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Stigma represents one of the biggest barriers to living well with dementia following diagnosis. Social isolation is common as roles, friendships and opportunities to participate in the broader community disappear. An intergenerational dementia choir is a joyful activity that offers opportunities for learning, friendships and purposeful engagement towards common goals (e.g., regular social engagement, public concerts at season’s end). Data collection involved surveys and interviews with 32 dyads comprised of persons with dementia (PwD) and caregivers, as well as focus groups with 29 high school students. Results illustrate the development of a choir community across weeks of participation with far reaching benefits. Both caregivers and PwD experienced reductions in health risks and improvements in quality of life. Students’ understanding of dementia became more positive over time and new friendships developed. The discussion focuses on the need for meaningful and inclusive community activities for PwD and their caregivers.

RÉSUMÉCette étude qualitative explore les expériences vécues par des personnes âgées participant dans un programme d’arts visuels créatifs dans un établissement de soins de Victoria (Colombie-Britannique). Une approche par enquête narrative a été utilisée dans le cadre d’entretiens en personne menés avec dix résidents et trois membres du personnel du programme. Les activités du programme et l’exposition artistique qui y était associée ont aussi fait l’objet d’une observation systématique. Les résultats démontrent que le programme a stimulé le sentiment de communauté des participants et augmenté leur estime d’eux-mêmes, en tant qu’artistes. Une exposition artistique publique dans un centre communautaire a permis de souligner la valeur de leur production artistique et a conféré un sens et un but à leur implication dans le programme. Les résultats démontrent l’importance des programmes artistiques stimulant la créativité chez la population âgée. Ils illustrent aussi que les personnes vivant en institution peuvent prendre conscience des multiples dimensions de leur personnalité à travers l’expression artistique. Cette étude souligne la pertinence d’accroître l’accès à des programmes artistiques pour les individus vivant en établissements de soins.

Arts-based interventions for person’s with dementia and their caregivers represent an inexpensive, non-invasive, and non-pharmacological intervention with the potential to improve psychological function as well as reduce healthcare costs. The paper presents an overview of Voices in Motion (ViM), and the impact of this social-cognitive intervention on changes in psychological function for those with dementia and their caregivers (current n=26 dyads). Choir rehearsals were held on a weekly basis, and included a social discussion component. A range of outcomes (neuropsychological and physiological function, neural activation) were assessed using an intensive repeated measures design that facilitates both between- and within-person analyses, including nuanced evaluation of whether psychological function improves post intervention relative to an individual’s personal average, yielding a conservative within-person test of the benefits of intervention. Discussion focuses on the promise of such interventions for mitigating dementia symptoms and facilitating the psychological health of caregivers.

Arts-based interventions represent an inexpensive, non-pharmacological, and non-invasive approach to help mitigate negative symptoms and improve quality of life for persons with dementia (PwD). The present study examined whether a social singing intervention can modulate patterns of cognitive change and whether select biopsychosocial indicators exhibit concomitant within-person time-varying covariation. Participants with dementia (n=32, mean age=79.6 years; 53% female) engaged weekly in the Voices in Motion project, an intergenerational, social-cognitive choral intervention spanning up to 18 months and 9 individual assessments. The Mini Mental State Examination (MMSE), gait velocity, and positive and negative affect were assessed using an intensive repeated-measures design, with multilevel models of change employed to disaggregate both between- and within-person effects. Across months of the social intervention, several significant within-person time-varying associations were observed; on occasions when a given individual performed one unit faster on gait velocity (p

Choir interventions confer psychological benefits for persons with dementia (PwD) and their caregivers. However, less is known about whether physiological function also exhibits improvements pursuant to such social-cognitive interventions. The present study, based upon a subsample of the Voices in Motion (ViM) project, explored whether participation in an intergenerational choir results in systematic improvements in gait velocity (indexed using a GAITRite computerized walkway) for both informal caregivers (n=14; 71.4% female) and PwD (n=14; 64.3% female). Longitudinal burst data from the first of three cohorts spanning 4 assessments over 3.5 months was analysed using multilevel modeling. Whereas caregivers exhibited significant improvements (p

