Background: Cannabis consumption has increased significantly among older adults since the legalization of recreational cannabis use in Canada. It is reported that older adult consumers of cannabis are more likely to be new users, and to use cannabis for medical reasons. Within this group, some requests for cannabis are initiated in long-term care settings. The purpose of this rapid review is to identify available knowledge about medical cannabis use in long-term care.
Methods: A systematic search of PsychINFO and PubMed electronic databases was conducted for literature published from 2005 to 2019. We included studies that examined cannabis therapy used in long-term care settings. Only peer-reviewed journals that were published in English were included in this rapid review.
Results: A total of 9 articles met inclusion criteria. These articles illustrate that cannabis is currently being tested as a therapy for five conditions that are prevalent in long-term care: pain, arthritis, cancer, dementia, and MRSA infections. Hypothesized benefits include reduced pain and inflammation, improved appetite, and reduced neuropsychiatric symptoms
Conclusion: Currently, since there are only a small number of studies of cannabis therapy in long-term care populations, evidence of safety and treatment efficacy is inconclusive, future research is needed.
Background: The Neil and Susan Manning Cognitive Health Initiative (CHI) is a donor-funded collaboration between the Vancouver Island Health Authority and the University of Victoria established to improve dementia care on Vancouver Island, BC. In September 2019, the CHI established a Specialist Memory Clinic (SMC) within a tertiary Seniors Outpatient Clinic (SOPC); a multidisciplinary clinic staffed by specialists from geriatrics and neurology. In Ontario, family practitioner led Primacy Care Memory Clinics (PCMC) have successfully reduced dementia referral volumes to geriatric speciality services. This model is not currently available in BC. We sought to determine the potential impact PCMCs could have on Vancouver Island to reduce referral volumes to geriatric specialists.
Methods: SOPC staff meet weekly to perform secondary triage and categorize referrals by primary referral reason and identify appropriate SMC referrals. The following criteria were applied to determine if referrals could hypothetically be seen by a PCMC: no complex/comorbid medical conditions; absence of responsive behaviours; intact ADLs; low-to-moderate frailty.
Results: Over a 19-month period from October 2019 to April 2021, the SOPC received 2357 referrals. Of those, 1365 (58%) were referred to SMC for cognition, and 870 (64%) of the SMC referrals were candidates for evaluation at a PCMC.
Conclusions: The establishment of PCMCs on Vancouver Island has the potential to reduce referral burden on geriatric specialty services by 37% and potentially decrease patient wait times for initial consultations. Work in Fall 2021 will endeavour to calculate the real-world impact of these nascent clinics.
Smoking can be a barrier to a long term care home admission for older adults. Long term Care homes often identify they feel ill equipped to accept smokers into their care facilities. There are concerns of risks for residents participating in covert smoking and associated risks for fires. In this workshop participants will learn how to support safe smoking cessation in long term care at the point of transition. This session will explore two approaches to becoming a smoke free environment; from a mental health hospital setting and from the setting of an urban long term care home. The participants will learn ways to support residents with safe smoking cessation or without dementia who have nicotine dependence. This workshop will help clinicians to support residents with nicotine dependence. Participants including administrators and policy makers will learn how benefit from discussions on ways to inform policy to practice to support smoke free environments in LTCH. Behavioural and Pharmacotherapeutic approaches in the treatment of nicotine use disorder will be discussed. Care and compassion to support residents to safely and comfortably participate in smoking cessation is a key component to success.
