HealthcarePapers最新文献

Health system leaders, researchers and the public alike recognize the multiple and often tragic ways in which our health systems continue to fail older adults. We have long been aware of the demographic shifts in our population that are seeing an increasing percentage of the population over the age of 65 years; in fact, up to 30% of the Canadian population is projected to be over 65 years of age by the year 2068 (Statistics Canada 2022). However, we have not yet seen the system-wide adaptations and reforms to health systems to support people to maintain their health as they age.

This paper explores the rapidly growing integration of technology in the delivery of health and social care specifically focused on enabling "Ageing in the Right Place" (AIRP) (Iciaszczyk et al. 2022: 1). While exploring emerging opportunities and challenges, it specifically highlights growing disparities that are creating digital divides, as well as ethical concerns that will need to be addressed and supported by comprehensive evaluation frameworks and policies. Ultimately, the development of inclusive and ethical technologies for enabling AIRP in collaboration with all relevant stakeholders - including policy makers, researchers, caregivers and older adults - is needed to ensure that new technologies can both empower and ultimately improve the lives of older adults.

Members of the Indigenous mental wellness and trauma-informed specialist workforce - including Mental Wellness Teams (MWTs), Crisis Support Teams (CSTs), the Indian Residential Schools Resolution Health Support Program workforce, and other community-based cultural support workers - are often the primary and urgent care providers for individuals and families in need of culturally safe supports. While fulfilling a critical role, these teams contend with distinct challenges stemming from colonial impacts and health systems that continue to undermine Indigenous mental wellness and cultural traditions of healing. During the COVID-19 pandemic, increasing rates of mental illness and substance use among Indigenous populations strained the already overworked and under-resourced mental wellness workforce. First Peoples Wellness Circle sought out and embraced new approaches for meaningful virtual engagement to sustain and enhance workforce wellness and capacity by facilitating culturally relevant and culturally led connections from coast to coast to coast.

Patients and professionals face important crises through their "normal" experiences of illness and care, which can either prepare them or make them more vulnerable to global crises. What can we learn from these experiences to nurture more resilient health ecosystems? In this commentary, we reflect on resilience in times of crisis, based on our lived experience as patient and physician. We learned that identifying "who is strong" and "who is vulnerable" can be surprising and unexpected, that patients and professionals can lean on one another at different stages of crises and that resilient health ecosystems require reciprocal, caring relationships at the individual and collective levels.

We are honoured to bring this special edition to you and hope that it will resonate with and cause you to think and rethink what it means to engage people as they intersect with the healthcare system. Being co-editors of this special edition has provided us with a unique opportunity to learn from the lived and professional experiences of people actively working to develop and nurture engagement-capable environments (ECE). Individually, and in partnership as co-editors, we bring a profound belief in the importance of ECEs as they affect the lives, health and healthcare of individuals, families and communities.

Patient and caregiver engagement is a core component of high-quality healthcare systems. The COVID-19 pandemic revealed to us the fragility of patient and family engagement that was not as firmly rooted in the health system as expected. In this paper, we reflect on case examples from healthcare organizations across Canada where pivots and adaptations were made to patient engagement activities. We share core enablers of engagement in times of high system stress, drawing on illustrative examples. We then synthesize key learnings in relation to existing literature and conclude with reflective questions as we orient the work of engagement into the future.

In their insightful commentary, Kokorelias et al. (2024) explore the potential of technology in supporting aging in the right place, addressing both opportunities and challenges from individual to societal levels. Our commentary specifically focuses on recent empirical evidence for technology's benefits in enhancing social connectivity and reducing loneliness for older adults, both with and without cognitive impairments. It emphasizes the need for a proper balance between the use of technology and face-to-face interactions and highlights the importance of addressing concerns related to privacy, cybersecurity and safety in this domain. In addition to the barriers outlined by Kokorelias et al. (2024), we discuss challenges related to the transfer of technology, the necessary steps required to ensure that technological interventions are effective beyond well-controlled studies and the responsibility of industries to design technology in such a way that innovations can benefit as many people as possible.

As the Canadian population ages, the imperative to support aging in the community grows increasingly urgent. In this commentary, we build on Kokorelias et al.'s (2024) article to address the ethically appropriate role of digital technologies in supporting aging at home. We argue that a nuanced perspective on this topic is crucial. Focusing on the pivotal role of personal support workers in home and community care, we highlight the multiple challenges they face, from precarious employment to safety concerns. While digital innovations offer promise, we suggest that a holistic approach blending policy initiatives with technological advancements is imperative.

The evolving concept of "[a]geing in the right place (AIRP)" (Iciaszczyk et al. 2022: 1) underscores the importance of enabling older adults to receive comprehensive care and support across various settings. There is growing evidence that innovative technologies can empower more persons to maintain their autonomy while better ensuring their safety, well-being and quality of life and also improve the experience of family caregivers and paid care providers. While there exists a powerful belief that technologies can solve all problems, the reality is that they can also present risks, particularly around cybersecurity, privacy and ethical concerns and not deliver any real benefits and in some cases, cause users harm. This paper summarizes a number of pragmatic strategies for addressing these challenges and maximizing the impact of technology in supporting AIRP.

Advocates and researchers have made myriad recommendations to guide policy actors in stopping conversion therapy. This commentary extends these recommendations by identifying core challenges that policy actors face with interventions that solely focus on conversion therapy. Conversion therapy exists because of pervasive social values and beliefs that devalue, erase and stigmatize Two-Spirit, lesbian, gay, bisexual, transgender, queer and other sexual and gender minority (2SLGBTQ+) people, in turn, creating a supply and demand market. That is, those who espouse oppressive values enable and supply conversion therapy for the demand of 2SLGBTQ+ people struggling against these values and those who influence their lives (e.g., guardians). The discussion underscores why policy actors must disrupt the cisheteronormative bedrock that sustains conversion therapy. It is imperative for policy actors to expand policies and programming beyond conversion therapy using an intersectional framework that considers colonialism, racism and cisheterosexism. Interventions must encompass all systems (e.g., health, legal, social, economic) that shape 2SLGBTQ+ people's lives to disrupt the market of conversion therapy.