Persons with dementia (PwD) experience challenging neuropsychiatric symptoms (NPS) as their illness progresses. Antipsychotic drugs (APD) have been regularly used in residential care to manage this issue despite the risk of adverse events and increased morbidity and mortality. This study examines the role of culture of care in relation to continued inappropriate APD use when managing NPS in PwD. Culture of care consists of sets of norms, beliefs, and cognitive frames which inform clinical practice and care delivery. The study also considers organizational readiness for change in examining the implementation of alternate non-pharmaceutical practices to address the issue of NPS. Findings were obtained from three Canadian residential care facilities that worked on reducing inappropriate use of APD. Data came from interviews with 16 licenced practical nurses, 12 nurses, 17 health care assistants, 3 activity leaders, 3 directors of care, 10 physicians, and 14 family members. We found that care providers varied in their perceived capacity to implement novel care strategies and in the support received for innovative thinking and action. We also identified variations in how care providers informally share information on alternate strategies to manage NPS and in the contextual factors facilitating such communication. Finally, we found differences in how family members’ input was meaningfully integrated into care planning. Overall, the study shows how culture of care reflects entrenched responses to NPS but also evolves to support challenges to the decision to prescribe APD, non-pharmaceutical approaches to care, and the meaningful involvement of family members in care planning.

Community choir participation for persons with dementia (PwD) confers benefits to health status and well-being, including the benefit of socializing which can reduce feelings of loneliness and social isolation. Using Social Network Analysis (SNA), this study examines the benefits of participation in a community-based choir for 14 PwD and their caregivers in terms of the development of social relationships with other choir members, including high school students also participating in the choir. Data collection involves egocentric SNA methods whereby PwD are surveyed at 1, 3 and 5 months on the number and nature of their relationships and the attributes of their relational partners. The study examines how PwD interact with other individuals in the choir and how people they identify interact with one another. Data from in-depth qualitative interviews with PwD and caregivers offer further information on the quality and perceived benefits of these interactions.

Cette etude a compare les correlats de la charge pour le conjoint et les soignants qui sont enfants adultes a deux moments dans le temps et a evalue si les correlats de T1 a T2 predit la charge. L’echantillon etait constitue de 878 soignants pour les adultes plus âges de la Colombie-Britannique auxquels on a prescrit des inhibiteurs de la cholinesterase. La charge a ete mesuree six mois apres la personne âgee a ete prescrit le medicament et un an plus tard ( n = 759). Les resultats suggerent que les enfants adultes sentent plus fort la charge que les conjoints a T1 et T2 , avec les enfants adultes, mais pas les conjoints, diminuant leur fardeau au fil du temps. Les correlats de la charge de T1 ont explique des quantites importantes de variance, revelant la correlation differentielle pour les deux groupes et l’importance des caracteristiques des soignants sur les caracteristiques des patients. La charge au T2 s’explique principalement par les facteurs de T2 , plus la charge de T1 , suggerant l’importance des facteurs relativement immediats des effets directs sur la charge des soignants. Les effets indirects etaient operationnels par la charge de T1 . ABSTRACT: This study compared the correlates of burden for spouse and adult child caregivers at two points in time and assessed whether correlates at T1 predicted burden at T2 . The sample consisted of 878 caregivers to older adults throughout British Columbia who were prescribed cholinesterase inhibitors. Burden was measured six months after the older adult was prescribed the medication and one year later ( n = 759). Findings suggest that adult children experience more burden than spouses at both T1 and T2 with adult children but not spouses decreasing their burden over time. Correlates of T1 burden explained significant amounts of variance, revealing differential correlates for the two groups and the importance of caregiver characteristics over patient characteristics. Burden at T2 is explained mostly by T2 factors, plus T1 burden, suggesting the importance of relatively immediate factors for direct effects on caregiver burden. Indirect effects operated through T1 burden.