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Social workers in hospitals are mobilized around discharge planning of older adults with loss of autonomy. Discharge planning require an amalgamation of direct and indirect activities. The quantity and duration of activities may vary depending on the complexity of the clinical situation. Objective: to elucidate the complexity and the variability of the activities carried out in the discharge planning processes by social workers. Methodology: A time and motion study was carried out to describe the interventions performed by social workers. Semi-structured interviews were conducted with social workers to understand the clinical reasoning underlying the activities performed. The complexity of the clinical situation of the older adults was established with a review of the medical files supported by a grid based on the synergic model. Results: Social workers perform an average of 45 activities per day, 86% of the activities observed were indirect activities, 45% were communications with team members or external partners (private or community services) to collect or to give information about the hospital discharge. According to the criteria of the synergic model, moderate to high level of clinical complexity were due to unpredictability, instability, insufficient formal and informal support and difficulty with decision making. Conclusion: The time devoted to communication raises questions about the tools available to social workers to do an efficient job, in particular the lack of information technologies. The results allow better targeting of complex situations that can be detected upon admission for rapid management.
Purpose: To investigate the association between sedentary time, physical function, and hospitalization in middle-aged and older adults. Methods: Baseline data on physical function (Timed Up and Go (TUG) and grip strength), self-reported sedentary time from the Physical Activity for Elderly Scale and relevant covariates, and follow-up data on hospitalization from participants in the Canadian Longitudinal Study on Aging (CLSA), Comprehensive cohort, were analyzed using logistic regressions (n=27,765, mean age 62.7 (10.1) years, 59% female). Results: Associations between sedentary time and the three hospital outcomes (overnight hospitalization, emergency department visit, and falls-related hospitalization) differed by age and sex. In middle-aged females, those with high levels of sedentary time had lower odds of reporting a falls-related hospitalization compared to those with low levels of sedentary time (OR 0.37; CI:0.16, 0.81). Among older females, higher TUG scores (every second) were associated with higher odds of falls-related hospitalization (OR1.17; CI:1.07,1.31). In middle-aged males, those with high levels of sedentary time had higher odds of reporting an emergency department visit (OR 1.14; CI:1.00, 1.30). Among older males, higher TUG scores (every second) was related with overnight hospitalization (OR 1.06; CI:1.03, 1.10) and emergency department visits (OR 1.03; CI:1.01, 1.07). Conclusion: The associations of sedentary time and physical function with hospitalization appear to vary by sex and age. Future intervention research is needed to determine the effect of reducing or breaking up sedentary time on hospitalization and falls.
The purpose of this project (TeachingCity Oshawa initiative) is to evaluate the effectiveness of the Oshawa Senior Community Centres (OSCC55+)’s virtual, online programs in addressing the needs for social connection and interaction for older adults with dementia and their caregivers during COVID-19 pandemic.
A mixed methods research design will be used to examine the lived experiences of persons with dementia (PWD) and their caregivers during COVID-19 physical distancing, and to evaluate the feasibility, satisfaction, and effectiveness of virtual community-based programs by OSCC55+ to promote social connectedness during the COVID-19 pandemic. A mixed methods methodology with quantitative surveys, as well as qualitative methodology using individual in-depth interviews and focus groups will be employed to explore the perspectives of PWD, informal caregivers, and program staffs regarding their experiences of OSCC55+ virtual programs (Adult Day Programs), including program barriers, facilitators and opportunities.
This project will have the impact of advancing TeachingCity Oshawa’s initiatives by providing important insights about the effects of utilizing digital technology, building capacity of volunteer workforce and community partnerships to support social connectedness of older adults with cognitive impairment in the City of Oshawa. Project deliverables will include recommendations regarding: (1) Ways to promote the social engagement of seniors using virtual programming; (2) Strategies to improve access to the delivery of program services for seniors and caregivers in isolation; (3) Recommendations to increase the understanding about opportunities on how city customer service staff and volunteers can better engage, communicate, and deliver services to older adults with cognitive impairments.
Although volumes of research have been done regarding the positive health and healing effects of music and singing, there is limited research about programs in general hospitals that have developed as a result of the studies. The purpose of this case study is to discuss the development and current functioning of the HEAR (Health,Education,Advocacy & Research) Music in Medicine program for acute care of rehabilitation patients in a Canadian general hospital. It is hoped that this discussion may evoke interest among researchers in various parts of the world and the creation of collaborative networks of practitioners who can work together to set up similar programs in their locale.
