory input to the brain, which in turn generates tinnitus sensation. More specifically, the study aims to:

  • Assess models of how cortical and subcortical brain activity is reorganised in tinnitus, and examine the role of neural plasticity in this process;
  • Create training procedures to normalise auditory cortical representations likely implicated in tinnitus, and evaluate the treatment and prevention potential of these procedures;
  • Become a clearinghouse for ideas and research pertaining to tinnitus.

The research plan involves six independent but complementary studies. The first study aims to examine changes in neuron firing patterns and tonotopic map organisation in cats following hearing loss. It also aims to look at how exposure to high-frequency sounds affects these changes. The second study sets to explore how impaired patterns of activity in auditory nerve fibres influence neural processing in the auditory system, particularly in the dorsal cochlear nucleus and the inferior colliculus. Third, investigators aim to develop a model of cortical processing in the auditory cortex after peripheral auditory damage. The fourth project focuses on the development of improved psychophysical methods for measuring tinnitus, and how they can be used in the clarification and treatment of tinnitus. The fifth study involves the development and optimisation of procedures that alleviate tinnitus for short periods of time following exposure to external sounds that match the tinnitus sensation (a phenomenon called "residual inhibition" in the tinnitus literature). And finally, the sixth study aims to examine whether short-term and long-term changes can be induced in tinnitus by procedures that are known to reorganise cortical activity in normal hearing subjects.

Activities in each study are in full swing and have already led to interesting and encouraging outcomes. Results from this research project are expected to aid in the prevention of tinnitus in individuals at risk as result of partial hearing loss, and to guide the design of treatment procedures that are beneficial for tinnitus sufferers. On a broader level, they are likely to provide insight into how the brain reorganises as a result of sensory deprivation, and other phantom phenomena such as phantom limb sensations. As for future directions, the team plans to examine more closely treatment options for tinnitus and prevention strategies for reduction of industrial noise and similar risk factors for hearing impairments.

Dr. Larry Roberts brings together this group of investigators from the University of British Columbia, University of Calgary, McMaster University, and the Rotman Research Institute in Toronto. He describes his team as congenial, supportive and energetic, with each member contributing complementary expertise and strengths that are exceptional and indispensable to the project.

Dr. Roberts' research interests include auditory neuroscience and plasticity. Dr. Eggermont is a world-acclaimed expert in auditory physiology, more specifically how the auditory cortex produces sounds. Dr. Becker and Dr. Bruce provide expertise in neural computation, particularly mathematical models of the auditory cortex and auditory periphery respectively. Dr. Ward offers his expertise in auditory psychophysics and human neural plasticity, and Dr. Pantev in cortical plasticity and sensory function.

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Health and Aging in Rural Environments

Limited evidence on healthy aging in rural communities is becoming a significant concern for the Canadian aging population, as stated in the Romanow report. In rural and remote areas, community-based care is incomplete and primary health care is challenging, as primary care providers often have to adapt their practices to the rural realities of seniors. Also, the manner in which they do so, and their attitudes and their expectations are not well documented. Also deserving of attention are differences in health services utilisation by seniors across rural communities. In response, this research program aims to:

  • Explore the differences in health services and utilisation between seniors residing in various rural areas;
  • Determine the issues and obstacles involved in the delivery of services for rural seniors and their unpaid caregivers;
  • Assess new health promotion strategies targeting rural seniors.

To achieve such goals, the research plan includes six inter-related complimentary research projects. The first step involves a systematic evaluation of the existing evidence on healthy aging in rural and remote areas, and the development of a rural health and aging researchers' network. The second project aims to examine the differences in health status and utilisation of health services by seniors across communities in Manitoba, and the role of health determinants in these differences. In the third project, investigators intend to look into medication prescribing patterns by rural physicians (number and costs of medication prescribed, improper prescribing, treatment adherence, and differences across communities). The fourth initiative focuses on attitudes and expectations of rural health care planners and providers. The fifth initiative aims to consider the health of older rural farm families. Finally, investigators intend to develop innovative strategies aiming to enhance healthy aging in rural areas, based on knowledge acquired in the first five initiatives, and evaluate their effectiveness through pilot-testing. The outcomes of this research program are expected to provide significant insights on rural health and aging, propose new lines of investigations and facilitate research translation for health care planners and providers, researchers, and rural community members. Through many of its studies, this research program addresses a clear lack of evidence regarding the issues and barriers influencing provision of care in rural areas and the differences across rural communities. This research project not only tackles an important research priority, it is expected to provide an opportunity to broaden the investigators' focus and direct their efforts towards a national research agenda.

