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Objectives: Identifying the correlates of mental health resilience (MHR)—defined as the discrepancy between one’s reported current mental health and one’s predicted mental health based on their physical performance—may lead to strategies to alleviate the burden of poor mental health in aging adults. Socioeconomic factors, such as income and education, may promote MHR via modifiable factors, such as physical activity and social networks. Design: A cross-sectional study was conducted. Multivariable generalized additive models characterized the associations between socioeconomic and modifiable factors with MHR. Setting: Data were taken from the population-based Canadian Longitudinal Study on Aging (CLSA), which collected data at various data collection sites across Canada. Participants: Approximately 31,000 women and men between the ages of 45 and 85 years from the comprehensive cohort of the CLSA. Measurements: Depressive symptoms were assessed by the Center for Epidemiological Studies Depression Scale. Physical performance was measured objectively using a composite of grip strength, sit-to-stand, and balance performance. Socioeconomic and modifiable factors were measured by self-report questionnaires. Results: Household income, and to a lesser extent, education were associated with greater MHR. Individuals reporting more physical activity and larger social networks had greater MHR. Physical activity accounted for 6% (95% CI: 4 to 11%) and social network accounted for 16% (95% CI: 11 to 23%) of the association between household income and MHR. Conclusions: The burden of poor mental health in aging adults may be alleviated through targeted interventions involving physical activity and social connectedness for individuals with lower socioeconomic resources.

Objectives Older adults (65 years and older) are increasingly providing care for their spouses, family members, and non-kin others (e.g., friends and neighbours). However, available knowledge of older caregivers is limited to spousal caregivers and their psychological outcomes. Other caregiver role types or social outcomes among older caregivers are less well studied. Thus, this study examines the social participation and social support among older caregivers by comparing three types of older caregivers, including spousal caregivers, non-spouse family caregivers, and non-kin caregivers. Methods Participants for this study were drawn from the Baseline and Follow-up 1 data from the Canadian Longitudinal Study on Aging. A total of 3,789 older adults became caregivers during the two data collection timepoints. Linear mixed models were applied to examine the change of social participation and social support among the three caregiver role types over the course of survey. Results The study finds that after transitioning into the caregiving role, spousal caregivers and non-kin caregivers experienced a decline in social participation, and spousal caregivers also received less social support over time. When comparing the three caregiver role types, spousal caregivers reported the greatest decline in social participation and social support. Discussion This study adds to the relatively limited knowledge on older caregivers by presenting the changes of social participation and social support after transitioning into three types of caregiver roles. The results indicate the need to provide support for caregivers, particularly spousal and non-kin caregivers, to help them maintain social relationships and networks for participation and support.

Background and ObjectivesMore older adults with multimorbidity are aging in place than ever before. Knowing how the environment affects their mental well-being could enhance the efficacy of age-friendly interventions for multimorbidity resilience. With reference to the Transdisciplinary Neighborhood Health Framework, we construct and examine a priori models of environmental influences on life satisfaction and depressive symptoms.Research Design and MethodsBaseline and follow-up data (after 3 years) were drawn from the Canadian Longitudinal Study on Aging to identify a subsample (n = 14,301) of participants aged at least 65 years with at least 2 chronic diseases. Path analysis examined sociobehavioral attributes (i.e., social support, social participation, walking) and loneliness as primary and secondary mediators, controlling for age, sex, education, and outcomes during baseline.ResultsGood model fit was found (TFI = 1.00; CFI = 1.00; RMSEA < 0.001; SRMR < 0.001). The total effects of housing quality (rtotal = 0.08, −0.07) and neighborhood cohesion (rtotal = 0.03, −0.06) were weak but statistically significant in the expected direction. The mediators explained 21%–31% of the total effects of housing quality and 67%–100% of the total effects of neighborhood cohesion. Loneliness mediated 27%–29% of these environmental influences on mental well-being, whereas walking mediated a mere 0.4%–0.9% of the total effects. Walking did not explain the relationship between housing quality and mental well-being.Discussion and ImplicationsData supported a priori pathways from environment to mental well-being through sociobehavioral attributes and loneliness. If these pathways from neighborhood cohesion to life satisfaction reflect causal effects, community-based age-friendly interventions should focus on enhancing neighborhood cohesion to mitigate loneliness among multimorbid older adults for their mental well-being.

Background The literature suggests depressive symptoms differ in a non-linear fashion across adulthood and are more commonly reported in women as compared to men. Whether these trends are observed across countries in population-based cohorts is unclear. Methods Cross-sectional observational study of approximately 138,000 women and men between the ages of 45 and 95 from three population-based cohorts representing Canadian, European, and American populations. Age, gender, educational attainment and annual income were assessed in each cohort. Depressive symptoms were assessed by the Center for Epidemiological Studies Depression Scale in the US and Canadian cohorts, and by the EURO-D in the European cohort. Results Across all three cohorts, non-linear age trends and gender differences were observed in the report of depressive symptoms, independent from educational attainment and annual income effects. The non-linear age trends reflected a negative association between depressive symptoms and age during midlife and then a positive association in late life. Females reported greater depressive symptoms than males; however, an interaction between gender and age was also observed in the Canadian and European cohorts. Among Canadians, the gender differences were largest after age 70, whereas among Europeans, gender differences where largest among those approximately aged 60. Limitations Limitations include: 1) the cross-sectional nature of the study, resulting in age differences potentially reflecting cohort effects rather than a developmental process; and 2) the use of different depressive symptoms measures across cohorts. Conclusions Characterization of depressive symptoms over mid and late adulthood in women and men provides insights into potential focal points for intervention and allocation of resources.

