Search

Permanent supportive housing (PSH) is the main approach advocated in Western countries for eradicating homelessness. Considering that PSH residents are not a homogeneous group and that their quality of life (QoL) and community integration (CI) might differ in this setting, improving our understanding of these residents' profiles may help stakeholders formulate informed recommendations to improve PSH. This study identified PSH resident profiles based on their QoL, CI, and sociodemographic and clinical characteristics and associated these profiles with housing features and service use. A total of 308 PSH residents were recruited in Montreal (Canada) in 2020–2022. Structured interviews were conducted. PSH resident profiles were produced with cluster analysis and subsequently compared using chi‐square, Fisher's, and t‐tests, taking into account housing features and service use. Three PSH resident profiles were found. Profile 1 residents (22% of the sample) had low QoL and CI, were younger, and had major social and health issues and unmet needs. Showing moderate QoL and CI, Profile 2 residents (27%) were more educated, had little foster care history, were older on their first homelessness episode, and had few co‐occurring MD‐SUD. Profile 3 residents (51%) had the best QoL and CI and mostly included men with little education, affected by co‐occurring MD‐SUD and satisfied with services. More intensive housing support and care coordination may be recommended for Profile 1 PSH residents in response to their diverse needs. Work integration may be beneficial to Profile 2 residents, with programs such as Individual Placement and Support, along with increased rehabilitation activities. A better integration of MD‐SUD treatments may be promoted for Profile 3 residents. Considering most PSH residents had multiple health issues and unmet needs, satisfaction with care could be monitored better, as it was found to be a key variable in measuring care adequation. [ABSTRACT FROM AUTHOR]

Introduction: Physical activity (PA) and exercise (EX) participation rates have not been increasing among older adults, with many not meeting recommended guidelines. This qualitative descriptive study examined factors influencing engagement in PA within and outside an older adult fitness club context, using self-determination theory (SDT). Methods: Thirty-seven community-dwelling adults 65 years and older participated in focus groups or telephone interviews. Two researchers independently coded and analyzed transcript data inductively and deductively using SDT. Results: Two broad themes, The Spectrum of Motivating Factors and Facilitators and Barriers, and nine sub-themes, Physical Activity and Exercise Brings Me Joy; Meaningful Personal Impetuses; I Get Active with a Little Help from my Spouse and Others; I See Changes and Improvements (Theme 1); I Can Do This; Connections and Sense of Belonging; I Cannot Do This; Setting, Environment, and People Supports; and Pragmatics (Theme 2), emerged from the data. All participants discussed several motivating factors: enjoyment, managing health conditions, being held 'to account' by others, opportunities for socialization, and seeing improvements in health and well-being. A lack of supportive environments, knowledgeable staff and suitable settings and programs were cited as barriers by participants who were not older adult fitness club members. Discussion: Factors along the extrinsic to intrinsic regulation continuum facilitated or hindered community-dwelling older adults to engage in and sustain PA within and outside an older adult fitness club context. The findings underscore the need for programs, settings, environments, and related components to be expressly older-adult-tailored to enhance motivation through competence, autonomy, and relatedness support for maximal engagement and participation in PA or EX. [ABSTRACT FROM AUTHOR]