We know much about caregiving women compared with caregiving men and caregiving spouses compared with caregiving adult children. We know less about the intersections of relationship and gender. This article explores this intersection through the well-being (burden and self-esteem) of caregivers to family members with dementia. Throughout British Columbia, Canada, 873 caregivers were interviewed in person for on average, over 1½ hours. The results reveal that daughters experience the highest burden but also the highest self-esteem, suggesting the role is less salient for their self-identities. Wives emerge as the most vulnerable of the four groups when both burden and self-esteem are considered. The data confirm the usefulness of the intersectionality framework for understanding co-occupancy of more than one status and indicate that positive cognitive well-being and negative affective well-being can be differentially related. Multivariate analyses confirm the importance of caregiver, not patient, characteristics for burden and self-esteem.

RÉSUMÉCette étude a exploré comment les immigrants âgés d’origine sud-asiatique, parlant le pendjabi (quatre groupes de discussion; 33 participants) de Surrey en Colombie-Britannique, perçoivent leur santé buccale et les problèmes connexes. L’analyse a relevé deux thèmes généraux: les interprétations de la condition bucco-dentaire et les défis de santé bucco-dentaire. Le thème des interprétations avait quatre sous-thèmes: les dommages causés par lewai, les perturbations causé par la carie, l’adaptation aux prothèses dentaires, et qualité de vie; alors que le thème des défis considérés: remèdes à domicile, dentisterie occidentale; et difficultés d’accès aux dentistes. Les participants ont expliqué les maladies bucco-dentaires en termes d’une infection systémique (resha) et ont dit préféré les remèdes faits maison pour diminuer les écarts de chaleur (wai) dans la bouche. Nous concluons que les immigrants âgés d’origine sud-asiatique parlant le pendjabi interprète la santé et les maladies bucco-dentaires dans un contexte mixte de traditions occidentales et Ayurvédique, et gèrent leur santé buccale au moyen de remèdes traditionnels faits maison, complémentés au besoin par des soins d’urgence dispensés au Canada.

Voice first technology offers older adults with dementia support that may maintain independence, reduce social isolation and improve quality of life (QoL). This study investigates the impact of a voice-controlled technology customized to the needs of participants living with dementia and their caregivers. A mixed methods design focused on psychosocial factors and usability characteristics. The purposive sample consisted of older adults with dementia (n=12) and their care partners (n=12)) living independently in the community. Validated measures for cognition, depression, caregiver burden, quality of life and usability were included. Qualitative in-home interviews were conducted to assess impact on social connections and independence. Results indicate that voice first technology can reduce caregiver burden and can support the independence and QoL of older adults with dementia. The discussion considers the value of low cost voice first technology as a way to support older adults with dementia and their caregivers.

Community choir participation for persons with dementia (PwD) confers benefits to health and well-being, including the benefit of socializing which can reduce feelings of loneliness and social isolation. Using the concept of social capital, this study examines the degree to which two intergenerational Voices in Motion choirs facilitate the development of social relationships between PwD, caregivers, and high school students. Data collection involved interviews with 17 dyads of PwD and caregivers, completion of a social relationship questionnaire, and focus groups with a total of 29 high school students. The results show a gradual increase in the level of interactions between all participants, with students in particular interacting more frequently with PwD. Over time, trust and reciprocity emerged within the choirs as more people shared information about themselves. Students’ understanding of dementia changed over time as they learned to appreciate PwD as unique human beings with rich life stories and experiences.

