Canadian Journal on Aging-Revue Canadienne Du Vieillissement最新文献

We evaluated the feasibility and acceptability of frailty screening using handgrip strength with gait speed measures within four primary care-based memory clinics in Ontario. This mixed methods quality improvement initiative examined the reach, effectiveness, adoption, implementation, and maintenance of frailty screening from the perspective of patients (N = 216), care partners (N = 142), and healthcare providers (N = 9). Frailty screening was well-received by patients and care partners and perceived as quick and easy to administer and integrate into assessment processes by healthcare providers at all four memory clinics. The ease of integrating frailty screening into clinic processes was a key factor facilitating implementation; few challenges or suggestions for improvement were identified. All four clinics plan to continue frailty screening, three using the methods adopted in this study. Integrating frailty screening into memory assessments is feasible and acceptable and, given the interactional relationship between frailty and dementia, provides a significant opportunity to improve health outcomes for older adults.

Increasing rates of dementia in First Nations populations require culturally grounded approaches to dementia diagnosis and care. To respond to the need for a culturally appropriate cognitive assessment tool, a national team of health services researchers and community partners, guided by a Nakoda Advisory Group, aimed to adapt the Canadian Indigenous Cognitive Assessment tool for a Nakoda First Nation in Carry the Kettle First Nation, Saskatchewan, Canada. The adaptation of the CICA for a Nakoda First Nation community resulted in a slightly modified version of the CICA signalling that the CICA requires minimal adaptation to be used in different First Nations contexts.

Canadians overwhelmingly do not want to live in long-term care institutions (LTCIs) when they age; yet many end up there for lack of home care, because family care partners burn out, or because they and their professional advisors are unaware of alternatives to institutions. Not only is institutional dementia care riven with problems, it segregates disabled people, thereby abrogating human rights. Because systemic ageism and ableism cloud seniors' care, institutions remain the default option for Canadians with dementia. Yet, decades of deinstitutionalization enabled younger disabled Canadians to live in the community with supports. Why not seniors? We describe a plethora of noninstitutional dementia-care alternatives. We then present a roadmap for considering all relevant care options in service plans, one that incorporates supported decision making by people with dementia. We propose a paradigm shift in how Canada serves its senior citizens - not just the current generation, but those to come, including ourselves.

To improve transitions in care, a new patient navigation (PN) program was introduced to support older adults with complex care needs transition from hospital to home. The patient navigator is a community social worker embedded in the hospital's care teams. A cohort observational design was used to conduct the study by analysing the patient navigator's clinical notes and hospital's administrative data to describe the characteristics of patients, scope of the patient navigator's activities, and patient outcomes. Ninety patients were assigned to the patient navigator's caseload (November 2019-November 2021) in which the average age was 78.9 (range 55-95). The most frequent PN intervention types were referrals to community services (66%, n = 59) and discharge planning (61%, n = 55). The patient navigator supported 66% patients (n = 59) in returning home and provided follow-up care for 74 days (average). This study provides important insights into the patient navigator's role to guide decision makers in implementing PN programs for older adults in a hospital setting.

Supportive public policies are suggested as ways to lessen gentrification's impact for older adults. While explicit policies designed to help older adults with gentrification are rare, literature on age-friendly cities is a close proxy. We utilized three North American cases undergoing gentrification: New York City, NY, and Denver, CO, in the United States and Hamilton, in Ontario, Canada, to present existing neighbourhood-based policies as social determinants of health in housing, resource access, healthcare, transportation, and communal places. Age-friendly policy application gap examples and COVID-19's impact were included. Using a qualitative comparative case study method, we found policies were not specifically designed to address older adults' gentrification needs. With the call for age-friendly designations, the role of gentrification in neighbourhoods with older populations must be included. We call for gentrification-specific policies for older adults to provide greater safeguards especially when events such as COVID-19 compete for existing, over-stretched resources.

As demographics and gender norms shift, more older men will be providing care for their wives living with dementia than ever before. Research on husbands as caregivers is limited and offers an incomplete picture of their role development and how they experience caregiving. This study examined husbands whose wives have dementia and how they provide care and construct their sense of self. Semi-structured interviews with 11 men aged 61-88 were conducted in Ontario, Canada. Data were analyzed using constant comparison analysis and a constructivist grounded theory (CGT) approach. Two categories were developed: Adapting to the Role of Caregiver and Staying a Husband. Caregiving as a husband for a wife living with dementia required revision of the role of husband to include that of caregiver by reimaging intimacy, being a protector in new ways, and finding new meanings to being a provider and the value of wealth.

This study provides researchers, practitioners, and policy makers with a profile of older adults' travel behaviour and the older adult population that reports unmet travel needs. In addition, we quantified associations between reporting an unmet travel need and measures of health and social connectedness. Data came from the second follow-up survey of the Canadian Longitudinal Study on Aging, collected from 2018 to 2021 (n = 14,167). Nine in ten (90.2%) older adults aged 65 years and older indicated that driving is the main way they get around. Older adults with an unmet travel need were more likely to be women, have lower household incomes and education levels, and have a mobility limitation. People with an unmet travel need had 2.7 times the odds of reporting fair or poor general health (OR = 2.66, 95% CI: 2.19, 3.22) and 3.1 times the odds of feeling socially isolated (OR = 3.10, 95% CI: 2.57, 3.72) compared to those without an unmet need.

The relationship between frailty and glycemic control in older adults with diabetes remains uncertain, mainly due to the fact that previous studies have not accounted for measures of body composition. In older adults with diabetes, we examined the association between three types of frailty measures and glycemic control, while accounting for fat-free mass (FFM) and waist circumference (WC). Eighty older adults (age ≥65, 27 women and 53 men, mean age 80.5 ± 0.6 years) had gait speed, Cardiovascular Health Study Index (CHSI), Rockwood Clinical Frailty Scale (RCFS), and glycosylated hemoglobin (Hg_A1C) measured. Hg_A1C showed a negative association only with CHSI (standardized β = -0.255 ± 0.120, p = 0.038), but no association with gait speed or the RCFS. Even after accounting for FFM and WC, we demonstrated a negative association between glycated hemoglobin and increasing frailty in older adults with diabetes.

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.

As Western society becomes increasingly digitally dependent and many older adults actively engage in the online world, understanding the experiences of those who largely do not use digital technology in their daily lives is crucial. Individual interviews were conducted (pre-pandemic) with 23 older adults who, based on self-identification, did not regularly use digital technology, exploring how their experiences as limited digital technology users may have impacted their daily lives. An iterative collaborative qualitative analysis demonstrated three main themes: internet concerns, frustrations with digital technology, and conflicting motivators to use digital technology. Findings suggest that addressing digital concerns and providing effective digital skill learning opportunities may encourage some older adults to become more digitally engaged. However, as people, including older adults, can be uninterested in using these technologies, organizations and institutions should work to offer ways to support people of all ages who are not engaged online.