Worldwide, the community transition process away from institutions has increased in the past 30–50 years among persons with severe intellectual and developmental disabilities. This process, also known as "deinstitutionalization", could potentially impact problem behaviors and communication. This study examined the impacts of community transitions on behavioural and communication outcomes in Canadians with intellectual and developmental disabilities. Data were collected using the Comprehensive Health Assessment Program and medical chart reviews. Descriptive, aggregate-level, and individual-level analyses were conducted for 32 adults who transitioned to community living. Descriptive analyses and the McNemar Chi-Square Test were conducted. Following community transitions, the study group experienced a significant decrease in problem behaviours and changes in communication. The study findings suggest that deinstitutionalization could provide effective strategies for addressing problem behaviors and fostering improvements in communication, promoting the well-being and quality of life of persons with intellectual and developmental disabilities. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Oncology Nursing Journal is the property of Pappin Communications and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: We sought to identify innovative navigation programs across Canadian jurisdictions that target their services to individuals affected by life-limiting illness and their families, and articulate the principal components of these programs that enable them to address the needs of their clients who are living in the community. Methods: This realist evaluation used a two-phased approach. First, we conducted a horizon scan of innovative community-based navigation programs across Canadian jurisdictions to identify innovative community-based navigation programs that aim to address the needs of community-dwelling individuals affected by life-limiting illness. Second, we conducted semi-structured interviews with key informants from each of the selected programs. Informants included individuals responsible for managing and delivering the program and decision-makers with responsibility and/or oversight of the program. Analyses proceeded in an iterative manner, consistent with realist evaluation methods. This included iteratively developing and refining Context-Mechanism-Outcome (CMO) configurations, and developing the final program theory. Results: Twenty-seven navigation programs were identified from the horizon scan. Using specific eligibility criteria, 11 programs were selected for subsequent interviews and in-depth examination. Twenty-three participants were interviewed from these programs, which operated in five Canadian provinces. The programs represented a mixture of community (non-profit or volunteer), research-initiated, and health system programs. The final program theory was articulated as: navigation programs can improve client outcomes if they have supported and empowered staff who have the time and flexibility to personalize care to the needs of their clients. Conclusions: The findings highlight key principles (contexts and mechanisms) that enable navigation programs to develop client relationships, personalize care to client needs, and improve client outcomes. These principles include staff (or volunteer) knowledge and experience to coordinate health and social services, having a point of contact after hours, and providing staff (and volunteers) time and flexibility to develop relationships and respond to individualized client needs. These findings may be used by healthcare organizations – outside of navigation programs – to work towards more person-centred care. [ABSTRACT FROM AUTHOR]

This paper reports on and synthesizes new research that examines how a collaborative community response can promote successful aging in place for older adults with hoarding behaviour. Through interviews with older adults with hoarding behaviour, who used a particular community support and a focus group interview with members of the community collaborative that directed supports for this population, our findings suggest that there were valuable outcomes for both groups. These older adults with hoarding behaviour were able to remain in their own homes, their safety was enhanced, their sense of isolation was minimized, empowerment was fostered, and they gained valuable insight into their behaviour. The members of the community collaborative were able to access the expertise of other professionals, maximize their own expertise, and they generated an enhanced understanding of the experience of older adults living with hoarding behaviour in Edmonton. This study is a significant addition to the much too sparse literature about the community planning needs of older adults with hoarding behaviour. It offers knowledge that is integral to theories and principles of better aging in place but attempts to translate this into practice. [ABSTRACT FROM AUTHOR]

This study aimed to describe how occupational therapists evaluate older adults with cognitive impairments. A descriptive qualitative study design was used. Four focus groups were conducted with 16 occupational therapists working with cognitively impaired older adults in institutional and community care settings. An inductive thematic analysis of the content of the interviews was applied. Occupational therapists described a three-stage assessment process that was predominantly occupation-based, linear and iterative: (a) gathering information from the older adult, their care network and family members to plan the assessment, (b) assessing cognitive impairment and occupational performance using non-standardized observations and standardized tests, and (c) applying clinical reasoning to predict further performance issues and safety. Despite using a predominantly occupation-based assessment process, occupational therapists reported a lack confidence to predict safety. Occupational therapists may require additional knowledge, skills and tools to support them in assessing older adults with cognitive impairments. [ABSTRACT FROM AUTHOR]