Dr. Laurel Strain heads this team, which benefits from a good mixture of academic and applied interests in rural health issues. The team maintains a long history of collaboration with community agencies and government as it ensures the relevance of their efforts. Investigators showed enthusiasm in the projects fromthe beginning, states Dr. Strain, and brought solid experience and a level of practicality in rural health and aging research.

Dr. Strain's research focuses on rural and urban differences in health and service utilisation and support services for seniors. She also puts forward her considerable skills and experience in longitudinal aging studies. Dr. Hawranik offers her expertise of coping strategies in caregivers and senior wellness programs, and Dr. Grymonpre in medication use and pharmaceutical care for rural adults. In addition to his clinical experience, Dr. St.John brings his background in rural geriatric med-icine and epidemiology.

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Strategic Training Programs

The purpose of the CIHR Strategic Training Program is to encourage transdisciplinary, integrative health research, in part through the training of the next generation of researchers, and to increase the capacity of Canada's health research enterprise to address important research questions in all areas of health research. Trends in health research reveal the convergence of mathematics, physical sciences, social sciences and humanities, together with biological, behavioural and clinical approaches to answer important questions in health and disease. Accordingly, there is a growing demand for highly skilled and adaptable individuals who can embrace a diversity of approaches in solving complex problems and in applying solutions. The objectives of the CIHR Strategic Initiative in Health Research Training are to:

  1. Increase the capacity of the Canadian health research community, including areas where it can be demonstrated that there is a need to develop capacity;
  2. Enable recruitment and retention of highly qualified individuals from Canada and abroad to undertake health research training in Canada;
  3. Support the development of innovative, effective, transdisciplinary, and internationally competitive training programs;
  4. Engage new mentors and educators in the development and evolution of training strategies;
  5. Encourage programs that:
  • Embrace diverse research disciplines and methodological approaches to resolve major health issues and scientific challenges;
  • Integrate training and discussion on the ethical conduct of research and related ethical issues;
  • Develop and measure the individual's communication, teamwork, and leadership skills i.e. grant writing, peer review;
  • Incorporate effective research strategies that translate knowledge into practice.
  1. Interdisciplinary Training Network in Health and Aging Research
  2. Strategic Research Training Program in Communications and Social Interactions in Healthy Aging
  3. Transdisciplinary Understanding and Training on Research - Primary Health Care
  4. Training Program in Neurobiology and Behaviour

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Interdisciplinary Training Network in Health and Aging Research

Together, greater life expectancy and an aging population have given rise to a need for research capacity in health and aging. However, the numerous factors associated with healthy aging are multidimensional and multifactorial, making interdisciplinary research efforts indispensable. Faced with the scarcity of investigators with interdisciplinary research skills, the Université de Montréal, the Université Laval and the Université de Sherbrooke joined forces to created the FORMSAV training network for interdisciplinary training in health and aging research. The following are the program's objectives:

  • Expand and enhance Canadian research capacity in healthy aging by attracting the best creative minds.
  • Provide training in a core discipline and interdisciplinary research skills.
  • Provide knowledge pertaining to issues relevant to healthy aging research,as ethics, research translation etc.
  • Enhance training skills of mentors.

Leaders of the FORMSAV training network plan to optimise existing training resources and those specifically developed for the purpose of interdisciplinary research training. While favouring a holistic approach, the program offers a curriculum allowing for specialisation in a core area and training in relevant disciplines by means of internships with other mentors and workshops on interdisciplinary research. Other compulsory workshops focus on topics such as ethics, peer review, optimisation of research outcomes, research trans-lation, information dissemination and grant writing. Finally, mentors have an opportunity to take part in discussion groups and internships outside the training network in order to enhance their interdisciplinary training skills.