Objectives: Since 2014, the Alzheimer Society of Canada (ASC) has included people with lived experience of dementia (PWLE) in the Alzheimer Society Research Program’s (ASRP) peer review process through the role of the Citizen Reviewer, however, this has been limited in scope. In 2019, a pilot study expanded this role to a broader panel of Citizen Reviewers as equal participants in the peer review process, scoring applications and providing valuable contextual feedback. In 2020, this process was further formalized, to allow for greater participation and engagement.
Method: Qualitative feedback was collected from panelists following the 2019 pilot which demonstrated a collective desire to improve overall engagement while formalizing a systematic process. The data was thematically assessed and used to create several resources to virtually recruit and train Citizen Reviewers as equal and valued participants in the peer review process.
Results: Data from the 2019 pilot resulted in a four-step process for recruitment, orientation, and training of Citizen Reviewers. This process included semi-structured interviews, a comprehensive orientation package, a virtual orientation session, and technical support meetings. This, in turn, led to the creation of a new resource for engaging PWLE in research, which demonstrates how to operationalize engaging and valuing the experiences of people affected by dementia.
Conclusions: The expansion of the Citizen Reviewer role has created a new way to improve the inclusivity of those with lived experiences within the evaluation of research proposals. While requiring significant preliminary preparations, the value of real-life experience in prioritizing research is unparalleled.
Lesbian, gay, bisexual, and transgender (LGBT) people who are older are a vulnerable yet resilient group who may have experienced unusual stressors as they age. This study examines LGBT-related long-term care policy, where the results of an institutional survey are discussed.
Methods: LGBT policy information were gathered across several long-term care homes in northwestern Ontario. The survey examined any policy related to the care of residents who identify as LGBT, as well as the demographics of residents in the long-term care home.
Results: None of the participating long-term care homes had policies related to the care of LGBT residents, and none of the homes collected information on sexual orientation/identity. Only 1 of the 8 long-term care homes had cared for residents who identified as LGBT. Any issues related to sexual identity were often handled on a case-by-case basis. The facilities acknowledged a need for policy and training related to sexual identity.
Discussion: This study contributes to the growing body of knowledge regarding older LGBT adults' concerns about long-term care by examining policy-related care of residents identifying as LGBT. This study suggests that none of the responding long-term care homes had policies related to the care of LGBT residents, and any instance would most often be dealt with on a case by case basis. This paper identifies implications for practice, policy, and training.
Introduction: Semantic function plays a central role in lifelong-acquired knowledge, and is the basis for name, face, word, and object recognition. This function is typically preserved in healthy aging, although it is known to deteriorate in cases of mild cognitive impairment and Alzheimer’s disease. Lifelong bilingualism may affect the efficiency of semantic processing in older adults with cognitive decline.
Methods: The goal of this study is to evaluate semantic performance of English monolingual (n=66) versus French-English bilingual (n=42) participants on a novel semantic battery that assesses different modalities of semantic function. The battery comprises nine tasks which assess semantic functioning based on both spoken and written linguistic input, and with different output measures of semantic function, including both verbal and gestural (pointing). It was hypothesized that monolinguals would outperform bilinguals on this battery overall.
Results: Monolinguals outperformed bilinguals on four of the nine tasks. These tasks assess lexical recall and associative matching. Group differences in the remaining five tasks may have not reached significance due to a ceiling effect.
Discussion: Overall, monolinguals outperformed bilinguals on tasks assessing lexical access and associative matching. This finding may reflect increased competition for semantic-processing resources in bilinguals relative to monolinguals. Future research should investigate semantic-processing competition in bilinguals using more difficult tasks, and examine how this competition may affect performance on semantic tasks in older adults with cognitive decline.