Background: This article describes the development and refinement of a component of a first-year nursing course called 'Theoretical perspectives in nursing care: complexities in seniors care'. Initially developed in 2020 in response to the pandemic restrictions and guided by the philosophy of personcentredness and person-centred practice, a senior mentorship programme called 'Engaging with your senior mentor in the community' has become an important element of the broader theoretical course. Aim: To report on the experiences of older persons living in the community who volunteered to be mentors to first-year bachelor of nursing students, and explain how their experiences informed personcentred quality improvements for future courses. Methods: Appreciative inquiry principles guided the study. Qualitative descriptive design methods -- online surveys and focus groups -- were employed to evaluate the senior mentorship initiative. Thematic analysis was performed to identify themes that described what the experience of participating in the initiative was like from the perspective of the senior mentors themselves. Findings: Our analysis identified five themes: (a) sharing; (b) contributing; (c) listening; (d) selfreflecting; and (e) communicating expectations. Conclusion: Sharing wisdom informed by lived experience can be a rewarding part of ageing. Senior mentors believed they had contributed in a meaningful way to the student nurses' learning. Implications for practice: • This article reaffirms that older persons are keen to participate in education initiatives • Insights from the senior mentors will inform educators in health and social sciences who want to incorporate the voices of older persons in their classroom and practice teaching • Older persons should be considered potential partners who can help educators develop a culture of person-centredness to help students prepare to appreciate the older persons in their care [ABSTRACT FROM AUTHOR]

Objectives: Increasing numbers of older people are living longer, often alone, in their own homes. Services and products that enable older people to remain safely in their own homes are required. The My Smart Home project recruited 30 community-dwelling people aged 65+ to co-design a package of technology to address their individual goals for safety and security at home. The technology package, up to the value of $4000, included installation of health monitoring, communication and entertainment devices, and security alarms, with 6 hours of technology coaching. Methods: Participants completed the Personal Wellbeing Index (PWI), the Australian Quality of Life-8 Dimensions (AQoL-8D) and the Canadian Occupational Performance Measure (COPM) at baseline, and after 4 weeks' use of the technology package. Semi-structured interviews were also used to qualitatively understand the challenges, enablers and outcomes of the project with respect to safety and security in the home. Results: Significant improvements in PWI (p < 0.01), AQoL-8D (p < 0.001) and COPM for goal performance (p < 0.001) and goal satisfaction (p < 0.001) were reported. Participants also reported feeling safer and more secure in their own homes. Common barriers to adoption of technology, cost, integration with already-owned technology and lack of confidence were overcome with this technology and coaching package. Conclusions: An individualised package of technology, with coaching, that supports older people to realise their personal goals with technology resulted in improved well-being, quality of life and sense of safety and security in community-dwelling older people. Ultimately, this should support a longer and better quality of life at home. [ABSTRACT FROM AUTHOR]

Since the onset of the COVID-19 pandemic, community-dwelling people living with dementia and their family caregivers have experienced many challenges. The unanticipated consequences of public health measures have impacted these families in a myriad of ways. In this interpretive policy analysis, which used a longitudinal, qualitative methodology, we purposively recruited 12 families in British Columbia, Canada, to explore the impacts of pandemic public health measures over time. Semi-structured interviews were conducted every 3 months and participants completed diary entries. Twenty-eight interviews and 34 diary entries were thematically analyzed. The findings explore ways that families adopted and adapted to public health measures, loss of supports, both formal and informal, and the subsequent consequences for their mental and physical well-being. Within the ongoing context of the pandemic, as well as potential future wide-spread emergencies, it is imperative that programs and supports are restarted and maintained to avoid further harm to these families. [ABSTRACT FROM AUTHOR]

Contact!Unload , a research-based theatre production, portrays veterans experiencing mental health challenges and overcoming them through therapeutic enactment. It was performed eight times by veteran performers in 2017 for audiences in two Canadian cities comprised of civilians and military-connected personnel and their families (n = 525). Drawing upon qualitative and quantitative data sources, this paper evaluates the immediate and longer-term impacts of Contact!Unload as a knowledge translation intervention for audience members. Our findings suggest that the performance: 1) improved knowledge of mental health concerns and symptoms that some veterans experience when transitioning to civilian life, 2) increased knowledge of the need for mental health supports and care for veterans, 3) sustained impacts on awareness and knowledge six months after the play and 4) sparked dialogue and actions after the show for some audience members. Moreover, theatre was seen as a powerful medium to engage audience members both cognitively and affectively in the topic. Research-based theatre has significant potential as a knowledge translation intervention for mental health topics. The work also points to the untapped potential of using RbT to engage audience members in a mental health literacy intervention. Future work is needed to study how to effectively combine research-based theatre with intervention design frameworks and other mental health literacy interventions. • Research-based theatre (RbT) is an effective method for knowledge translation. • The embodied experience of theatre bolsters empathy and receptivity to learning. • Short and longer-term cognitive and affective impacts for audiences were achieved. • RbT can also shift social responses to and professional practices in mental health. • RbT holds untapped potential as a mental health literacy intervention. [ABSTRACT FROM AUTHOR]

