Older adults who have reduced decision-making capacity and no family or friends to compensate for these deficiencies are known as unbefriended and require a public guardian. The purpose of this study was to review the peer-reviewed and grey literature to determine the scope of available research on unbefriended older adults in Canada and the United States. We found limited research examining unbefriended older adults. No Canadian studies or reports were located. Unbefriended older adults were childless or had fewer children, were more cognitively impaired, and were older than older adults who were not unbefriended. These findings demonstrate a stark scarcity of studies on unbefriended older adults. Research is urgently needed using standardized data collection of guardianship status in order to enable studies of the prevalence of public guardianship in Canada.

Several fall prevention programs have been implemented to reduce falls among seniors. In some rural areas or in French-speaking minority communities, the availability of such programs is limited. The objectives of this paper are to: (a) describe the Fall Prevention Program Marche vers le futur, offered in French, by videoconference; and (b) present the results of the evaluation of the program objectives. Results demonstrate that participants have improved their physical abilities, gained knowledge, adopted new behaviors and lifestyle habits. In short, Marche vers le futur reduces fall risk factors in a manner equal or superior to other programs. Marche vers le futur has made possible the provision of services in French in communities where availability of French-language resources is very limited, therefore fostering equity in access to health services.

Care aides working in nursing homes are often exposed to responsive behaviours in older adults living with Alzheimer’s disease. As these behaviors may induce psychological distress, the current research aims to estimate the contribution of a set of variables on the psychological distress reported by care aides. Variables include perceived frequency of responsive behaviours, primary and secondary cognitive appraisal, and coping strategies. A total of ninety-two day care aides were recruited in nursing homes in the Quebec City area. Standard multiple regression was completed and findings show that frequency of responsive behaviours, primary appraisal of threat, secondary appraisal (feeling incapable of changing the situation) and seeking emotional support contribute to care aides’ psychological distress. This study highlights the importance of responsive behaviours on the units and discusses the psychological mechanisms used by care aides.

Hospitalized older adults are at high risk of falling. The HELPER system is a ceiling-mounted fall detection system that sends an alert to a smartphone when a fall is detected. This article describes the performance of the HELPER system, which was pilot tested in a geriatric mental health hospital. The system’s accuracy in detecting falls was measured against the hospital records documenting falls. Following the pilot test, nurses were interviewed regarding their perceptions of this technology. In this study, the HELPER system missed one documented fall but detected four falls that were not documented. Although sensitivity (.80) of the system was high, numerous false alarms brought down positive predictive value (.01). Interviews with nurses provided valuable insights based on the operation of the technology in a real environment; these and other lessons learned will be particularly valuable to engineers developing this and other health and social care technologies.

We examined ageist beliefs, attitudes, and knowledge towards sexuality in later life among 148 nursing students and 137 social work students in their first year of studies. The students completed the Fraboni Scale of Ageism, the Attitudes and Knowledge towards Older Adults’ Sexuality Scale, and questionnaires regarding contact with older adults, prior sexual education, and socio-demographics. The results indicated that nursing students have more conservative attitudes towards older adults’ sexuality. Ageist beliefs correlated positively with more conservative attitudes towards older adults’ sexuality. These conservative attitudes ’were negatively correlated with knowledge about sexuality in later life. Older students have more knowledge about sexuality in later life and more permissive attitudes towards older adults’ sexuality. Religious students have less knowledge, and more conservative attitudes, towards older adults’ sexuality. Previous sexual education was not associated with the students’ attitudes and knowledge towards older adults’ sexuality. Implications for designing continuing education programs are discussed.

Several determinants of developing fear of falling (FoF) overlap with the consequences of diabetes mellitus (DM). We compared the prevalence and severity of FoF in older adults with and without DM and identified which FoF determinants contribute to FoF severity in older adults with DM. We used Canadian baseline data from the International Mobility in Aging Study (IMIAS) which identified 141 older adults with DM (DM-group;age:68.88±2.80years) and 620 without DM (noDM-group;age:68.81±2.68years). FoF was quantified with Falls Efficacy Scale–International (FES-I). FoF determinants were evaluated in demographic/health-related, physical, psychological, and social domains. High concern of FoF was more prevalent and of higher severity in 10/16 FES-I activities in the DM-group compared to the noDM-group. Higher FoF severity in the DM-group was associated with poor physical performance, being female, fall history, and clinical depressive symptoms. Protocols developed for screening and interventions may reduce FoF severity in this population.