The FORMSAV training network was warmly received by the leaders of the various research institutes involved, and graduating trainees are sure to benefit from a worthwhile addition to their basic formation. The FORMSAV training network aims to develop and enhance Canadian research capacity in health and aging by generating researchers with indispensable and progressive skills for interdisciplinary research. Skills that will sustain and improve health services for and well-being of seniors.

Three universities are involved in the development of the FORMSAV training network, with distinguished and well-established investigators leading its efforts: Université de Montréal with Yves Joannette , Université de Sherbrooke with Hélène Payette , and Université Laval with René Verreault. By means of exceptional leadership and drive, FORMSAV now encompasses more than 70 mentors from the three French universities in the province of Québec. Also, the three training network leaders have been actively involved with the Réseau Québecois de recherche sur le vieillissement, the latter being FORMSAV's fourth partner.

FORMSAV's mentors are representing virtually all disciplines associated with healthy aging, and display strong training skills and unrelenting solidarity. Accordingly, such qualities ensure outstanding supervision and guidance for trainees.

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Strategic Research Training Program in Communications and Social Interactions in Healthy Aging

Seniors frequently experience difficulties in everyday communication activities. Since several impairments may contribute to these problems, researchers need to adopt appropriate approaches to examine communication in seniors. Taking a transdisciplinary approach is indispensable to effectively study communication and social interactions, as they are multimodal and affected by psychological, physical and socio-environmental factors. Accordingly, researchers must broaden their vision and become familiar with each of the related disciplines. Guided by this principle, this training program allows trainees to develop transdisciplinary approaches to examine communication systems and how they affect social interactions in seniors. More specifically, the training program has five objectives:

  • Provide training in one core area: hearing sciences, visual sciences, cognitive sciences, gerontology, human factors or biomedical engineering.
  • Draw trainee's attention to the importance of a transdiciplinary approach and risks involved in its absence.
  • Offer working knowledge of techniques developed by and used in related disciplines, including their strengths and weaknesses.
  • Provide experience in transdisciplinary research.
  • Train in effective research translation.

With a distinctive curriculum, this training program reinforces the importance of a transdisciplinary approach. First, trainees attend an Introductory Workshop presenting the philosophy and objectives of the training program, as well as its various opportunities. Second, trainees acquire working knowledge of assessment techniques used in related disciplines through "hands-on" modules. Trainees are required to take the modules on auditory and visual techniques, and are offered two modules on cognitive assessment and interviewing techniques. Third, mentors and trainees participate in a four-day research seminar, during which trainees present their research projects and guest speakers are invited to comment on them. Fourth, trainees spend one semester participating in transdisciplinary research projects in a discipline other than their own. And finally, the program plans to offer a web-based "Community of learners" and increased availability of graduate courses by means of web broadcasts once technical setbacks are settled.

After its first year of operation, this training program has generated remarkable interest and has been praised by its participants. It is to be expected, as it allows graduating trainees to significantly contribute to the study of communication in seniors. First, they are better equipped to translate research finding into clinical practice. Second, they benefit from more naturalistic settings to study communication in seniors at The Sheridan Elder Research Centre. Third, they gain valuable technical skills in and knowledge of related disciplines, in addition to a solid foundation in a specific discipline. Finally, they acquire lasting experience in transdisciplinary research environments and in translational research.

Dr. Bruce Schneider leads this training program, bringing together 11 mentors from across Canada excelling in various disciplines related to communications and social interactions. He characterises his group as a compelling mixture of new and well-established researchers. He speaks highly of his group's communication skills, casual nature, and willingness to learn. Mentors, in their thirst for knowledge, were even spotted at the training modules held for their trainees.