This study examines associations between lifestyle behavioural factors and appraisals of “healthy aging” among older adults experiencing multimorbidity. A Social Determinants and Health Behaviour Model (SDHBM) is used to frame the analyses. Using baseline data from the Canadian Longitudinal Study on Aging (CLSA), we studied 12,272 Canadians 65 years of age or older who reported 2 or more of 27 chronic conditions. Additional analyses were conducted using three multimorbidity clusters: cardiovascular/metabolic, musculoskeletal, and mental health. Using hierarchical logistic regression, it was found that, for multmorbidity and the three illness clusters, healthy aging is consistently associated with not smoking (except for the mental health cluster), an absence of obesity (except for the cardiovascular and metabolic cluster), better sleep, and a better appetite. It is not associated with inactivity. Several socio-demographic, environmental, and illness covariates were also supported. The findings are examined using the SDHBM coupled with a resilience lens in order to elucidate how modifiable health behaviours can act as resources to mitigate multimorbidity adversities. This has implications for healthy aging for persons with multimorbidity, especially during the COVID-19 pandemic.

A scoping review was conducted to identify patterns, effects, and interventions to address social isolation and loneliness among community-dwelling older adult populations during the COVID-19 pandemic. We also integrated (1) data from the Canadian Longitudinal Study on Aging (CLSA) and (2) a scan of Canadian grey literature on pandemic interventions. CLSA data showed estimated relative increases in loneliness ranging between 33 and 67 per cent depending on age/gender group. International studies also reported increases in levels of loneliness, as well as strong associations between loneliness and depression during the pandemic. Literature has primarily emphasized the use of technology-based interventions to reduce social isolation and loneliness. Application of socio-ecological and resilience frameworks suggests that researchers should focus on exploring the wider array of potential pandemic age-friendly interventions (e.g., outdoor activities, intergenerational programs, and other outreach approaches) and strength-based approaches (e.g., building community and system-level capacity) that may be useful for reducing social isolation and loneliness.

It is well established that family and work-retirement transitions are increasingly becoming more complicated, extended, and reversible among aging parents. Combined with improved life expectancy, older parents are now confronted with new opportunities and challenges including their access to leisure activities. However, a paucity of research exists with regard to the extent to which older-aged parents are satisfied with their amount of leisure time as well as their ideal leisure preferences. Drawing upon socio-cultural life course theory, this paper examines how socio-demographic and ethnocultural variables (i.e., gender, ethnic identity), family-related factors (e.g., presence of children in the household), and socio-economic and work contexts (i.e., income satisfaction and retirement status) shape leisure time satisfaction and activity preferences. Data are drawn from the “Families and Retirement Project,” a sample of 588 diverse (British-, Chinese-, Iranian/Persian-, South-Asian Canadians) aged 50 + (mean age = 59.6) residing in Metro Vancouver with at least one young adult child aged 19–35. Quantitative analyses reveal that leisure time satisfaction is higher among: those reporting lower levels of parental stress, the fully retired, those with less education, and among Chinese parents (compared to British). Moreover, strong variations by ethnic background are shown in preferred leisure activity, based on a thematic analysis of data. Results are discussed in terms of contributions to a socio-cultural family life course activity theory. Implications for community service provision (e.g., culturally sensitive and relevant recreational programs and services) are also highlighted, given the salience of participation in enjoyable leisure activities to healthy aging.

Background Loneliness and social isolation are prevalent public health concerns among community-dwelling older adults. One approach that is becoming an increasingly popular method of reducing levels of loneliness and social isolation among older adults is through technology-driven solutions. This protocol outlines a research trajectory whereby a scoping review will be initiated in order to illustrate and map the existing technological approaches that have been utilized to diminish levels of loneliness and social isolation among community-dwelling older adults aged 60 years or older. We will address the question: what are the most common and less used technological approaches to reduce loneliness and social isolation among community-dwelling older adults? Methods A scoping review of Academic Search Premier, AGEline, Global Health, MEDLINE, PsycINFO, and Web of Science databases will take place using our search terms including the following: loneliness, social isolation, older adults, elderly, Aged, Aged 80 and over, program, evaluation, trial, intervention, technology, computer, information and communication technology, internet, and robot. The initial electronic search will be supplemented by reviewing the reference lists and review articles to identify any missing studies. To meet study inclusion criteria, intervention studies had to pertain to community-dwelling adults aged 60 years or older, include technological interventions, include loneliness and/or social isolation as outcome variables, and be written in the English language. Two parallel independent assessments of study eligibility will be conducted for the title, abstract, and full-text screens. Any disagreement will be resolved by consensus and a third reviewer consulted to make a decision if consensus is not achieved initially. Finally, the amalgamation of results will be an iterative process whereby reviewers will refine the plan for presenting results after data extraction is completed so that all of the contents of the extraction may be included in the results. Discussion The information gleaned in this scoping review will be essential to understand the degree to which technological interventions influence social isolation and loneliness among older adults and identify gaps for further research.

Family care-giving is associated with social isolation, which can lead to adverse health and wellbeing outcomes among family care-givers. The role of geographic distance in care-giver social isolation (CSI) is unclear and has received mixed research findings. Framed by the Ecological Model of Caregiver Isolation, this study examined the relationship between geographic distance and CSI, including the interaction between geographic distance and care-giving intensity for CSI. Linear regression and analysis of covariance were used to test these hypotheses using a sub-set of family care-givers from the 2012 Canadian General Social Survey (N = 2,881). Care-givers living a short distance from receivers reported lower levels of social isolation than co-resident, moderate-distance and long-distance care-givers. Being involved in higher-intensity care-giving as the primary care-giver, undertaking more care-giving tasks and providing care more frequently resulted in higher CSI scores. Long- and moderate-distance care-givers reported greater CSI than co-resident and short-distance care-givers only when providing higher-intensity care-giving. Employing a granulated measure of geographic distance positioned within an ecological framework facilitates an understanding of the nuanced association between geographic proximity and CSI. Furthermore, the identified interaction effects between geographic distance and care-giving intensity on CSI further explicate the complexity of care-giving experiences. The findings are relevant for programmes supporting care-givers in different contexts, especially distance care-givers.