Long-term care is a growing component of health care spending but how much is spent or who bears the cost is uncertain, and the measures vary depending on the source used. We drew on regularly published series and ad hoc publications to compile preferred estimates of the share of long-term care spending in total health care spending, the private share of long-term care spending, and the share of residential care within long-term care. For each series, we compared estimates obtainable from published sources (CIHI [Canadian Institute for Health Information] and OECD [Organization for Economic Cooperation and Development]) with our preferred estimates. We conclude that using published series without adjustment would lead to spurious conclusions on the level and evolution of spending on long-term care in Canada as well as on the distribution of costs between private and public funders and between residential and home care.

This study involved the longitudinal trajectories of loneliness with aging and models the effects of relevant risk factors. Data came from the second to the sixth waves (2004/5 – 2012/13) of the English Longitudinal Studies of Ageing (ELSA). Respondents who participated in at least two waves and offered valid responses to the UCLA three-item loneliness scale were included (baseline n = 9,171). Although statistics describing the inter-wave changes confirmed the longitudinal stability of loneliness among older people, serious attention should be paid to the small percentage of older people who are “longitudinally lonely”. Self-reported health and relations with spouse and children were significant risk factors, and it was the change of closeness to spouse rather than the loss of spouse that most affected the change of loneliness scores. Future research should aim to identify personal and social events that make older people lonely over a long period of time.

Hip fracture rehabilitation has two streams: high tolerance short duration (HTSD) and low tolerance long duration (LTLD). This study examined patient characteristics and outcomes in HTSD and LTLD associated with length of stay (LOS) and discharge destination. We retrospectively examined patients’ medical charts following hip fracture surgery and collected demographic, functional, and health characteristics. A statistical analysis was done to describe the differences between HTSD (n = 73) and LTLD (n = 57) patient characteristics and their relationship with LOS and discharge destination. Those in LTLD were significantly older, less independent with prefracture bathing and instrumental activities of daily living, had lower Functional Independence Measure (FIM) admission scores, and more co-morbidities. Higher FIM motor score on admission in HTSD and greater change in FIM total score in LTLD was significantly correlated with discharge home. Diabetes in LTLD and lower total admission FIM in HTSD was significantly associated with increased LOS.

It is critical to ensure that long-term care (LTC) homes are sensitive to the needs of lesbian, gay, bisexual, and transgender (LGBT) older adults. However, the extent to which the LTC home sector has adopted recommended strategies is unknown. This qualitative study reports findings from two initiatives: Semi-structured telephone interviews with Canadian LTC home administrators on strategies adopted to support LGBT inclusivity (n = 32), and discussions with participants attending a 2-day meeting on supporting LGBT inclusivity in LTC (n = 25). We found that LGBT inclusivity training was the most commonly adopted strategy among the LTC homes surveyed. Study findings further suggested that practices more visible to residents and families, such as LGBT-themed programming, inclusive language and symbols, or joint initiatives with LGBT communities, were less commonly adopted because of anticipated negative resident/family reactions. The importance and benefits of comprehensive strategies that include staff, residents, and family are discussed.

Canada is experiencing population aging, and given the heterogeneity of older adults, there is increasing diversity in late life. The purpose of this study was to help fill the research gaps on LGBT aging and end-of-life. Through focus groups, we sought to better understand the lived experience of older LGBT individuals and to examine their concerns associated with end-of-life. Our analysis highlights the idea that identifying as LGBT matters when it comes to aging and end-of-life care. In particular, gender identity and sexual orientation matter when it comes to social connections, in the expectations individuals have for their own care, and in the unique fear related to staying out of the closet and maintaining identity throughout aging and end-of-life. This study underscores the need to consider gender identity and sexual orientation at end-of-life. In particular, recognition of intersectionality and social locations is crucial to facilitating positive aging experiences and end-of-life care.