Offering expertise in audiology and speech perception are Dr. Gagné, Dr. Kunov, Dr. Pichora-Fuller and Dr. Schneider. Speaking on behalf of vision sciences are Dr. Bennett, Dr. Faubert, Dr. Scialfa and Dr. Sekuler. Also, Dr. Daneman provides expertise in memory and Dr. Spadafora in gerontology and sociology, while Dr. Li covers cognition and sensorimotor function.

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Transdisciplinary Understanding and Training on Research - Primary Health Care

Primary health care constitutes a dominant section of our health care system, yet few experts combine the clinical and scientific efforts required to appropriately investigate it. Also, the multifaceted nature of primary health care commands an interdisciplinary and integrated approach, and despite an emerging need for research, suitable transdisciplinary training opportunities are rare. Hence, the objectives of this program are to:

  • Build a critical mass of skilled, independent researchers through both student opportunity and faculty (supervisor) development;
  • Enhance transdisciplinary and interdisciplinary efforts in primary health care research.

The curriculum includes an on-site three-day symposium followed by on-line workshops and discussion groups. While trainees have a primary mentor, they can benefit from the leadership and support of other mentors in the program. The symposium and on-line workshops address topics such as interdisciplinary theory and process, research methods unique to primary health care, and the interdisciplinary experiences of mentors. The symposium aims to foster enthusiasm, discussions, resourceful relationships, material dissemination and skills for interdisciplinary research in primary health care. On-line discussion groups allow trainees to log on at their convenience and present their research projects to trainees who provide suggestions and feedback. Efforts are currently underway to have the symposium and on-line workshops accredited as electives across institutions and disciplines. This training program lends itself well to dissemination of information. For instance, all educational material will be packaged, distributed and promoted. Also, supervisors and mentors involved with the program are encouraged to teach the material in their home universities.

In the first year, the program received 50 applicants, from which 12 were selected. Graduating trainees are expected to have a solid grasp of various aspects of primary health care, namely, interdisciplinary theory and process, as well as research methods unique to primary health care research. Their access to experts in topics spanning family health, health promotion and disease prevention, mental health and delivery of integrated health care provides invaluable support to their personal research endeavours. The mentors will offer support and guidance to the trainees as needed after completion of the program until they are established in their primary health care research career. In coming years, the team expects to extend the number of core disciplines to include anthropology, pharmacy, optometry, sociology, political science, and health economics.

Dr. Moira Stewart is the principal investigator for this training program, bringing together 18 members from The University of Western Ontario, Dalhousie University and McMaster University. The mentors are educators and researchers from various disciplines relevant to primary health care.

Dr. Stewart, Dr. Brown, Dr. Burge, Dr. Harris, Dr. Hutchison, Dr. Sangster, and Dr. Weston offer expertise in family medicine. Dr. Campbell, and Dr. Vingilis put forward their backgrounds in epidemiology. Drawn from the discipline of psychology are Dr. Reid, Dr. Dozois, Dr. McGrath, Dr. Pederson, and Dr. Swartzman. Experts in nursing include Dr. DiCenso and Dr. McWilliam, and in social work, Dr. Watt.

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Training Program in Neurobiology and Behaviour

Disorders of the nervous system give rise to chronic, long-term and devastating conditions that represent an important expenditure for individuals and society. With an aging population and a steady increase in prevalence, careful and appropriate research in neuropsychiatric diseases is called for. Trends in neuroscience research reveal a shift from discipline-based research to interdisciplinary research efforts. In line with this trend, this training program offers graduate students and postdoctoral fellows a unique opportunity to study brain processes affecting behaviour within an interdisciplinary approach. The program's objectives are to:

  • Introduce trainees to the various areas of neuroscience in order todevelop appropriate research skills, and gain insight into relevant ethical, clinical and social issues;
  • Move research in neuroscience towards interdisciplinary efforts to better comprehend how the brain affects and is affected by behaviour;
  • Develop an international centre for neuroscience training.

