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RésuméLes difficultés cognitives consécutives aux troubles neurocognitifs majeurs (TNCM) engendrent des enjeux dans la réalisation d’activités de la vie quotidienne. Ce projet visait à identifier auprès des proches aidants et des intervenants des situations nécessitant des méthodes optimisant l’apprentissage pour faciliter l’engagement de personnes vivant avec un TNCM dans leurs activités de la vie quotidienne. Des entrevues individuelles semi-dirigées, d’une durée de 60 à 90 minutes, ont été menées auprès de proches aidants et d’intervenants. Les résultats montrent que les activités quotidiennes et domestiques sont notamment affectées par les difficultés à repérer ou à utiliser les objets, à garder en tête la tâche en cours, à mettre en séquences des étapes, à ne pas se laisser distraire par autre chose et à constater ses difficultés pour s’y adapter. Les proches aidants souhaitent du soutien dans l’application des méthodes optimisant l’apprentissage pour contribuer au maintien de l’autonomie des personnes vivant avec un TNCM.

Résumé:Les difficultés cognitives consécutives aux troubles neurocognitifs majeurs (TNCM) engendrent des enjeux dans la réalisation d'activités de la vie quotidienne. Ce projet visait à identifier auprès des proches aidants et des intervenants des situations nécessitant des méthodes optimisant l'apprentissage pour faciliter l'engagement de personnes vivant avec un TNCM dans leurs activités de la vie quotidienne. Des entrevues individuelles semi-dirigées, d'une durée de 60 à 90 minutes, ont été menées auprès de proches aidants et d'intervenants. Les résultats montrent que les activités quotidiennes et domestiques sont notamment affectées par les difficultés à repérer ou à utiliser les objets, à garder en tête la tâche en cours, à mettre en séquences des étapes, à ne pas se laisser distraire par autre chose et à constater ses difficultés pour s'y adapter. Les proches aidants souhaitent du soutien dans l'application des méthodes optimisant l'apprentissage pour contribuer au maintien de l'autonomie des personnes vivant avec un TNCM.Abstract:Cognitive difficulties resulting from major neurocognitive disorders generate challenges in the performance of activities of daily living. This project aimed to identify, with family caregivers and health professionals, situations requiring methods to optimize learning so as to facilitate the involvement of people living with a major neurocognitive disorder in their activities of daily living. Semi-structured one-on-one interviews, lasting 60 to 90 minutes, were conducted with family caregivers and healthcare professionals. The results show that daily and domestic activities are particularly affected by difficulties in locating or using objects, keeping in mind the task in progress, sequencing steps, not being distracted by something else, noticing their difficulties and adapting to them. Family caregivers would like to have access to support in order to apply learning strategies to help people living with a major neurocognitive disorder to maintain their independence.

This study aimed to explore effects of a two-session Educational Person-centered Intervention on Compensatory Strategies (EPICS) designed to increase knowledge of strategies, reduce barriers, and improve accomplishment of meaningful leisure activities (MLA) and well-being in older adults living with frailty. Using a double-blind concurrent mixed-methods design, 36 community-dwelling older adults were assigned to the experimental (EPICS) or control (friendly visits) group through a covariate adaptive randomization. Questionnaires were administered prior to the intervention and ± two months post-intervention. Individual semi-structured interviews conducted at the end of the study furthered the authors’ understanding of the effects of the intervention. Quantitative analysis revealed significant increase in knowledge of compensatory strategies and reduction of barriers for the experimental group only. Qualitative analysis (purposive sample, n= 8) showed enhanced well-being and self-activation. Discussions about barriers to accomplishment may be sufficient to trigger self-activation in someolder adults living with frailty to improve participation in MLA and well-being.