Background and Objectives There has been a proliferation of research on dementia-friendly communities in recent years, particularly on interpersonal and social aspects. Nonetheless, the neighborhood built environment remains a co-constituent of the lived experience of people living with dementia (PLWD) that is amenable to interventions for health and well-being in the community. This scoping review presents a narrative synthesis of empirical research on dementia-friendly neighborhoods, with a focus on the built environment and its associated sociobehavioral aspects. Planning and design principles are distilled to identify research and policy implications. Research Design and Methods We reviewed 29 articles identified through a systematic search of AgeLine, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Global Health, Medical Literature Analysis and Retrieval System Online, and Scopus. Peer-reviewed articles that employed quantitative and/or qualitative methods in community settings were included. Results An equal number of studies focused on behavioral/psychosocial aspects of the built environment and assessment of specific environmental features. The former often used qualitative methods, whereas statistical methods were common in studies on discrete features of the neighborhood built environment. Few studies focused on rural contexts. Emerging research areas include interactions between dementia risk factors and neighborhood environments to support primary and secondary prevention. Discussion and Implications The body of literature needs expansion into planning and design fields to foster community participation of PLWD by optimizing environmental stimuli, minimizing environmental barriers, and engaging PLWD in dementia-friendly community initiatives. While evidence has accumulated on landmarks and social participation at the individual level, research at the community and policy levels is limited. This requires advanced mixed methods.

Individual socioeconomic status is known to correlate with multimorbidity, but the role of neighbourhood-level socioeconomic deprivation is uncertain. Participants from five cities (n = 16,313) fro...

Although older adults may experience health challenges requiring increased care, they often do not ask for help. This scoping review explores the factors associated with the help-seeking behaviors of older adults, and briefly discusses how minority ethnic populations can face additional challenges in help-seeking, due to factors such as language barriers and differing health beliefs. Guided by Arksey and O’Malley’s scoping review framework and the Preferred Reporting Items for Systematic Reviews and Meta-AnalysesScoping Review guidelines, a systematic search of five databases was conducted. Using a qualitative meta-synthesis framework, emergent themes were identified. Data from 52 studies meeting inclusion criteria were organized into five themes: formal and informal supports, independence, symptom appraisal, accessibility and awareness, and language, alternative medicine and residency. Identifying how factors, including independence and symptom appraisal, relate to older adults’ help-seeking behaviors may provide insights into how this population can be supported to seek help more effectively.

Given the increasing complexity and fluidity of parenting, caregiving, and paid work patterns, in tandem with an increased risk of multimorbidity in mid-life, this study examines the relationship between these three concurrent roles and social isolation among middle-aged persons across multimorbidity statuses. Drawing upon life course theory, we applied linear mixed models to analyze 29,847 middle-aged participants from two waves of the Canadian Longitudinal Study on Aging. Findings reveal that participants experience greater social isolation over time, albeit the difference is extremely small. Among participants without multimorbidity, holding multiple roles is associated with lower social isolation. For those with multimorbidity, being employed full-time and providing intensive care are associated with social isolation. The occurrence of multiple roles demonstrates unique associations with social isolation among those with and without multimorbidity over time. Future research should study multimorbidity as a salient contextual variable. Moreover, enhanced support is needed for multimorbid middle-aged individuals with different role demands.

It is well established that family and work-retirement transitions are increasingly becoming more complicated, extended, and reversible among aging parents. Combined with improved life expectancy, older parents are now confronted with new opportunities and challenges including their access to leisure activities. However, a paucity of research exists with regard to the extent to which older-aged parents are satisfied with their amount of leisure time as well as their ideal leisure preferences. Drawing upon socio-cultural life course theory, this paper examines how socio-demographic and ethnocultural variables (i.e., gender, ethnic identity), family-related factors (e.g., presence of children in the household), and socio-economic and work contexts (i.e., income satisfaction and retirement status) shape leisure time satisfaction and activity preferences. Data are drawn from the "Families and Retirement Project," a sample of 588 diverse (British-, Chinese-, Iranian/Persian-, South-Asian Canadians) aged 50 + (mean age = 59.6) residing in Metro Vancouver with at least one young adult child aged 19-35. Quantitative analyses reveal that leisure time satisfaction is higher among: those reporting lower levels of parental stress, the fully retired, those with less education, and among Chinese parents (compared to British). Moreover, strong variations by ethnic background are shown in preferred leisure activity, based on a thematic analysis of data. Results are discussed in terms of contributions to a socio-cultural family life course activity theory. Implications for community service provision (e.g., culturally sensitive and relevant recreational programs and services) are also highlighted, given the salience of participation in enjoyable leisure activities to healthy aging.