Keywords: Semantic function, monolingualism, bilingualism, healthy aging
Abstract
Background and Objectives: Approximately 40% of North American older adults may spend at least some portion of time in long-term care (LTC) facilities (Statistics Canada, 2020; Hyer et al., 2005). With LTC being a final living environment for some, understanding the factors that enhance quality of life for LTC residents is imperative. Studies in residential palliative care suggest that preserving dignity is vital to individuals’ quality of life. However, the role of dignity in non-terminally ill older adults’ quality of life in residential care is not well understood. The objective of this study was to develop a better understanding of what dignity means to older adults (≥ 70 years) living in an LTC setting.
Method: Seven participants living in a Quebec LTC facility participated in a semi-structured, open-ended interview regarding what defined their sense of dignity. Transcripts were analyzed using in vivo thematic analysis by two independent coders.
Results: The construct of dignity comprised three broad themes: The Self, The Facility, and World Events. A variety of sub-themes shaped participants’ conceptualization of dignity including physical, cognitive, and mental health; core values; social life; features of life in the LTC facility; and the world event of COVID-19.
Implications: This study contributes insights into the experience of dignity by older LTC residents and highlights the influences of modifiable LTC factors as well as COVID-19–related policies. These findings could influence development of programs to enhance dignity and quality of life among older adults in this context.
Background: The Manitoba Follow-up Study (MFUS) began in 1948 with a cohort of 3,983 men found fit for aircrew training in the RCAF during the Second World War. Currently, fewer than 100 men are actively participating, and fewer than 10 are missing data on vital statistics. Objectives: To explore the participants’ attitudes toward participation in the study; and to determine if attitude towards participation is associated with survival. Methods: Participants submit medical examinations, and complete questionnaires on a regular basis. In 2003, 1,292 participants were alive at a mean age of 83.2y (sd 7.0). Approximately two thirds of these men responded to a short questionnaire asking four questions about their perception of the value of their participation: had the time invested been worth their while (93% yes); had MFUS contributed to society’s understanding of human health (90% yes); had participation impacted their personal health (67% yes); and how much longer should MFUS continue [no more than 10 more years (32%), to the last man standing (40%), “other” including willingness to continue participation as long as deemed useful by the MFUS director (28%)]. Those responding to the survey had a significantly (p<0.001) better survival rate compared to non-respondents. The mortality hazard between 2003 and today was associated with participants’ report of the length of time the study should continue, with men leaving the decision to the study investigators (the majority of those in the “other” category) having the best survival rate. Conclusion: These results suggest that participant motivation include altruism.
Community-based participatory action research is a growing model of research that recognizes community stakeholders as equal partners throughout the research project. Located in northwestern Ontario, the North West Dementia Working Group (NWDWG) is a grassroots group of people living with dementia and care partners acting as a voice for people living with dementia. As a steering committee, the NWDWG directs the work of the Building Capacity research project, which aims to foster inclusion and engagement of people living with dementia. University faculty and staff support the NWDWG in their endeavours.
As part of this larger research project, this study explored the history and success of the NWDWG. Data was collected in a two-part virtual focus group with NWDWG members (n = 16) in the summer of 2020. Audio files were transcribed, and the research team analyzed the transcripts for themes. As their motivation, NWDWG members have a shared desire to help other people living with dementia and their families in the broader community. Relationships and friendships were found to be an integral part of the group, in its onset, perseverance, and success. A related social program which shares members of the NWDWG, along with food and humour have helped relationships extend beyond the scope of the research project. These results are consistent with previous work on meaningfully engaging with people living with dementia. The importance of relationships in meaningful engagement is highlighted in community-based participatory action research, and the implications for research with lived experience of dementia are discussed.