Persons living with dementia-related disorders (PwD) can experience challenging behavioural and psychological symptoms (BPSD) as their illness progresses. There is a continued reliance on antipsychotic drugs (APD) in long-term care to manage this issue despite the well-documented risks of adverse events and increased morbidity and mortality. This study examines the role of culture of care in relation to efforts at reducing inappropriate APD use in managing BPSD within long-term care. Culture of care consists of shared norms, beliefs, and cognitive frames which guide clinical practice and inform the development and implementation of care strategies. Findings were obtained from three Canadian long-term care facilities working on reducing inappropriate use of APD. Data came from interviews with 6 nurses, 18 licenced practical nurses, 14 health care assistants, 4 activity leaders, 4 directors of care, 1 chaplain, and 10 physicians. We found that direct care providers initially varied in their perceived ability to develop and use alternate care strategies with health care assistants being most concerned about safety and exposure to violence. Change involved detective work and innovative thinking in assessing possible causes of BPSD beyond psychosis, including pain and feelings of confusion. Informal reciprocal patterns of communication emerged among health care assistants to identify effective non-pharmaceutical strategies to manage BPSD. Overall, the study shows how shared beliefs in the need for and value of alternate care practices among direct care providers along with the existence of effective informal communication can contribute to successful reduction in APD use when managing BPSD in PwD.

Informal caregivers provide 80% of the care needed to support community-dwelling older adults with dementia. Over time caregivers often face adverse effects on their health, quality of life and well-being; particularly those caring for someone with dementia. This study examines the impact of participation in the Voices in Motion (ViM) choir on caregiver burden, mood and quality of life. A measurement burst approach was used to investigate intraindividual variability on key psychosocial and health indicators. Results indicate that choir participation significantly improves caregiver well-being (e.g. mood, burden) and quality of life. Findings suggest that choirs offer significant caregiver support and respite. The discussion focuses the public policy and on the potential economic implications which suggests a shift is needed in the services available to older adults with dementia and their caregivers.

Neglect of the mouth can lead to impairment, disability, and discomfort; as a result, it can have a negative impact on quality of life in old age. Some minority groups in North America shoulder a disproportionate burden of dental impairment compared to people of European origins, possibly because of different cultural beliefs and a distrust of Western oral healthcare. This paper explores these factors in elderly Chinese immigrants through a meta-synthesis of selected literature that reveals a dynamic interplay of traditional Chinese beliefs about oral health, immigration, and structural factors mediating access to Western dentistry. It also identifies several conceptual issues and gaps in knowledge, offers avenues of research including the cross-cultural application of two recent models of oral health, and discusses various strategies for improving access to dental services for minority populations.

Family caregivers are the backbone of long-term care for older adults living with dementia in the community. Over time, the physical, psychological, social and economic impacts of living with dementia can adversely impact caregiver health, quality of life and well-being. Choir participation is a joyful, meaningful and supportive activity that can improve quality of life and well-being. This study examines the impact of participation in a dementia-friendly community-based choir on caregiver stress, burden and quality of life. A burst measurement design allows between and within-individual analyses that increase our understanding of the impact of the choir on caregiver burden and quality of life. Analyses will explore the cost-benefits of the choir as a novel intervention for caregiver support and respite. The discussion will focus on the policy and program implications for family caregivers and their community-dwelling care recipient.

This research explores the experiences of older adults participating in an innovative visual arts program at a long-term care facility in Victoria, British Columbia, Canada. The program offers participants an opportunity to explore their creativity and identity as artists. Conceptually, the study draws from Tornstam’s gerotranscendance framework (Tornstam, 2005) and the theory of meaning (Frankl, 1963). A narrative inquiry approach was used with data collected through face-to-face interviews and observations of 10 residents and three staff involved in the visual arts program. Findings indicate that the program fostered a sense of community among participants and enhanced their quality of life. The public exhibition of their art work at a community-based art exhibit, validated the merit of their work and gave meaning and purpose to their participation in the program. Findings contribute to a greater understanding of the importance of arts programs that foster creativity in later life and resonate with Tornstam’s (2005) argument that older people living in institutions can experience multiple dimensions of the self through individualized forms of expression. This study concludes by highlighting the need to increase access to arts programs for older people living in residential care.