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BackgroundPatient engagement in research priority-setting is intended to democratize research and increase impact. The objectives of the Canadian Frailty Priority Setting Partnership (PSP) were to engage people with lived or clinical experience of frailty, and produce a list of research priorities related to care, support, and treatment of older adults living with frailty.MethodsThe Canadian Frailty PSP was supported by the Canadian Frailty Network, coordinated by researchers in Toronto, On-tario and followed the methods of the James Lind Alliance, which included establishing a Steering Group, inviting partner organizations, gathering questions related to care, support and treatment of older adults living with frailty, processing the data and prioritizing the questions.ResultsIn the initial survey, 799 submissions were provided by 389 individuals and groups. The 647 questions that were within scope were categorized, merged, and summarized, then checked against research evidence, creating a list of 41 unanswered questions. Prioritization took place in two stages: first, 146 individuals and groups participated in survey and their responses short-listed 22 questions; and second, an in-person workshop was held on September 26, 2017 in Toronto, Ontario where these 22 questions were discussed and ranked.ConclusionResearchers and research funders can use these results to inform their agendas for research on frailty. Strategies are needed for involving those with lived experience of frailty in research.

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A more pro-active stance towards cognitive decline of vascular etiology is warranted, with some evidence supporting both prevention and symptomatic therapy.

Objective To provide family physicians an updated approach to the diagnosis of Parkinson disease (PD). Sources of informationPublished guidelines on the diagnosis and management of PD were reviewed. Database searches were conducted to retrieve relevant research articles published between 2011 and 2021. Evidence levels ranged from I to III.Main message Diagnosis of PD is predominantly clinical. Family physicians should evaluate patients for specific features of parkinsonism, then determine whether symptoms are attributable to PD. Levodopa trials can be used to help confirm the diagnosis and alleviate motor symptoms of PD. "Red flag" features and absence of response to levodopa may point to other causes of parkinsonism and prompt more urgent referral.This article is eligible for Mainpro+ certified Self-Learning credits. To earn credits, go to https://www.cfp.ca and click on the Mainpro+ link. This article has been peer reviewed.

How can I best manage insomnia in older patients?This article is eligible for Mainpro+ certified Self-Learning credits. To earn credits, go to www.cfp.ca and click on the Mainpro+ link.

How can we best care for patients with acute illness in a hospital setting who also have dementia? Bottom lineFamily physicians play an important role in hospital care, particularly in smaller communities. Canada's hospitals are buckling under the rising numbers of patients with dementia, but many hospitals and health policy makers seem unaware. Acute illness and hospitalization are challenging for people with dementia, as hospitals are not well structured to optimally care for these patients, resulting in negative outcomes for patients and impacting our limited hospital capacity. Evidence• Canada has one of the lowest numbers of hospital beds per capita of the Organisation for Economic Co-operation and Development nations. 1 • Seniors with dementia are 1.5 times more likely to experience harm in hospital and have twice the hospital length of stay (LOS) compared with seniors without dementia. 2 • Almost half of alternate level of care (ALC) days in Canada are now related to dementia. 2This article is eligible for Mainpro+ certified Self-Learning credits. To earn credits, go to www.cfp.ca and click on the Mainpro+ link.

Who and when should clinicians screen for cognitive impairment, and what tests should they use?