Résumé:Cette étude documente l'offre de services et les enjeux vécus par les organismes communautaires soutenant les personnes aînées et les proches aidants au Québec lors de la pandémie de COVID-19, ainsi que les stratégies prometteuses pour adapter les services dans ce contexte. Un sondage électronique, incluant des questions ouvertes et fermées, fut réalisé en juillet 2020. Près des trois quarts des 307 répondants (71,4 %) ont déclaré avoir maintenu leurs services au moins partiellement pendant la période de confinement, et une majorité d'entre eux (85,3 %) ont adapté leurs services. Parmi les principaux défis rencontrés se trouvent les difficultés à dépister et à soutenir les personnes les plus vulnérables (54,8 %), à gérer les risques pour la santé des usagers (60,2 %) et à recruter des bénévoles (59,5 %). Les stratégies prometteuses identifiées incluent: des stratégies pour rejoindre les aînés et comprendre leurs besoins (p. ex. appels téléphoniques systématiques) ainsi que des interventions directes pour les soutenir (p. ex. activités favorisant les liens sociaux), la mise en œuvre de mesures de prévention et protection, l'accès et l'utilisation de technologies, la gestion des ressources humaines (p. ex. recrutement de nouveaux bénévoles), la recherche de soutien financier pour l'organisation, le développement de partenariats intersectoriels (p. ex. cellule de crise multisectorielle), et la promotion d'une vision positive des personnes aînées. L'intégration des perspectives intersectorielles des différents acteurs concernés pourrait favoriser l'identification de solutions pérennes et transférables à d'autres crises pour répondre aux besoins des personnes aînées.Abstract:This study documented the provision of services and issues experienced by community organizations supporting older adults and caregivers in the province of Quebec during the coronavirus disease (COVID-19) pandemic, as well as promising strategies to adapt the provision of services in this context. A cross-sectional electronic survey using open- and closed-ended questions was conducted in July 2020. Almost three-quarters of the 307 respondents (71.4%) reported having maintained services at least partially throughout the lockdown, and the majority (85.3%) adapted their services. Among key challenges, participants reported difficulties identifying and supporting older adults at greater risk of vulnerability (54.8%), managing health risks for service users (60.2%), and recruiting volunteers (59.5%). Promising strategies included strategies to reach out to older adults and understand their needs (e.g., systematic phone calls) in addition to direct interventions supporting them (e.g., activities promoting social ties); implementing prevention and protection measures; accessing and using technologies; human resources management (e.g., recruiting new volunteers); finding financial support for their organization; developing intersectoral partnerships (e.g., multisectoral crisis cell); and promoting a positive view of older adults. The integration of multiple perspectives from different stakeholders may help identify strategies potentially transferable to other crises in order to meet older adults' needs.

AbstractThis study documented the provision of services and issues experienced by community organizations supporting older adults and caregivers in the province of Quebec during the coronavirus disease (COVID-19) pandemic, as well as promising strategies to adapt the provision of services in this context. A cross-sectional electronic survey using open- and closed-ended questions was conducted in July 2020. Almost three-quarters of the 307 respondents (71.4%) reported having maintained services at least partially throughout the lockdown, and the majority (85.3%) adapted their services. Among key challenges, participants reported difficulties identifying and supporting older adults at greater risk of vulnerability (54.8%), managing health risks for service users (60.2%), and recruiting volunteers (59.5%). Promising strategies included strategies to reach out to older adults and understand their needs (e.g., systematic phone calls) in addition to direct interventions supporting them (e.g., activities promoting social ties); implementing prevention and protection measures; accessing and using technologies; human resources management (e.g., recruiting new volunteers); finding financial support for their organization; developing intersectoral partnerships (e.g., multisectoral crisis cell); and promoting a positive view of older adults. The integration of multiple perspectives from different stakeholders may help identify strategies potentially transferable to other crises in order to meet older adults’ needs.

AbstractOlder persons experiencing a longer length of stay (LOS) or delayed discharge (DD) may see a decline in their health and well-being, generating significant costs. This review aimed to identify evidence on the impact of cognitive impairment (CI) on acute care hospital LOS/DD. A scoping review of studies examining the association between CI and LOS/DD was performed. We searched six databases; two reviewers independently screened references until November 2019. A narrative synthesis was used to answer the research question; 58 studies were included of which 33 found a positive association between CI and LOS or DD, 8 studies had mixed results, 3 found an inverse relationship, and 14 showed an indirect link between CI-related syndromes and LOS/DD. Thus, cognitive impairment seemed to be frequently associated with increased LOS/DD. Future research should consider CI together with other risks for LOS/DD and also focus on explaining the association between the two.