Long-term care homes (LTCHs) restricted family caregivers (FCGs) from in-person visitations during the COVID-19 pandemic, and technology-based visits were offered to maintain connections. While technology-related challenges experienced by older adults are well known, little is known about the potentially modifiable factors that impacted technology use for FCGs during this visitor ban. This study is a qualitative exploration of the LTCH-related factors that impacted FCGs’ experiences using technology to connect with loved ones. Seven caregiver focus groups (N=30) were conducted virtually in 2021 with FCGs from Ontario and British Columbia, Canada. The interview data was open-coded line-by-line and similar codes were collapsed into themes for thematic analysis. Three themes emerged: 1) “Home coordination and staffing” encapsulated the significant impact LTCH planning had on FCGs’ ability to access and utilize technology (e.g. scheduling issues or lack of staffing to set up the technology); 2) “Unmet resident needs” referred to residents’ cognitive and physical impairments that were not considered hindering communication at times. This theme also included reducing distractions and a noisy environment. And, 3) “Lack of technology and infrastructure” included the lack of technological infrastructure such as a lack of wi-fi as well as technology resources (e.g. number of tablets). These results emphasize a need for family and person-centred approaches that consider FCGs and residents’ needs. Further, larger policies and standards related to staffing, and to updating the technological infrastructures in LTCHs are required to ensure equitable access to technologies that enable meaningful connections.
Objectives: Late-life involves many life transitions that are linked to health and well-being. Better public understanding of occupational therapy’s important role within seniors’ support is critical to supporting older adults as they navigate these life transitions. Knowledge dissemination, a core component of knowledge translation (KT), involves tailored and targeted distribution of information through determined channels. Digital knowledge dissemination is an innovative way to reach and involve audiences beyond the academy, including peers or citizens. The flexibility and interactivity of digital modes allow for information to be shaped and matched to meet the needs of different end-users to improve their access and use of evidence in healthcare decision-making.
Methods: En-AGE (see: www.en-age.ca) is a knowledge portal designed to increase public awareness about the ways that occupational therapists support older adults as they navigate challenges related to later life transitions. En-AGE synthesizes and re-packages empirical research, “translates” knowledge of older adults, caregivers and occupational therapists through storytelling, and incorporates feedback from stakeholders to refine its ongoing development.
Results: Through an inside look into the process and outcomes of En-AGE, we recount the challenges and lessons learned from the perspectives of the various stakeholders that could be applied to future KT projects, and present evidence of our successes as determined by website metrics and end-user focus groups. Suggestions for transferable practices for future KT dissemination efforts with older adults will be offered.
Conclusion: Findings will help inform how innovative practices in knowledge dissemination can inform future initiatives targeted at this age demographic.
Objectives
In response to the pandemic, Food for Life created a Senior’s Healthy Food Package delivered to the door for those unable to access fresh food. Our research uncovered how well the package has been meeting client needs, and what gaps remain to address food security and isolation during COVID-19.
Methods
We surveyed recipients of the package to capture demographics, nutritional risk, food security, satisfaction with the current package, perceptions of COVID and socialization.
Survey results were shared with team members, who met during two design sessions, where we identified major themes, emerging needs, and brainstormed how to address these needs, through a series of activities.
In order to learn about the impact of the modifications made, and what needs remain, we conducted a follow-up survey.
Results
Of the 800 baseline surveys distributed, 216 were completed. Respondents wanted modifications to the food package contents and packaging process. Respondents reported being worried about COVID, needing PPE, making fewer trips outside of their apartment buildings for supplies and recreation, and a reduced social life.
Conclusions
We modified “back end” processes at Food for Life to increase variety and improve packaging. The team applied and received funding for: additional protein, PPE, and to fund an intergenerational community letter writing campaign to connect clients to the wider community to reduce social isolation. We also provided information about community supports and food rescue.
We discuss the impacts of these activities and what work remains to address food security and overall wellness among isolated older adults.