Self-reported health is a common measure predictive of morbidity and mortality among adults. Many factors are known to be associated with self-reported health including the number of chronic conditions (i.e., multimorbidity). While the association between self-reported health and morbidity and mortality has been well-established, the factors that shape the relationship with self-reported health (e.g., modify and mediate) are poorly understood. Further, it is unknown why some older adults, despite having high numbers of chronic conditions, continue to rate their health positively. This is known as the well-being paradox. This mixed methods research study was designed to address these knowledge gaps. The objectives of the proposed research are to (1) determine what factors shape the relationship between multimorbidity and self-reported health and how they do so; (2) describe the ways that older adults define and perceive their individual health; and (3) explain the well-being paradox. Informed by a multimorbidity resilience framework, the quantitative component of research will analyze Canadian Longitudinal Study on Aging data while the qualitative component will collect and analyze interview data from 12 to 20 community-dwelling older adults using a case study design. Findings from this study have the potential to inform and advance future health intervention programs or services aimed at improving health-related quality of life for community-dwelling older adults.

Objectives To understand the experience of Metro Vancouver’s Homelessness Partnering Strategy-funded Housing First program and how it is functioning from the perspective of a representative sample of providers and clients who deliver and receive HF services. Methods Thirty-four clients and providers who currently or formerly delivered HF in Metro Vancouver participated in one-on-one interviews (n = 26) or focus groups (n = 8) between March and April 2017 and data were thematically analyzed. Results Strengths of the HF program included: the ability to transition persons from the street into housing with individualized service supports and, in certain cases, with 12-month rent subsidies, household goods, and connection to community resources. Identified program weaknesses were: eligibility criteria, limited rent subsidy funds, limited provider capacity, and workload burden. Suggested opportunities to improve HF were: streamlining federal and provincial reporting and rent subsidy systems and building friendly landlord networks. Potential threats to HF described were: limited affordable housing, stigma and discrimination toward clients, inadequate income assistance, and limited opportunity for cross-sector collaboration. Conclusions The delivery of HF in regions that have limited affordable housing presents unique challenges. Recommendations are provided to improve HF practice and policy in these contexts.

Objective:Recently, there has been a growing interest in examining forms of illness-related resilience. This study examines associations between lifestyle behavioral factors and multimorbidity resilience (MR) among older adults.Methods:Using baseline data from the Comprehensive Cohort of the Canadian Longitudinal Study on Aging, we studied 6,771 Canadian adults aged 65 or older who reported two or more of 27 chronic conditions, and three multimorbidity clusters: cardiovascular/metabolic, osteo-related, and mental health. Associations were explored using hierarchical linear regression modeling, controlling for sociodemographic, social/environmental, and illness context covariates.Results:Among older adults with two or more illnesses, as well as the cardiovascular/metabolic and osteo-related illness clusters, having a non-obese body mass, being a non-smoker, satisfaction with quality of sleep, having a good appetite, and not skipping meals are associated with MR. However, the mental-health cluster resulted in different behavioral lifestyle associations, where MR was not associated with obesity, smoking, or appetite, but inactivity demonstrated moderate positive associations with MR.Discussion:While there are similar patterns of lifestyle behaviors across multimorbidity and multimorbidity clusters involving physiological chronic illnesses, those associated with mental health are distinct. The results have implications for healthy aging among persons coping with multimorbidity.

Rapid population aging and high rates of immigration from non-Western countries are contributing to an increasingly diverse ethnic mosaic of North American family life. Drawing upon a life course theoretical perspective synthesized with a sociocultural stress and coping model, this study examines stress among parents aged 50+ with at least one adult child aged 19–35. Data are drawn from a mixed-methods study conducted in Metro Vancouver, British Columbia, Canada. Interviews were conducted with 588 parents in 2015/16, and a smaller sub-set of face-to-face in-depth follow-up interviews (n = 32). Respondents self-identified with one of four ethnocultural groups: British-, Chinese-, Persian/Iranian- or South Asian-Canadian. Hierarchical OLS regression, in addition to qualitative thematic analysis was used to analyze the data set. Higher parental stress was found among: Persians/Iranians, and Chinese parents (compared to British); those with greater intergenerational conflict; those with unemployed children; lower education of parents; fewer years lived in Canada; and those with lower income satisfaction. An interaction effect for Persian men compared to British females was also revealed. Overall, the findings demonstrate the salience of cultural dimensions, intergenerational relationship dynamics, and economic factors in furthering our understanding of parental stress in ethnically diverse aging families.

Residential care and assisted living services provide support to seniors who may not have the ability to live independently. However, East Asian residents often do not have sufficient access to cul...

Background and objectives Age related changes often compromise the ability to drive safely. Some elders report that they listen to others’ advice, but there have been no studies that have examined how much influence families have on their driving decisions. This study fills this gap by exploring older drivers’ perceptions of how family members affect their driving decisions. Research design and methods A quasi-experimental ranking task was used to examine the expected influence that 48 hypothetical statements, drawn from related literature, have on a convenience sample of 37 adults, age 70–96 years. Analysis was conducted by gender and by habit strength for driving. Results Four domains of influence were identified from the literature, representing family aims to influence the elder to: (1) continue driving, (2) modify driving, (3) reduce driving, and (4) stop driving. Statements aimed at supporting the driver to continued driving (62%) and to reduce driving (62%) were found to have the most influence, with slightly less support for statements aimed to influence them to stop driving (58%) or modify their driving (52%). Women rated statements supporting them to continue driving as having the highest influence on them, whereas men reported that they were more influenced by statements encouraging them to reduce their driving. In addition, participants with high habit strength for driving were less likely to rate family statements as having a high influence on them. Discussion and implications This study contributes new understanding of the influence of families on the driving decisions of older adults. These findings may be used to support families, in addition to informing the development of effective programs aimed at older driver safety.