Background: Older adults with multiple chronic conditions (MCC) rely heavily on caregivers for assistance with care. However, we know little about their psychosocial experiences and their needs for support in managing MCC. The purpose of this study was to explore the experiences of caregivers of older adults living in the community with MCC. Methods: This qualitative study was a secondary analysis of previously collected data from caregivers in Ontario and Alberta, Canada. Participants included caregivers of older adults (65 years and older) with three or more chronic conditions. Data were collected through in-depth, semi-structured interviews. Interview transcripts were coded and analyzed using Thorne's interpretive description approach. Results: Most of the 47 caregiver participants were female (76.6%), aged 65 years of age or older (61.7%), married (87.2%) and were spouses to the care recipient (68.1%). Caregivers' experiences of caring for community-living older adults with MCC were complex and included: (a) dealing with the demands of caregiving; (b) prioritizing chronic conditions; (c) living with my own health limitations; (d) feeling socially isolated and constrained; (e) remaining committed to caring; and (f) reaping the rewards of caregiving. Conclusions: Healthcare providers can play key roles in supporting caregivers of older adults with MCC by providing education and support on managing MCC, actively engaging them in goal setting and care planning, and linking them to appropriate community health and social support services. Communities can create environments that support caregivers in areas such as social participation, social inclusion, and community support and health services. [ABSTRACT FROM AUTHOR]

Purpose: To explore participants' experiences in a group-based yoga with psychoeducation intervention designed to facilitate community integration for people with traumatic brain injury and their caregivers. Materials and methods: We conducted semi-structured interviews with 13 people with traumatic brain injury and three caregivers who had completed LoveYourBrain Yoga, a 6-session, manualized, group-based yoga intervention that incorporates breathing exercises, yoga, meditation, and psychoeducation. Interviews were analyzed using content analysis. Results: We identified seven themes: ease of participation, belonging, sustaining community connection, physical health, self-regulation, self-efficacy, and resilience. All participants valued the community-based yoga studio environment and multifaceted structure of the program. Participants reported improvements in strength, balance, flexibility, and attention control, and a greater sense of belonging, community connection, and ability to move forward with their lives. Participants reported ongoing use of tools (e.g., breathing exercises) to cope with negative emotions and stress. About half of participants sustained relationships built during LoveYourBrain Yoga and felt more capable of accessing other activities in their community. Conclusions: LoveYourBrain Yoga successfully promoted community integration for people with traumatic brain injury. It also facilitated diverse and meaningful physical, psychological, and social health benefits, which suggest that it may be an effective mode of community-based rehabilitation. Traumatic brain injury survivors often struggle to participate in their community, the ultimate goal of rehabilitation Yoga is a holistic therapy with many benefits, yet is not accessible to the traumatic brain injury population at the community level Participants in a community-based yoga with psychoeducation intervention in six states experienced diverse and meaningful physical, psychological, and social health benefits Group-based yoga with psychoeducation may be an effective mode of community integration and community-based rehabilitation for traumatic brain injury survivors [ABSTRACT FROM AUTHOR]