The curriculum focuses on two principal themes, the learning brain and the aging brain, and offers various types of educational experiences. Formal course work introduces trainees to the various areas of neurosciences. Mentors and trainees participate in weekly and monthly lectures on disciplines relevant to neuroscience and their various scientific advances. The centre organises an annual extravaganza to gather all members and trainees together, to provide a venue for project presentations and discussions. Short courses offer various presentations on neuroscience topics and other necessary career skills including grant preparation, teaching, writing manuscripts and reviewing literature. These seminars provide opportunities for students to think critically about current literature, and facilitate exchange and interactions among trainees. The program also offers laboratory rotations, where trainees can appreciate the fundamentals and methodological approaches of biomedical and behavioural sciences.

The first group of trainees, expected in September 2003, are given an exciting opportunity to take part in challenging interdisciplinary research projects, while recognising the value of methodology and approaches in applied, natural and social sciences. Also, trainees have access to a variety of technical resources: imaging systems for cellular and molecular biology; facilities for mouse behavioural genetics; fMRI imaging for animal and human studies; and an updated PET imaging infrastructure. Above research skills and knowledge in pertinent disciplines, the training program aims to pass on enthusiasm and commitment towards multidisciplinary approaches to neuroscience.

Dr. Steven Vincent leads a group of 10 key mentors and close to 20 collaborators excelling in clinical settings and basic sciences, and with expertise spanning neurology, psychology, psychiatry, pharmaceutical sciences, molecular medicine, genetics and zoology. The international aspect of this team generates much excitement and brings recognition to the program.

Members of this team are either affiliated with renowned research institutes, or lead clinical research projects, clinical trials, and health care delivery studies. Dr. Vincent points out that the mentors' assets go beyond research excellence; they are outstanding teachers embracing and encouraging a multidisciplinary approach to neuroscience and harmonious communication amongst the different research groups.

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IHRT Interdisciplinary Health Research Teams

The Interdisciplinary Health Research Teams (IHRT) Program was one of the transition programs created to launch the CIHR's activities. The transition programs were intended to strengthen Canadian health research capacity, build and enhance interdisciplinary groups and research networks, increase funding opportunities, and provide research operating support. Interdisciplinary Health Research Teams consist of five or more researchers who will pool their expertise, different perspectives, and resources to address or resolve an important health research issue. The research plans of an IHRT will require an ongoing, active and substantive working relationship among researchers who would normally be associated with two or more of the biomedical, clinical, health services, or population health research sectors. IHRTs will emphasise the discovery of new knowledge, and the translation of research findings into improvements in the health of Canadians. This will be accomplished through strategies for prevention, diagnosis or treatment of illness, promotion of wellness, or improved delivery of health care and health services.

  1. The Challenge of Understanding and Meeting the Needs of Frail Older Persons in the Canadian Health Care System
  2. Respiratory Infections in Older Adults: An Interdisciplinary Approach
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The Challenge of Understanding and Meeting the Needs of Frail Older Persons in the Canadian Health Care System

Today's sporadic health care system is ill-equipped to provide the medical and social services required to properly care for the frail elderly. Health services for frail seniors are fragmented, and health care providers find it difficult to tailor services and care around the needs of this population. Also, the oldest old subgroup is the fastest growing segment of the Canadian population aged 65 and over. Hence, there is an urgent need for integrated and cost-effective health care delivery adapted to the needs and medical realities of frail seniors, such as multiple pathologies and cognitive and physiological impairments. In response, investigators aim to:

  • Document the multifaceted health status and circumstances of frail seniors;
  • Determine health services utilization patterns in frail seniors andassociated costs;
  • Examine the effectiveness of health and social care systems, intervention approaches, assistance programs, intervention methods and clinical practice.

To achieve these objectives, the team drew up an extensive research plan, comprising numerous studies and components. To accomplish the first objective, investigators set to sketch cognitive impairments and functional disabilities associated with frailty over time, while considering relevant risk factors and socio-economic and psychosocial issues. Various projects come into play to attain the second objective. Researchers intend to profile service utilization, costs and needs of frail seniors and their caregivers, to then examine how they all evolve together over time. Also, investigators propose to develop and evaluate tools to assess interventions and services in terms of cost/utilization, access and effectiveness. To reach the third objective, investigators plan to evaluate services, interventions and models that were examined and identified in research activities under the first and second objectives.

