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Introduction: Up to 50% of community-dwelling older adults report living with some chronic pain that interferes with their daily functioning and leads to disabilities. Hence, it is crucial to provide these individuals with strategies to effectively manage pain. An interdisciplinary approach is warranted considering the numerous factors contributing to pain among older adults. Although several studies have been conducted on various interdisciplinary pain self-management programs, little effort has been made to synthesize knowledge about such programs for older adults. Objective: The objective of this review was to synthesize the characteristics and effects of interdisciplinary chronic pain self-management interventions targeting community-dwelling older adults. Methods: A scoping review was conducted following the steps recommended by Arksey and O'Malley (2005) and Levac et al. (2010). Keyword searches were performed in MEDLINE, CINAHL, EMBASE, and the Cochrane Library. Results: Sixty-six articles were included. Most interventions were based on a cognitive-behavioral group approach and used a combination of modalities, including education and training on the use of self-management strategies. The professionals most frequently involved in group interventions were psychologists, physiotherapists, and occupational therapists. Several benefits of these programs have been reported concerning pain intensity, independence in daily functioning, mental health, and quality of life. Conclusions: Interdisciplinary chronic pain self-management programs appear promising in guiding clinical and rehabilitation interventions for older adults living with chronic pain. [ABSTRACT FROM AUTHOR]

Introduction: The challenges experienced by adults living with autism spectrum disorder (ASD) regarding their interaction with their home environment are thinly documented, although these issues persist with age. Based on the Model of Competence, this study aims to explore the human and nonhuman elements of the home environment influencing the functioning of autistic adults. Methods: An exploratory-descriptive qualitative study was conducted in Quebec City, Canada, with autistic adults (n = 6). Individual semi-structured interviews were undertaken by a single interviewer until data saturation was reached. A content analysis was conducted using NVivo software with a list of codes adjusted according to new emerging themes. Results: Eight themes emerged and were grouped into three categories: 1) Person – Adult living with ASD: coping skills, anxiety; 2) Microsystem – Home environment: entourage, sensory elements, spatial arrangement; 3) Person-environment interaction: routines, socialization, control. The experiences of autistic adults highlight the varied interactions experienced with the nonhuman and human elements of their homes, sometimes resulting in a situation of handicap related to their activities and roles. Conclusion: This qualitative exploration of the environmental challenges experienced at home by autistic adults introduces a better understanding of the person-environment interaction, allowing for easier functional assessment and improved home support. [ABSTRACT FROM AUTHOR]

Objective: To identify facilitators and barriers to older adults' participation in telehealth interventions for primary prevention and health promotion. Methods: Relevant articles were searched using keywords in Embase and MEDLINE. Study characteristics, type of telehealth interventions and technology involved, as well as facilitators and barriers to their use, were extracted from selected articles. The Unified Theory of Acceptance and Use of Technology 2 (UTAUT2) model was used to organise data. Results: A total of 24 articles (pertaining to 20 studies) were included. Nine facilitators and 11 barriers influencing the participation in telehealth interventions for primary prevention and health promotion among older adults were identified. The most recurrent facilitators were related to the individual's performance expectancy and effort expectancy, as well as the presence of a social dimension associated with the intervention (i.e. having a good relationship with the other participants in the program). The two most prevalent barriers were also related to effort expectancy and performance expectancy, followed by barriers related to the inherent characteristics of the technology and older adults' health condition. Experience, age and gender were also found to moderate technology use and acceptance. Conclusions: This rapid review highlights the importance of adopting a holistic perspective when designing telehealth interventions aimed at preventive and health promotion purposes among older adults. [ABSTRACT FROM AUTHOR]

Rigorous assessments to better understand the person-environment interaction are essential to comprehend how neurocognitive disorders influence in-home functioning of older people living with dementia. No recent synthesis identifies validated instruments targeting the human (e.g. caregivers) and nonhuman (e.g. objects) elements of the home environment interacting with this population and used with the perspective of aging in place. Consequently, following Arksey and O'Malley's (2005) scoping review method, 2,182 articles were identified in six databases and in gray literature. Two reviewers independently selected 23 relevant articles describing 19 validated assessment tools targeting elements of the home interacting with older people with dementia, namely: nonhuman environment (n = 13), human environment (n = 3), and person-environment interaction (n = 3). This overview highlights the scarcity of tools addressing the human environment and the person-environment interaction to foster sustainable at-home living for older people with neurocognitive disorders, demonstrating the need to incorporate new evidence-based, holistic methods into dementia home care. [ABSTRACT FROM AUTHOR]