Background: Stroke is the leading cause of death and adult disability in Canada. Eighty percent of older adults (≥65 years) who have suffered a stroke will return to their homes, and 60% will require ongoing rehabilitation. The transition between hospital and home is often fragmented, leading to adverse health outcomes, hospital readmissions, and increased health-care costs. This study examined the feasibility of a 6-month integrated transitional care stroke intervention (TCSI), and explored its effects on health outcomes, patient and provider experience, and cost in 30 community-living older adults (≥55 years) with stroke and multimorbidity (≥2 chronic conditions) using outpatient stroke rehabilitation services. Methods: The TCSI is a 6-month intervention delivered by an interprofessional (IP) team (occupational therapist, physiotherapist, speech language pathologist, registered nurse, social worker). It involved care coordination, home visiting, and IP case conferences, supported by a web-based application. A qualitative descriptive approach was used to explore the feasibility of implementing the intervention. A prospective one-group pretest/posttest was used to evaluate the effects of the intervention on health outcomes and use and costs of health services, from baseline to 6 months. Results: Participants had an average of eight comorbid conditions. The intervention was feasible and acceptable to both older adults and providers. From baseline to 6 months, there was no statistically significant difference in health outcomes. However, there was a significant reduction in the total per person use and costs of health services. Conclusions: This study established the feasibility of conducting a larger randomized controlled trial of this intervention. [ABSTRACT FROM AUTHOR]

Background: The impact of long‐term conditions is the "healthcare equivalent to climate change." People with long‐term conditions often feel they are a problem, a burden to themselves, their family and friends. Providers struggle to support patients to self‐manage. The Practical Reviews in Self‐Management Support (PRISMS) taxonomy lists what provider actions might support patient self‐management. Objective: To offer providers advice on how to support patient self‐management. Design: Semi‐structured interviews with 40 patient‐participants. Setting and participants: Three case studies of primary health‐care organizations in New Zealand and Canada serving diverse populations. Participants were older adults with long‐term conditions who needed support to live in the community. Main outcome measures: Qualitative description to classify patient narratives of self‐management support according to the PRISMS taxonomy with thematic analysis to explore how support was acceptable and effective. Results: Patients identified a relationship‐in‐action as the mechanism, the how by which providers supported them to self‐manage. When providers acted upon knowledge of patient lives and priorities, these patients were often willing to try activities or medications they had resisted in the past. Effective self‐management support saw PRISMS components delivered in patient‐specific combinations by individual providers or teams. Discussion and conclusions: Providers who establish relationships with patients can support them to self‐manage and improve health outcomes. Delivery of taxonomy components, in the absence of a relationship, is unlikely to be either acceptable or effective. Providers need to be aware that social determinants of health can constrain patients' options to self‐manage. [ABSTRACT FROM AUTHOR]

Background: Family carers of older persons with Alzheimer's' disease and related dementia (ADRD) and multiple chronic conditions (MCC) experience significant, complex, and distressing transitions such as changes to their environment, roles and relationships, physical health, and mental health. An online intervention (My Tools 4 Care) was developed for family carers of persons with ADRD and MCC living at home, with the aim of supporting these carers through transitions and increasing their self-efficacy, hope, and health related quality of life (HRQoL). This study will evaluate My Tools 4 Care (MT4C) by asking the following research questions: 1. Does use of MT4C result in a 3 month (immediately post intervention) and 6-month (3 months after intervention) increase in HRQoL, self-efficacy, and hope, in carers of persons with ADRD and MCC compared to an educational control group? 2. Does use of MT4C help carers of community-dwelling older adults with ADRD and MCC deal with significant changes they experience as carers? and 3. Are the effects/benefits of the MT4C intervention achieved at no additional cost compared to an educational control group?Methods/design: Using a pragmatic mixed methods randomized controlled trial design, 180 family carers of community dwelling older persons (65 years of age and older) with ADRD and MCC will participate in the study. Data will be collected from the intervention and an educational control group at four time points: baseline, 1 month, 3 and 6 months. We expect to find that family carers using MT4C will show greater improvement in hope, self-efficacy and HRQoL, at no additional cost from a societal perspective, compared to those in the educational control group. General estimating equations will be used to determine differences between groups and over time.Discussion: Data collection began in Ontario and Alberta Canada in June 2015 and is expected to be completed in June 2017. The results will inform policy and practice as MT4C can be easily revised for local contexts and is scalable in terms of posting on websites such as those hosted by the Alzheimer Society.Trial Registration: ClinicalTrials.gov Identifier: NCT02428387. [ABSTRACT FROM AUTHOR]