One of the most at-risk groups during the COVID-19 crisis is older adults, especially those who live in congregate living settings and seniors’ care facilities, are immune-compromised, and/or have other underlying illnesses. Measures undertaken to contain the spread of the virus are far-reaching, and older adults were among the first groups to experience restrictions on face-to-face contact. Although reducing viral transmission is critical, physical distancing is associated with negative psychosocial implications, such as increased rates of depression and anxiety. Promising evidence suggests that participatory digital co-design, defined as the combination of user-centered design and community engagement models, is associated with increased levels of engagement with mobile technologies among individuals with mental health conditions. The COVID-19 pandemic has highlighted shortcomings of existing technologies and challenges in their uptake and usage; however, strategies such as co-design may be leveraged to address these challenges both in the adaptation of existing technologies and the development of new technologies. By incorporating these strategies, it is hoped that we can offset some of the negative mental health implications for older adults in the context of physical distancing both during and beyond the current pandemic.

The care needs for aging adults are increasing burdens on health systems around the world. Efforts minimizing risk to improve quality of life and aging have proven moderately successful, but acute shocks and chronic stressors to an individual’s systemic physical and cognitive functions may accelerate their inevitable degradations. A framework for resilience to the challenges associated with aging is required to complement on-going risk reduction policies, programs and interventions. Studies measuring resilience among the elderly at the individual level have not produced a standard methodology. Moreover, resilience measurements need to incorporate external structural and system-level factors that determine the resources that adults can access while recovering from aging-related adversities. We use the National Academies of Science conceptualization of resilience for natural disasters to frame resilience for aging adults. This enables development of a generalized theory of resilience for different individual and structural contexts and populations, including a specific application to the COVID-19 pandemic.

Coronavirus disease (COVID-19) is a highly contagious pathogen that has shown to result in high rates of morbidity and mortality. In early 2020, the COVID-19 global crisis appeared in numerous countries, spreading rapidly with multiple waves of infection. This has resulted in unprecedented health, social and economic challenges in terms of public health, health and continuing care systems, economies, communities, and families. We have conceptualized COVID-19 as a ‘gero-pandemic,’ defined as a disease that has spread globally with heightened significance and deleterious consequences for older people. This chapter examines the structural, system-level contexts of COVID-19, and individual-level risks, experiences and responses. We frame this chapter using a resilience model of aging, which provides a multi-level conceptual apparatus for understanding how societies and individuals overcome the adversities created by the COVID-19 gero-pandemic by identifying systemic weaknesses/problems, areas of strength and resilience, and evidence for successful mitigation and innovative responses. We are led to several core recommendations for public health and health promotion as societies attempt to adapt and respond to the COVID-19 crisis.

Drawing from a sociocultural life course perspective, this study examines the linkages between two age-related family transitions: young adult children leaving home and parental retirement. A sample of 580 ethnically diverse parents aged 50+ with at least one adult child aged 19–35 living in Metro Vancouver, British Columbia, Canada, was used in this study based on four cultural groups: British–, Chinese–, Persian/Iranian–, or South Asian–Canadian. Separate survival analyses are used to predict the timing of, and associations between children’s leaving home and parents’ retirement. Later timing of adult children’s leaving home is associated with delays in retirement of parents and is influenced by a number of predictors. Main and interaction effects were supported for ethnicity, where belonging to the Persian/Iranian ethnic group (compared to British) delays home leaving, and belonging to Persian/Iranian and South Asian ethnic groups (compared to British) delays retirement timing.

The COVID-19 global crisis is reshaping Canadian society in unexpected and profound ways. The significantly higher morbidity and mortality risks by age suggest that this is largely a “gero-pandemic,” which has thrust the field of aging onto center stage. This editorial emphasizes that vulnerable older adults are also those most affected by COVID-19 in terms of infection risk, negative health effects, and the potential deleterious outcomes on a range of social, psychological, and economic contexts – from ageism to social isolation. We also contend that the pathogenic analysis of this pandemic needs to be balanced with a salutogenic approach that examines the positive adaptation of people, systems and society, termed COVID-19 resilience. This begs the question: how and why do some older adults and communities adapt and thrive better than others? This examination will lead to the identification and response to research and data gaps, challenges, and innovative opportunities as we plan for a future in which COVID-19 has become another endemic infection in the growing list of emerging and re-emerging pathogens.

Objectives The caregiving outcomes of spousal and adult-child caregivers are widely studied since they are the most common source of support provided to adults. However, the literature on social isolation among spousal and adult-child caregivers is very limited. In order to further elaborate and specify unique caregiving outcomes, this study focuses on social isolation, both longitudinally and comparatively between spousal and adult-child caregivers. Methods This study was based on the Baseline and Follow-up 1 data from the Canadian Longitudinal Study on Aging. A total of 5,226 participants (1,293 spousal caregivers and 3,933 adult-child caregivers) were selected. The Linear mixed models were used to examine the effect of caregiver type and caregiving intensity on social isolation over the course of survey. Results Spousal and adult-child caregivers reported greater social isolation over time, and spousal caregivers exhibited a steeper increase in social isolation from Baseline to Follow-up 1 than adult-child caregivers. Also, an increase in caregiving hours resulted in greater social isolation. Finally, male spousal or adult-child caregivers were more likely to be socially isolated over time than their female counterparts. Discussion The findings of this study contribute to the existing literature on caregiving outcomes by demonstrating an association between family caregiving and social isolation. The results indicate a strong need for intervention programs that aim to enhance social connectedness among family caregivers, and especially for those who perform intensive caregiving, are older age, and are from a lower socioeconomic status.