Age-related changes, disease, medication use, dysphagia, and increased dependency put older adults living in residences at high risk of dehydration. While there are numerous strategies used to combat dehydration in these homes, no consensus exists on those most feasible and effective. The objective of this study was to determine the feasibility and acceptability of 20 evidence-based strategies (e.g., social drinking clubs, education) for use in residential care. An online survey was created and made available from January 30 to April 1, 2020. Respondents were eligible if they worked/conducted research in aging care. A short description of each strategy was followed by four questions; would the strategy (i) improve hydration, (ii) be easy to do, (iii) be likely to be used in the future [all responses ‘not likely, somewhat likely, very likely’] and (iv) had they used the strategy in the past [‘yes, no, not sure’]. Descriptive analyses were completed. Of 162 participants, most worked in long-term care (83%), as direct care providers (62%), and specialized in dietetics or food services (55%). Most were from Canada, with 36% being from Ontario. Staff education was the most popular hydration strategy, ranked in the top six interventions by 62% of participants. The most feasible/acceptable interventions were: increased drink options at meals, pre-thickened drinks, and social drinking events. There is a pressing need for manageable hydration-improving practices and this survey has helped to identify those most feasible and acceptable to residential care providers.
A multi-component intervention to prevent dehydration and increase fluid intake (PROMOTE) in residential care is being developed. The purpose of this study was to examine provider perspectives on the usefulness and feasibility of PROMOTE strategies in Canadian homes. Twenty-four care providers in seven Canadian provinces (BC, AB, SK, MB, ON, NS, NB) were interviewed by phone after reviewing the PROMOTE (Preferred vessels/Reminders/Offer fluid/with Medications/Open dining/Trolley/Educate) strategy descriptions. Participants included: dietitians/health professionals (n=14), management (n=7), and administration (n=3), with most (n=18) working in non-profit homes. Qualitative content analysis was conducted to summarize barriers and facilitators to the strategies. Participants appreciated the value of the PROMOTE strategies, but were not supportive of those that could not work in their specific situation or had been previously attempted/failed. Perceived barriers included: increase in staff time, implementation costs, ongoing costs, sanitization and infection control, resident safety, fluid intake documentation, education, organization, communication and evaluation. Several participants thought attaining long-term organizational support would be challenging but an important facilitator, as well as regulatory oversight, standards, and meaningful enforcement. Other suggested supports included an educational “tool kit” with ideas for tailoring the strategy, providing evidence on the effectiveness of strategies and tools to address implementation challenges. Providers believed the PROMOTE strategies would be useful in improving resident hydration even though they had concerns with systemic barriers in this setting. Providers suggested ways to support the uptake of PROMOTE. These study findings will be used to develop PROMOTE for future feasibility testing.
Numerous research studies have demonstrated poor fluid intake in long-term care (LTC) residents, leading to dehydration. Anecdotal clinical reports have suggested that this has been further exacerbated by COVID-19 infection control procedures. Unfortunately, there is no consensus among experts on how to prevent dehydration in this population. As such, the objectives of this study were to determine the pre-pandemic and COVID-related causes of reduced fluid intake and identify feasible strategies to improve fluid intake in LTC. Twenty-seven experts and providers in LTC participated in a three-hour virtual meeting focused on discussing barriers and facilitators to hydration in LTC. The guided discussion was audio-recorded and detailed notes were taken. Causes of reduced fluid intake and possible solutions were identified via qualitative content analysis. Results revealed potential barriers to hydration of LTC residents as a result of COVID-19 that were either resident-related (e.g., restricted access to beverages), staff-related (e.g., limited staffing) or home-related (e.g., disposable cups holding less liquid). Some examples of potential solutions included offering a trolley service of drinks between meals and educating staff on ways to encourage intake. To conceptualize a multi-component hydration intervention, potential strategies were mapped onto an existing oral hydration typology that characterizes various resident types and the reasons for reduced fluid intake. This study confirmed that COVID-19 has brought about new procedures and routines in LTC and offers suggestions to prevent dehydration both during and beyond the pandemic. A multi-component intervention is required to meet the needs of all residents.