RÉSUMÉ:Chez les personnes âgées, la durée de séjour prolongée (DSP) à l'hôpital et le report de congé (RC) peuvent contribuer à la dégradation de l'état de santé et du bien-être, et engendrer des coûts importants. Cette recension de la littérature visait à déterminer si les troubles cognitifs ont un impact sur la DSP et le RC en contexte de soins hospitaliers aigus. Une revue de portée a été réalisée et six bases de données ont été consultées jusqu'en novembre 2019. Deux réviseurs ont examiné les articles de façon indépendante. Une synthèse narrative a été utilisée pour répondre à la question de recherche et 58 études ont été retenues. Parmi celles-ci, 33 études ont mis en évidence une association positive entre les déficits cognitifs et la DSP ou le RC, huit études ont présenté des résultats mitigés et trois, une relation inverse. Un lien indirect entre des syndromes associés aux déficits cognitifs et la DSP ou le RC a été évoqué par 14 études. Ainsi, les troubles cognitifs sont souvent liés à une augmentation de la durée de séjour ou au report du congé. Les recherches futures devraient considérer les effets des troubles cognitifs simultanément à d'autres facteurs associés à la DSP ou au RC sur la prolongation des soins hospitaliers, pour clarifier l'association entre ces deux variables.ABSTRACT:Older persons experiencing a longer length of stay (LOS) or delayed discharge (DD) may see a decline in their health and well-being, generating significant costs. This review aimed to identify evidence on the impact of cognitive impairment (CI) on acute care hospital LOS/DD. A scoping review of studies examining the association between CI and LOS/DD was performed. We searched six databases; two reviewers independently screened references until November 2019. A narrative synthesis was used to answer the research question; 58 studies were included of which 33 found a positive association between CI and LOS or DD, 8 studies had mixed results, 3 found an inverse relationship, and 14 showed an indirect link between CI-related syndromes and LOS/DD. Thus, cognitive impairment seemed to be frequently associated with increased LOS/DD. Future research should consider CI together with other risks for LOS/DD and also focus on explaining the association between the two.

Leisure participation may promote cognitive health in older adults who have had a stroke. It is important to provide them with the appropriate tools and resources in order to enable them to engage in these activities. The objective of this study is to identify the educational needs of older adults who have had a stroke in order to support their participation in leisure activities that promote cognitive health. Convergent mixed-methods design was used, with the emphasis on qualitative data, and involving semi-structured interviews with 20 people aged 60 or older who have had a stroke and live at home. The results showed that the profile of participation in leisure and the level of met and unmet needs vary among participants. One of the main needs concerns long-term follow-up and support to pursue personal goals. Preferences include tools and resources promoting active involvement, interactions, and opportunities for choice and control. These results may guide the development of a leisure education program for this population at high risk of cognitive decline.

Description Plusieurs ergothérapeutes contribuent à l’évaluation de l’aptitude à prendre soin de sa personne et à gérer ses biens, mais peu de balises encadrent cette pratique auprès d’adultes ayant subi un traumatisme craniocérébral (TCC).But Cette étude explorait la contribution du Profil des activités instrumentales (PAI) à la documentation de l’aptitude suite à un TCC.Méthodologie La réalisation des tâches du PAI par un homme de 46 ans (ML) ayant été déclaré inapte suite à un TCC sévère a été comparée à celle de huit participants témoins (âge moyen 49,3 ± 4,2 ans). Les scores au PAI, les comportements observables, et les verbalisations ont été comparés en utilisant des statistiques descriptives (moyennes et écarts-types) et des analyses qualitatives.Résultats Le niveau d’indépendance de ML est inférieur à celui des témoins pour sept des huit tâches du PAI (p< 0,05), notamment pour préparer un repas chaud et faire un budget. ML se distingue par la généralisation de ses difficultés à plusieurs tâches et de la difficulté à critiquer les résultats obtenus.Conséquences Le PAI pourrait être utilisé lors d’une évaluation fonctionnelle visant à documenter l’aptitude.