This chapter integrates resilience frameworks (Richardson, J Clin Psychol 58:307–321, 2002; Wister et al., Int J Aging Hum Dev 82:290–313, 2016) with processes of adaptation articulated in the Selective Optimization and Compensation (SOC) model (Baltes and Baltes, Successful aging: perspectives from the behavioral sciences. Cambridge University Press, New York, 1990) to understand mobility challenges among older adults, termed mobility resilience. Forty-one studies were reviewed to identify the range of adaptive processes employed by older adults with mobility limitations in order to explore how these strategies are associated with the different classes of reintegration in the resilience model. The linking of models of resilience and adaption helps to (i) explain why some older adults adapt to or recover from mobility limitations better than others and (ii) understand the factors and processes involved in building mobility resilience, which in turn can guide the development of programs that enhance older adults’ health and well-being.

This chapter describes the development and application of a theoretical model of multimorbidity resilience, and a measure-multimorbidity resilience index specifically aimed for use in population health surveys. The Lifecourse Model of Multimorbidity Resilience (LMMR) links resources embedded in multi-level domains and elaborates key processes that occur during disruption and reintegration along a life trajectory. It furthers our understanding of resilience processes underlying the outcomes of wellness, recovery, and growth/development among older persons facing multimorbidity. In addition, a multimorbidity resilience index comprising functional, social, and psychological domains capturing both adversity and adaptation is described. The results of criterion validation of the index based on health care utilization and health status outcomes is presented, and offers support for this measure. Further confirmatory research is needed for both the LMMR and the multimorbidity resilience index using other known population health data sets. This relevance of multimorbidity resilience has been increased during the COVID-19 pandemic and beyond. Research is also warranted using different populations and sub-populations as well as clinical settings.

This chapter provides a rationale for the theme of this book, an overarching conceptual framework, and summarizes and integrates the other 11 chapters. It will also detail the Friesen Conference, entitled “Understanding and Fostering Resilience in Older Adults,” held at Simon Fraser University, June 10–11, 2019, that served as a springboard for this work. This chapter also positions resilience thinking against broader theoretical developments in the gerontological literature, including positive and developmental psychological approaches of aging, the selection, optimization, and compensation (SOC) model, life-course theory, stress and homeostasis theory, person-environment theory, socio-environmental theory, complex systems models, community development approaches, and successful aging models. It is contended that conceptual, theoretical, and measurement developments as well as innovations embedded in this volume will generate a new phase in resilience research applied to aging and older adults. This volume is particularly relevant in the current and post-COVID-19 era, which has placed aging-related issues in the forefront.

As the number of older adults increases worldwide, it is becoming increasingly important to find effective ways of fostering better ageing trajectories. The models used to shape this process inform...

Being homeless has a negative effect on health and the health needs of individuals experiencing homelessness are complex and challenging to address. As a result of limited access to and use of primary healthcare, the main point of entry into the healthcare system for individuals experiencing homelessness is often hospitals and emergency departments. Persons experiencing homelessness are commonly discharged from hospital settings to locations that do not support recovery or access to follow-up care (e.g. shelters or the street). This can be costly to both the healthcare system and to individuals' health and quality of life. We conducted a scoping review of the literature published between 2007 and 2017 to identify the types of health supports needed for persons experiencing homelessness who are discharged from the hospital. Thirteen literature sources met inclusion criteria and thematic data analyses by two researchers resulted in the identification of six themes related to the types of health supports needed for persons experiencing homelessness who are transitioning (i.e. being discharged) from the hospital. Using a community consultation approach, the scoping review themes were validated with 23 health and shelter service providers and included in our integrated findings. Themes included: (a) a respectful and understanding approach to care, (b) housing assessments, (c) communication/coordination/navigation, (d) supports for after-care, (e) complex medical care and medication management, and (f) basic needs and transportation. These themes were found to resonate with participants of the community consultation workshop. Recommendations for trauma-informed care and patient- or client-centred care approaches are discussed.

Background Multimorbidity is recognized as a major public health issue that increases with age and affects approximately two-thirds of older people in Canada, the US, Australia and many European countries. This study develops and tests a three domain (functional, social and psychological) multimorbidity resilience composite index based on a previously developed lifecourse model of multimorbidity resilience, incorporating measures of adversity and positive adaptation. The criterion validity of the measure is demonstrated by means of an analysis of key outcome variables drawn from the literature. Methods We used the baseline data from the Comprehensive Cohort of the Canadian Longitudinal Study on Aging. Associations of functional, social, psychological as well as total resilience with two health utilization and three illness context outcome variables were examined using logistic regression analyses, adjusted for age, gender, marital status, income, education, region, and number of chronic conditions. Results The sample included all 6771 Canadian adults aged 65 or older (mean age 73.0, 57% women) who reported two or more of 27 possible chronic conditions. Total resilience was associated with: perceived health (OR = 1.68, CI 1.59–1.77); sleep quality (OR = 1.34, CI 1.30–1.38); perceived pain (OR = 0.80, CI 0.77–0.83); hospital overnight stays (OR = 0.87, CI 0.83–0.91); and emergency department visits (OR = 0.90, CI 0.87–0.94)., after adjusting for socio-demographic factors, and number of chronic conditions. These associations were similar for the unadjusted models, as well as for the functional, social and psychological resilience sub-indices. Conclusions Combining components of adversity and positive adaptation within functional, social and psychological domains produces a measure of multimorbidity resilience that is associated with more positive health outcomes. Several implications of a composite multimorbidity resilience measure for clinical practice are identified. This measure can be replicated using measures found in other secondary health data sets. Future validation using longitudinal data is warranted. Electronic supplementary material The online version of this article (10.1186/s12877-018-0851-y) contains supplementary material, which is available to authorized users.