Efforts have already generated compelling results, and are expected to provide significant insights into the treatment, management and prevention of frailty. Anticipated outcomes include identification of the mechanisms for both prevention and reversal of factors leading to frailty. For frail seniors, findings from this project will likely lead to enhanced quality of life, cost-effective solutions for health care delivery, and effective interventions to prevent or delay risk factors underlying frailty.

Under the leadership of Dr. Francois Béland , this extensive team involves 26 researcher and nine collaborators drawn from a diversity of disciplines. They include, but are not limited to, health services, population and community health, geriatric medicine, nursing and rehabilitation. The team also includes government researchers, public health managers and representations from a variety of relevant agencies and private organisations. Dr. Béland speaks highly of his team's international implications, and of its constructive and co-operative nature, facilitating exchanges of ideas.

This IHRT initiative falls under the umbrella of the Solidage Research Group. The group was introduced in 1999 and is based at the Lady Davis Institute for Medical Research, Jewish General Hospital in Montreal. The group aims to support efforts and advance research on integrated services for the frail elderly.

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Respiratory Infection in Older Adults: An Interdisciplinary Approach

Respiratory infections are one of the most important health threats to Canadians, most of all for seniors. In fact, numerous reports recognise research on respiratory infections in seniors as an important priority. The following research project aims to determine the determinants of health contributing to the burden of respiratory infections in seniors. More specifically, its objectives are to:

  • Understand the determinants of community-acquired respiratory infections in seniors, in order to provide information relevant to seniors health;
  • Assess the use of health services for respiratory infections in both the community and long-term care facilities;
  • Evaluate innovative strategies for optimising management of respiratory infections in long-term care facilities to, in turn, improve the health care system's response to this issue;
  • Develop partnerships between relevant groups of researchers and key stakeholders.

The research plan favours a determinants of health approach, which distinguishes it from conventional biomedical methods used in investigating infectious diseases. In their approach, these investigators bring together biomedical, behavioural, environmental and social perspectives in the study of respiratory infections. With a special focus on influenza and community-acquired pneumonia, the research plan encompasses seven distinct research projects to study the role of health determinants in pneumonia in seniors. More specifically, the role that socio-economic status, ethnicity, nutrition, air pollution, crowding, immunity and environmental tobacco smoke have in the risk, etiology and health outcome of respiratory infections. The research plan also includes an evaluation of a clinical pathway aiming to improve management of pneumonia in long-term care facilities. Additionally, seniors, family caregivers and health care providers have an opportunity to provide qualitative feedback through semi-structured interviews and focus groups. Finally, investigators intend to examine the use of diagnostic tests for lower respiratory tract infections in residential long-term care facilities, and the effect of influenza on admissions to hospital in seniors with congestive heart failure.

Dr. Loeb affirms with enthusiasm that his research project is well underway, though their course of action was temporary brought to a halt in spring 2003 due to the Toronto SARS outbreak. Altogether, the team expects the results to lead to advances in health promotion strategies, specifically relating to immunization and nutrition, and strategies to reduce complications of respiratory infections in seniors. Outcomes are also expected to provide insights on strategies to improve utilisation of health services and reduce personal risks. Furthermore, findings will likely provide guidance to environmental and public health agencies formulating policies affecting the health of Canadian seniors.

Dr. Mark Loeb is heading this dynamic and highly interactive group, assembling new investigators and international figures in respiratory infection research. In his opinion, one of the group's most valuable assets is its ability to think outside the box in its examination of respiratory infections in seniors, which brought about interesting spins to the research projects.

The team includes 22 members and 11 collaborators from across Canada and the United States. Their expertise spans epidemiology, microbiology, bioethics, geriatric medicine, pharmacology, nutrition, biostatistics, sociology, program evaluation, infections in long-term care facilities and so on. The members are based in Hamilton, Toronto, Laval, Winnipeg, Calgary, and Halifax.

Appendix on Team Members and Contacts

Modified: 2004-04-11

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Important Notices