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Goal‐setting with older adults in home care is often inhibited by a lack of structure to support person‐ and family‐centred care planning, paternalistic decision‐making and task‐oriented delivery models. The objective of this research study was to determine how goal‐setting practices for older adults could be re‐oriented around individuals' self‐perceived goals, needs and preferences. Solution‐focused semi‐structured key informant interviews were conducted with older adult home care clients aged 65 years and older (n = 13) and their family/friend caregivers (n = 12) to explore changes, solutions and strategies for person‐ and family‐centred goal‐setting. Participants were recruited through community advertisement in a single region of Ontario, Canada between July and October of 2017. Interviews were conducted in‐person and were audio‐recorded and transcribed verbatim. Thematic analysis was guided by a multi‐step framework method. Four themes emerged from the data: (1) seeing beyond age enables respect and dignity; (2) relational communication involves two‐way information sharing; (3) doing 'with' instead of doing 'for' promotes participation and (4) collaboration is easier when older adults and caregivers lead the way. Older adults and caregivers want to be actively engaged in dialogue during care planning to ensure their preferences are included. The findings from this study add the direct perspectives of older adults and their caregivers to literature on solutions to address ageism, improve communication, enhance information sharing and promote collaboration in geriatric care. Next steps for this work could involve testing the changes, solutions and strategies that emerged to determine the effect on person‐ and family‐centred home care delivery. [ABSTRACT FROM AUTHOR]

Age-related changes can affect mental health, but aging-focused mental health research is limited. The objective was to identify the top 10 unanswered research questions on aging and mental health according to what matters most to aging Canadians. A steering group of experts-by-experience (e.g., older adults, caregivers, health and social care providers) guided three phases of a modified James Lind Alliance priority-setting partnership: (1) a broad national survey ( n  = 305) and a rapid literature scan; (2) a follow-up national survey ( n  = 703); and (3) four online workshops ( n  = 52) with a nominal group technique. Forty-two unique questions on aging and mental health resulted, of which 18 were determined to be answered by existing evidence. Of the 25 partially and unanswered questions, 10 were ranked as top priority. Findings can be used to prioritize future research, knowledge mobilization, and funding decisions, and to promote and support collaboration between longstanding siloed research and care fields.

Cette étude a examiné les mécanismes complexes intervenant lors de la prestation de soins axés sur la personne et la famille (SAPF) par des équipes de soins gériatriques à domicile. Une approche par synthèse réaliste a été utilisée pour élaborer un cadre d'évaluation qui a inclus 159 références provenant de la littérature scientifique, des consultations d'experts canadiens en SAPF, des recherches ciblées dans les bases PubMed/MEDLINE® et CINAHL, et des recensions de la littérature grise canadienne. Les références ont été sélectionnées par deux personnes, selon une approche consensuelle avec évaluation de la qualité. Les données ont été extraites et synthétisées en tenant compte du contexte, des mécanismes et des configurations des résultats dans un cadre théorique de SAPF d'équipe pour les soins gériatriques à domicile. Le cadre présente les contributions spécifiques prédominantes des infirmières, des ergothérapeutes et des physiothérapeutes, leurs apports collectifs impliquant des communications pour des équipes virtuelles, ainsi que le soutien du système nécessité pour la prestation de SAPF d'équipe complets. Les résultats de cette étude pourraient contribuer à l'amélioration de l'éducation sur les SAPF et des lignes directrices sur les pratiques exemplaires, en vue d'assurer une prestation plus intégrée des SAPF dans les soins gériatriques offerts à domicile ou dans d'autres milieux comportant des équipes de soins., This study investigated the complex mechanisms underlying team-based delivery of person- and family-centred care (PFCC) in geriatric home care. Using a realist synthesis approach, an evaluative framework was developed and populated with 159 references from scoping the literature, consulting Canadian experts in PFCC, purposive searching in PubMed/MEDLINE® and Cumulative Index to Nursing and Allied Health Literature (CINAHL), and reviewing grey literature within Canada. References were selected using a two-person review and/or consensus approach and quality appraisal. Data were extracted and synthesized using context, mechanism, and outcome configurations into a theoretical framework of team-based PFCC in geriatric home care. The framework details the predominant discipline-specific contributions of nurses, occupational therapists, and physiotherapists, their collective contributions through communication in the context of a virtual team, and the system-level support required for comprehensive team-based PFCC delivery. Findings from this study could inform improvements to PFCC education, best practice guidelines, and more integrated delivery of PFCC in geriatric home care and other team-based care environments.

This study explored informal family caregiver experiences in supporting care transitions between hospital and home for medically complex older adults. Using a qualitative, grounded-theory approach, in-depth semi-structured interviews were conducted with community and resource case managers, as well as with informal caregivers of older hip-fracture and stroke patients, and of those recovering from hip replacement surgery. Six properties characterizing caregiver needs in successfully transitioning care between hospital and home were integrated into a theory addressing both a transitional care timeline and the emotional journey. The six properties were (1) assessment of unique family situation; (2) practical information, education, and training; (3) involvement in planning process; (4) agreement between formal and informal caregivers; (5) time to make arrangements in personal life; and (6) emotional readiness. This work will support research and clinical efforts to develop more well-informed and relevant interventions to most appropriately support patients and families during transitional care.