Introduction: People with impaired mobility face difficulty accessing dental care. One solution is portable dentistry, which includes delivering dental care in homes or residential institutions. Dentists, however, appear reluctant to offer such services. Our objective was to understand how dentists perceived portable dentistry and potential challenges to its implementation. Methods: We conducted a qualitative descriptive study based on semi‐structured interviews with a sample of dentists in Quebec, Canada. We employed a combination of maximum variation and snowball sampling strategies to recruit 14 participants. The interviews were conducted and audio‐recorded through Zoom and lasted approximately 40 minutes. After transcribing them, we performed a thematic analysis with a combination of inductive and deductive coding. Results: Despite perceiving portable dentistry as a valuable practice model, participants showed little interest in adopting this approach, arguing it was not every dentist's "job" to provide portable services. They believed portable dentistry must be financially burdensome and difficult to integrate into their daily work due to lack of time and portable equipment. Accordingly, participants considered it was the duty of governments, professional organisations overseeing dentistry education and practice, and dental schools to develop portable dentistry programs and hire dentists to deliver such services. Conclusions: To promote portable dentistry, it may be necessary to improve the knowledge and competencies of dentists, but also to challenge their professional identity as well as the current model of dental clinics as the standard of care delivery. To achieve this, we need strong leadership from dental schools, professional organisations and government. [ABSTRACT FROM AUTHOR]

In nearly half of 107 occupational therapy departments in Quebec, occupational therapists participated in research, especially in university hospitals and rehabilitation centers. Most played the role of collaborator, paid evaluator, or research assistant. Research participation was facilitated by time allocation, administrative support, financial assistance, and a research center on site. (Contains 19 references.) (SK)

Supplemental Digital Content is Available in the Text. Background and Purpose: Musculoskeletal disorders (MSKDs) are the most common causes of disabilities for older adults. The aim of this systematic review and meta-analysis is to assess the effectiveness of multimodal interventions including exercise rehabilitation for older adults with chronic MSKDs. Methods: A literature search was conducted up to February 2019 in 5 bibliographical databases to identify randomized controlled trials (RCTs) that compared multimodal interventions including exercise rehabilitation with usual medical care or no intervention. Randomized controlled trials were assessed with the Cochrane risk-of-bias tool. Meta-analyses were performed and pooled mean differences (MDs) or standardized mean differences (SMDs) were calculated. Results: Sixteen RCTs (n = 2322 participants) were included. One RCT was considered at low risk of bias, 8 had some concerns of bias, and 7 had a high risk of bias. Participants suffered from hip or knee osteoarthritis (OA) (n = 12 RCTs), low back pain (LBP) (n = 2 RCTs) and generalized chronic pain (GCP) (n = 2 RCTs). Multimodal interventions were significantly more effective than usual care to decrease pain (visual analog scale, out of 10 points) in the short term, MD: −0.71 (95% confidence interval [CI] −1.08 to −0.34, n = 900), and in the long term: MD: −0.52 (95% CI −0.98 to −0.05, n = 575), but these differences are not considered clinically important. In terms of disabilities, multimodal interventions were also significantly more effective than usual care. The SMDs were −0.47 (95% CI −0.61 to −0.34, n = 903) and −0.29 (95% CI −0.46 to −0.13, n = 568) for OA trials in the short and long terms, respectively, and −0.47 (95% CI −0.81 to −0.12, n = 211) for LBP and GCP trials in the short term. The magnitude of these effects may be considered as small to moderate. Conclusion: Multimodal intervention including exercise rehabilitation combined with usual medical care is an efficacious therapeutic option to reduce disabilities in older adults with chronic MSKDs. A significant but not clinically important effect was observed for pain. The most beneficial component of the multimodal interventions in terms of education, exercises, or medication remains to be determined. [ABSTRACT FROM AUTHOR]