Background Restrictions implemented to mitigate the transmission of COVID-19 have affected the ability of many older adults to engage in social and physical activities. We examined the mental health outcomes for older adults whose ability to be socially and physically active was reduced during the course of the COVID-19 pandemic. Methods Data from the Canadian Longitudinal Study on Aging (CLSA), a nationally representative longitudinal cohort of Canadian residents aged 45–85 years, at CLSA baseline (2012–15), follow-up 1 (2018), COVID-19 baseline (April–May, 2020), and COVID-19 exit surveys (September–December, 2020) were used. Participants were asked the degree to which their ability to participate in social and physical activity had been affected by the COVID-19 pandemic. Binary logistic regression was used to examine the relationship between the risk of a positive screen for depression (Center for Epidemiological Studies Depression Scale score >10) and anxiety (Generalised Anxiety Disorder Assessment-7 score >10) and reduced participants' ability to participate in social and physical activity. Models were adjusted for age group, dwelling type, geographic area, household composition, Center for Epidemiological Studies Depression Scale, and smoking status at COVID-19 baseline; alcohol consumption at COVID-19 exit; and multimorbidity, physical activity, income, social participation, and diagnosis of anxiety or mood disorders before the COVID-19 pandemic. Findings Of the 24 108 participants who completed the COVID-19 exit survey, 5219 (22·0%) screened positive for depression and 1132 (5·0%) screened positive for anxiety. Depression and anxiety were associated with a decreased ability to participate in social activity (odds ratio [OR] 1·85 [95% CI 1·67–2·04] for depression; 1·66 [1·37–2·02] for anxiety) and physical activity (2·46 [2·25–2·69] for depression; 1·96 [1·68–2·30] for anxiety). Interpretation Older adults whose ability to participate in social and physical activities was reduced during the COVID-19 pandemic had poorer mental health outcomes than those whose ability remained the same or improved. Individuals who had low pre-COVID-19 levels of social and physical activity had a higher frequency of positive depression and anxiety screens. These findings highlight the importance of fostering social and physical activity resources in advance of, and during, future lockdown measures. Funding The CLSA COVID-19 Questionnaire study was funded by the Juravinski Research Institute, Faculty of Health Sciences, McMaster University, McMaster University Provost Fund, McMaster Institute for Research on Aging, Public Health Agency of Canada, and Government of Nova Scotia. The CLSA is funded by the Government of Canada through the Canadian Institutes of Health Research (grant number LSA94473) and the Canada Foundation for Innovation. PR holds the Raymond and Margaret Labarge Chair in Optimal Aging and Knowledge Application for Optimal Aging, and a Tier 1 Canada Research Chair in Geroscience. TDC is a Michael Smith Foundation for Health Research Scholar (grant number SCH-2020-0490).

Context:As a result of increases in life expectancy and decreases in fertility, the proportion of the population entering later life has increased dramatically in recent decades. When faced with age-related challenges, some older adults respond more positively to adversity than would be expected given the level of adversity that they have experienced, demonstrating ‘resilience’. Objectives:Having a clear conceptual framework for resilience is a prerequisite to operationalising resilience in a research context. Methods:Here we compare and contrast several approaches to the operationalisation of resilience: psychometric-driven and data-driven (variable-centred and individual-centred) methods. Results:Psychometric-driven methods involve the administration of established questionnaires aimed at quantifying resilience. Data-driven techniques use statistical procedures to examine and/or operationalise resilience and can be broadly categorised into variable-centred methods, i.e. interaction and residuals, and individual-centred methods, i.e. categorical and latent class. Conclusions:The specific question(s) driving the research and the nature of the variables a researcher intends to use in their adversity-outcome dyad will largely dictate which methods are more (or less) appropriate in that circumstance. A measured approach to the ways in which resilience is investigated is warranted in order to facilitate the most useful application of this burgeoning field of research.

Background Physical resilience is the ability to optimize or recover motor function in the face of disease, injury, or aging-related decline. Greater knowledge of how some individuals regain or maintain function despite pathology may help identify protective factors and approaches that promote healthy aging. To date, a scoping review on physical resilience has not been conducted. The aims are to (1) identify measurement instruments for physical resilience, (2) synthesize and map the key concepts of physical resilience, and (3) identify gaps and make recommendations for future research. Methods A scoping review of Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Medline Ovid, PsycINFO, and AgeLine databases will take place using the search strategy “resilience” AND (aging OR elderly OR older adult). The initial electronic search will be supplemented by hand searching the reference lists and review articles to identify any missing studies. Two parallel independent assessments of study eligibility will be conducted for the title, abstract, and full-text screens. To meet study inclusion criteria, the term “resilience” must be applied in relation to the physical health of older adults. Any disagreement will be resolved by consensus and a third reviewer consulted to make a decision if consensus is not achieved initially. Physical resilience information to be extracted are measurement instruments that describe the core domains of (1) body function or structure (signs or symptoms, etc.), (2) activity and participation (quality of life, etc.), and (3) societal impact. Tables and/or charts will map the data with distribution of studies by core domains. Finally, the amalgamation of results will be an iterative process whereby reviewers will refine the plan for presenting results after data extraction is completed so that all of the contents of the extraction may be included in the results. Discussion The information gleaned in this scoping review will be essential to understand how physical resilience is currently measured and identify gaps for further research. Electronic supplementary material The online version of this article (10.1186/s13643-019-0950-7) contains supplementary material, which is available to authorized users.