Falls among community-dwelling seniors constitute a major public health concern because of the potential morbidity and mortality associated with the fall. This study examined the informal care networks accessed by Canadian seniors who had visited the Emergency Department as a result of a fall, and considered the implications of the processes of asking for and receiving help on the senior's identity. Four themes were identified. The first was valuing independence. The remaining three themes concerned threats to the participants' identities linked to the need to ask for or receive help from family and friends. They were: becoming indebted, feeling devalued and becoming a burden to others. Seniors were noted to excuse family members from the expectation of helping because of work and family commitments, and illness. Participants described a mutually beneficial relationship with friends wherein both parties valued their independence and provided assistance to the other when needed. Their comments suggested that assistance was viewed as a good to be traded among peers. Our findings indicate that seniors value their independence and may not seek help even when it appears to be available, if asking threatens valued identities. Health and social care practitioners and policy makers responsible for planning and delivery of services should take this into account in order to ensure the best possible care for injured community-dwelling seniors. [ABSTRACT FROM PUBLISHER]

This feasibility study was prepared by Statistics Canada, under arrangement with the Strategic Policy Research Directorate, Human Resources and Skills Development Canada (HRSDC). It investigates issues associated with conducting surveys of abuse and neglect of older adults in community and institutional settings in Canada. A roadmap is provided for the work ahead, including options for a sampling frame, collection approaches, estimated costs, and an activity schedule. [ABSTRACT FROM AUTHOR]

Real uptake of recommendations is at the crux of community-based fall prevention. This mixed methods intervention study investigated how knowledge of one's own fall risk influenced self-reported behaviors and beliefs about falls and fall prevention in the home by older adults. Between one-on-one semi-structured interviews, participants received their individual scores compared to age-matched normative values for the Falls Efficacy Scale, Activities-specific Balance Confidence Scale, Biodex™ Fall Risk Test, and cut scores for the Timed Up and Go and Berg Balance Scale. Change scores on the Falls Behavioural Scale for Older Adults were reviewed as norm values were not found in the literature. Findings from the fall-related assessments and interviews reiterated the complexity of falls and fall prevention in a fluctuating curve of 'awareness' comprised of 'having concern, being careful,' 'accepting,' and 'action/behavior related to fall prevention.' Despite some uptake of recommended fall prevention advice, being perceived as susceptible to falls remained unacceptable to these participants, limiting real transfer or expressed belief in fall risk. [ABSTRACT FROM AUTHOR]

Objective. To explore how older people who are “aging in place” are affected when the urban neighbourhoods in which they are aging are themselves undergoing socioeconomic and demographic change. Methods. A qualitative case study was conducted in two contrasting neighbourhoods in Montréal (Québec, Canada), the analysis drawing on concepts of social exclusion and attachment. Results. Participants express variable levels of attachment to neighbourhood. Gentrification triggered processes of social exclusion among older adults: loss of social spaces dedicated to older people led to social disconnectedness, invisibility, and loss of political influence on neighbourhood planning. Conversely, certain changes in a disadvantaged neighbourhood fostered their social inclusion. Conclusion. This study thus highlights the importance of examining the impacts of neighbourhood change when exploring the dynamics of aging in place and when considering interventions to maintain quality of life of those concerned. [ABSTRACT FROM AUTHOR]

Objective: To identify and summarize published literature that examined the effectiveness of social and community integration interventions for children and adolescents with ABI in order to provide recommendations regarding future research on this topic. Methods: A literature review was conducted to identify studies that focused on social and community integration interventions for youth with ABI. Further manual searching of relevant journals with a paediatric rehabilitation focus was also carried out. Results: Currently, limited research has been published evaluating such interventions. The lack of research may stem largely from issues relating to how to measure community integration. Recommendations regarding intervention settings and structure are discussed. Conclusion: Additional studies investigating social and community integration interventions are necessary, including those with measures tailored specifically to community integration, larger samples, as are better controls and recruitment of youth with varying severities of brain injuries. [ABSTRACT FROM AUTHOR]