Abstract Background Many people who have suffered a stroke require rehabilitation to help them resume their previous activities and roles in their own environment, but only some of them receive inpatient or even outpatient rehabilitation services. Partial and unmet rehabilitation needs may ultimately lead to a loss of functional autonomy, which increases utilization of health services, number of hospitalizations and early institutionalization, leading to a significant psychological and financial burden on the patients, their families and the health care system. The aim of this study was to explore partially met and unmet rehabilitation needs of older adults who had suffered a stroke and who live in the community. The emphasis was put on needs that act as obstacles to social participation in terms of personal factors, environmental factors and life habits, from the point of view of four target populations. Methods Using the focus group technique, we met four types of experts living in three geographic areas of the province of Québec (Canada): older people with stroke, caregivers, health professionals and health care managers, for a total of 12 groups and 72 participants. The audio recordings of the meetings were transcribed and NVivo software was used to manage the data. The process of reducing, categorizing and analyzing the data was conducted using themes from the Disability Creation Process model. Results Rehabilitation needs persist for nine capabilities (e.g. related to behaviour or motor activities), nine factors related to the environment (e.g. type of teaching, adaptation and rehabilitation) and 11 life habits (e.g. nutrition, interpersonal relationships). The caregivers and health professionals identified more unmet needs and insisted on an individualized rehabilitation. Older people with stroke and the health care managers had a more global view of rehabilitation needs and emphasized the availability of resources. Conclusion Better knowledge of partially met or unmet rehabilitation needs expressed by the different types of people involved should lead to increased attention being paid to education for caregivers, orientation of caregivers towards resources in the community, and follow-up of patients' needs in terms of adjustment and rehabilitation, whether for improving their skills or for carrying out their activities of daily living.

Abstract Background Services to meet adequate rehabilitation needs of elderly stroke survivors are not always provided. Indeed, since 1995, in the wake of the Quebec shift to ambulatory care, home care services, mainly those related to rehabilitation of the elderly, are either unavailable or incomplete. The aim of this study was to examine the rehabilitation needs of this clientele from their hospitalization to their reintegration into the community. Methods The "Handicap Production Process" conceptual approach was chosen to help identify the rehabilitation needs of persons affected by physical or cognitive disabilities due to the interactions between personal and environmental factors, and (activities of daily living, social roles). This qualitative exploratory study was performed in 2003. Data were collected among four groups of experts: patients, caregivers, health care providers and administrators. Data triangulation was used to ensure a rigorous analysis and validity of the results. Results Unfulfilled needs could be found in the categories of pertaining to residence, community living, psychological and emotional needs. Indeed, it appears that a psychological follow-up to discuss acceptance and consequences of non-acceptance would facilitate mid-to long-term rehabilitation. Conclusion Improving accessibility to healthcare services, respecting priority parking spaces for the disabled as well as promoting public awareness would enable a better social reintegration and recovery of social roles, thus limiting the onset of handicap situations.

Two of the most salient problems in nursing homes are the responsive behaviours and falls of older people living with Alzheimer's disease and related disorders. Intelligent videomonitoring and mobile applications are potential technologies that may help prevent and manage these problems. However, evidence for the needs for technologies in nursing homes is scarce. This study aimed to explore the perceptions and needs of care managers, and of formal and family caregivers in nursing homes regarding these potential technologies. With an exploratory qualitative design based on Rogers' diffusion of innovation theory, individual interviews and a content analysis were conducted. Results show that the potential users of these technologies consider them relevant in nursing homes. The characteristics that would make these technologies useful in nursing homes are described. These results could be used to develop useful technologies to improve the quality of clinical practice in nursing homes. [ABSTRACT FROM AUTHOR]

Aims: The fall rate in urgency urinary incontinence (UUI) and mixed UI (MUI) older women is higher when compared with that of continent women. One hypothesis is that a strong desire to void (SDV) could alter gait parameters and therefore increase the risk of falls. The aim of this study was to investigate and compare the effect of SDV on gait parameters in UUI/MUI and continent older women who experienced falls. The secondary aim was to determine the relationship between UI severity and gait parameters in incontinent women. Methods: A quasi‐experimental pilot study was conducted with two groups of healthy community‐dwelling women who experienced at least one fall in the last year: continent (n = 17; age: 74.1 ± 4.3) and UUI/MUI (n = 15; age: 73.5 ± 5.9). We recorded, analyzed, and compared spatiotemporal gait parameters for participants in each group with both SDV and no desire to void condition. Results: A pattern of reduced velocity (P = 0.05) and stride width (P = 0.02) was observed in both groups with SDV. Incontinence severity was correlated with reduced velocity (rs = −0.63, P = 0.01), increased stance time (rs= 0.65, P =.01) and stance time variability (rs = 0.65, P =.01) in no desire to void condition and with reduced velocity (rs = −0.56, P =.03) and increased stride length variability (rs = 0.54, P =.04) in SDV condition. Conclusions: SDV reduced gait velocity and stride width regardless of continence status in older women at risk of falls. Further, UI severity in the UUI/MUI women was correlated to reduced gait velocity and increased variability. Our findings could explain the higher fall rate in this population. [ABSTRACT FROM AUTHOR]