RÉSUMÉL’isolement social a retenu l’attention des chercheurs, en particulier dans la recherche concernant les personnes âgées, étant donné les corrélations établies avec la mortalité et le risque de mauvaise santé physique ou mentale. Toutefois, les mesures utilisées jusqu’à maintenant pour l’isolement social ont grandement varié et manquent souvent de clarté conceptuelle. La présente étude s’appuie sur un cadre conceptuel de classification des mesures d’isolement social et explique l’élaboration et la validation d’un indice composite d’isolement social (ELCV-SII) qui a été créé en utilisant les données de l’Étude longitudinale canadienne sur le vieillissement (ELCV). L’échantillon de l’ELCV incluait 21 491 Canadiens âgés de 65 ans ou plus (âge moyen : 72,9 ans; à 53,5 % de sexe féminin) retrouvés dans les données de base des cohortes de suivi et de la cohorte globale de l’ELCV (n = 51 338). Le CLSA-SII a été élaboré en utilisant une méthodologie standard, qui a été suivie pour la création d’autres mesures, dont la résilience à la multimorbidité et les indices de vieillissement efficaces. Les associations entre l’ELCV-SII et quatre variables clés (échelle de satisfaction de vie, dépression, santé mentale perçue et santé perçue) ont été évaluées par des analyses de régression, en tenant compte de l’âge, du sexe, du revenu et de la scolarité. Les associations entre l’indice CLSA-SII et les quatre variables d’intérêt ont donné lieu à des associations modérées statistiquement significatives conformes à la tendance prévue, qui concordent avec les recherches antérieures, ce qui démontre une bonne validité convergente pour l’ELCV-SII.

The purpose of this article is to advance a Lifecourse Model of Multimorbidity Resilience. It focuses on the ways in which individuals face adversities associated with multimorbidity and regain a sense of wellness through a complex, dynamic phenomenon termed resilience. A comprehensive review of 112 publications (between 1995 and 2015) was conducted using several comprehensive electronic data bases. Two independent researchers extracted and synthesized resilience literature with specific applications to chronic illness. The article outlines five stages of theoretical development of resilience, synthesizes these with the aging and chronic illness literature, builds a rationale for a lifecourse approach to resilience, and applies the model to multimorbidity. Cultivating and maintaining resilience is fundamental to functioning and quality of life for those with multimorbidity. We found that there are a number of gaps in both basic and applied research that need to be filled to advance knowledge and practice based on resilience approaches.

Family caregiving is associated with social isolation, but the role of geographic distance between caregiver and receiver in caregiving experience is unclear with mixed research findings. This study examined the relationship between geographic distance and caregiver social isolation (CSI), and explored the interaction between geographic distance and caregiving intensity in association with CSI. Based on the Ecological Model of Caregiver Isolation, hierarchical linear regression and ANCOVA analyses were applied to conduct data analysis with the 2012 Canadian General Social Survey (N=2,881). Caregivers living a short distance from receivers reported the lowest CSI than coresident, moderate and long distance caregivers. Being involved in higher intensity caregiving as the primary caregiver, undertaking more caregiving tasks, and providing care more frequently resulted in higher CSI scores. Additionally, long and moderate distance caregivers reported greater CSI than coresident and short distance caregivers only when providing higher intensity caregiving. Geographic distance is a salient contextual factor affecting CSI, and longer distance creates environmental barriers for caregiving provision. Employing a granulated measure of geographic distance positioned within an ecological framework facilitates an understanding of the nuanced association between geographic proximity and CSI. Furthermore, the identified interactive effects between geographic distance and caregiving intensity on CSI further reveal the complexity of caregiving experience. The findings are relevant for programs supporting caregivers in different contexts, especially physical distance.

ObjectivesWe aimed to develop and internally validate a measure of multimorbidity burden using data from the Canadian Longitudinal Study on Aging (CLSA).DesignData from 40 264 CLSA participants (52% men) aged 45–85 years (a mean of 63 years) were analysed. We used logistic regression models to predict overnight hospitalisation in the last 12 months in the development dataset (random two-thirds of the total) and used these to construct 10 multimorbidity indices (5 models, each treated with and without an age interaction term). Thirty-five chronic conditions were considered for inclusion in these models, in addition to age and sex. We assessed predictive and convergent validity for these 10 different multimorbidity indices in the validation dataset (remaining one-third of the total).ResultsThe absolute count of chronic conditions plus an interaction with age, displayed strong calibration properties, outperforming other candidate indices. Discrimination was modest for all of the indices that we internally validated, with C-statistics ranging from 0.66 to 0.68. The indices showed weak correlations (ie, convergent validity) with satisfaction with life, functional disability and mental health (absolute Pearson’s correlation coefficients ranging from 0.11 to 0.30) but generally moderate correlations with self-rated general health (0.32–0.45).ConclusionsWe investigated alternative methods to measure the multimorbidity burden of individuals, tailored to the CLSA. Our findings show that an absolute count of conditions, along with an age interaction term, has the strongest calibration for overnight hospitalisation in the last 12 months. The utility of an age interaction term in measuring multimorbidity burden may be applicable to the study of chronic disease in cohorts other than the CLSA.

In Metro Vancouver (Canada) there has been a significant increase in homelessness among persons aged 55+. This group has worse health than the general population. Moreover, discharging homeless patients from hospital to community settings is difficult, particularly for older adults. To improve continuity of care and enhance outcomes for older homeless persons, a better understanding of the health supports required for discharge is needed. We conducted 40 in-depth interviews to capture the perspectives of housing and healthcare providers and persons with lived experience of homelessness to identify the health supports needed for these transitions. Thematic analysis revealed older adults are often discharged to inappropriate locations, such as shelters, given a lack of better options. Older adults experience vulnerability in shelter settings and face unique challenges in light of complex health issues. Recommendations for senior-specific shelter and transitional housing and services will be described.