ABSTRACTWestern societies currently face the aging of their populations. New challenges are experienced by health professionals who are involved in competency assessment that may necessitate a public guardianship. This assessment is complex and its consequences are significant. The Competency Assessment Tool (CAT) can be used to provide a rigorous, objective and ethical evaluation by an interdisciplinary team. The purpose of this study was to validate the CAT. To do this, a Delphi study was conducted among 33 experts from five professions (social worker, occupational therapist, physician, neuropsychologist and nurse), working in seven administrative regions of Quebec. An expert consensus on the content of the CAT was obtained in the first round of consultation. Thus, this study has validated an assessment and decision-making process (CAT) designed for health and social professionals. This decision model can guide the competency assessment of the ability of persons with cognitive impairment to take care of themselves and to manage their finances. Further studies will be necessary to support use of the CAT in practice

AbstractThe accelerated aging of the Canadian population is a recognized fact and leads to an increasing number of seniors with cognitive impairments (Curateur public du Québec, 2010a). This has a definite impact on health professionals who have to assess their competency to live independently and manage their finances. This decision, which has important consequences for the person, must be based on an objective and rigorous assessment. The purpose of this paper is to analyse the available tools, both in the scientific literature and in clinical settings, to better document the various components to assess seniors’ competency to live independently and manage their finances. The goal is to help practitioners who work with older people with cognitive impairments to accurately assess their ability to manage themselves and their property. A review of the relevant literature and training available, as well as three group consultations, showed that there is no consensus about the tools used to assess the capacity to take care of oneself and one’s property. Additional studies are thus needed to fill the gap in knowledge about specific tools used to assess competency.

Abstract:The accelerated aging of the Canadian population is a recognized fact and leads to an increasing number of seniors with cognitive impairments (Curateur public du Québec, 2010a). This has a definite impact on health professionals who have to assess their competency to live independently and manage their finances. This decision, which has important consequences for the person, must be based on an objective and rigorous assessment. The purpose of this paper is to analyse the available tools, both in the scientific literature and in clinical settings, to better document the various components to assess seniors’ competency to live independently and manage their finances. The goal is to help practitioners who work with older people with cognitive impairments to accurately assess their ability to manage themselves and their property. A review of the relevant literature and training available, as well as three group consultations, showed that there is no consensus about the tools used to assess the capacity to take care of oneself and one’s property. Additional studies are thus needed to fill the gap in knowledge about specific tools used to assess competency.Abstract:Le vieillissement accéléré de la population canadienne est un fait bien documenté, qui amène un accroissement du nombre de personnes âgées atteintes de déficits cognitifs (). Cette situation peut avoir un impact sur le travail des professionnels de la santé et des services sociaux. Ils seront de plus en plus appelés à se prononcer sur l’aptitude des personnes âgées à prendre soin de leur personne et à gérer ses biens. Cette décision comporte des conséquences importantes sur celle-ci. Elle se doit de reposer sur une évaluation objective et rigoureuse. Le but de cet article est de recenser les outils et méthodes d’évaluation disponibles ainsi que ceux utilisés par les professionnels de la santé et des services sociaux pour mieux documenter les différentes composantes à évaluer. À cette fin, une recension des écrits scientifiques et un inventaire des formations offertes au Québec sur ce sujet ont été réalisés. Par ailleurs, trois groupes de consultation ont aussi exploré cette thématique. Suite à l’analyse de ces données, il ressort qu’il n’y a pas de consensus sur les outils utilisés pour documenter la capacité à prendre soin de sa personne et à gérer ses biens. Des études supplémentaires s’avèrent nécessaires pour combler le manque d’outil spécifique à l’évaluation de l’aptitude.

The article reports on the development of IDÉO information technology tool at the Université Laval in Quebec to foster collaboration among students and enables the teaching team to monitor their progress closely. It outlines methods used in the integration of the tool application into a teaching process. It shows that the application offers several advantages such as focused learning, enhanced students' independence, and consistent teaching methods.