Currently, 564,000 Canadians are living with dementia. This number will continue to rise as the population ages. Family physicians play an integral role in the diagnosis and management of dementia patients. Although studies have looked at family physician perspectives on dementia care in the urban setting, much less is known about challenges in rural areas. This study aimed to explore rural family physicians’ experiences in caring for patients with dementia in rural Alberta, Canada. We conducted three semi-structured focus groups with 16 family physicians to evaluate barriers and facilitators to providing care to persons with dementia in three rural communities. We developed focus group questions based on the theoretical domains framework (TDF) and analysed them using a framework approach. Physician capabilities, opportunities, and motivations appear to play important roles in caring for these patients. These research findings can be used to advance quality of care for rural dementia patients.

We assessed clinicians’ continuing professional development (CPD) needs at family practice teaching clinics in the province of Quebec. Our mixed methodology design comprised an environmental scan of training programs at four family medicine departments, an expert panel to determine priority clinical situations for senior care, a supervisors survey to assess their perceived CPD needs, and interviews to help understand the rationale behind their needs. From the environmental scan, the expert panel selected 13 priority situations. Key needs expressed by the 352 survey respondents (36% response rate) included behavioral and psychological symptoms of dementia, polypharmacy, depression, and cognitive disorders. Supervisors explained that these situations were sometimes complex to diagnose and manage because of psychosocial aspects, challenges of communicating with patients and families, and coordination of interprofessional teams. Supervisors also reported more CPD needs in long-term and home care, given the presence of caregivers and complexity of senior care in these settings.

Given Canada’s aging population, the demand for home care is expected to increase significantly. To date, little is known about home care for older adults in Canada such as characteristics of home care recipients, gaps in services, or interventions designed to support home care client needs. Consequently, we conducted a systematic review of seven electronic databases for the years 2000–2016 to examine the current knowledge of home care services for Canada’s older adults. This synthesis examined four main themes in the literature: older adult client-level predictors; unmet care needs; interventions; and issues and challenges in home care. This review found significant knowledge gaps on home care for older adults across the country, as over half of the studies were focused primarily in Ontario. Although promising strategies were evident, more research and evaluation of interventions, and outcomes are required to effectively support Canada’s home care system now and over time.

Despite the increasing complexity of nursing home care, the role of physicians caring for residents is largely unexplored. This international, exploratory study sought to learn about physicians’ roles, responsibilities, and tasks as well as investigate the unique qualities of medical practice in nursing homes. We conducted interviews with 18 physicians, who reported making important contributions to the quality of resident care, including clarifying the goals of care, working to reduce unnecessary medication and hospitalization, as well as contributing to staff education. Nursing home practice involved physicians in networks of relations that were instrumental to the quality of medical care and physicians’ job satisfaction. The importance of these relationships disrupts the oft-drawn boundary between the medical and the social, suggesting that good medical practice depends on good social practice. Reflecting the exploratory nature of the study, we recommend research to better understand and support the relational dimensions of nursing home medicine.

It is possible for individuals with a diagnosis of cancer to see the illness as an opportunity to change and to make certain decisions that could improve their chances of recovery. We aimed, through qualitative research, to understand the experience of cancer in older adults through new behaviors and habits, intentions to change and maintenance of old behaviors and habits in the context of the disease. Our participants were 10 people aged 60 to 73 with a diagnosis of cancer. The majority of participants expressed intentions to change or adopted new behaviors or habits. Relatives had very little influence on participant’s choices and participants did not seek information on cancer or ways to contribute to healing. However, they were very receptive to the recommendations made by physicians.

Primary progressive apraxia of speech (PPAoS) is a neurodegenerative syndrome characterized by speech apraxia at its onset; as it progresses, it often evolves into total mutism. Even though this syndrome is increasingly recognized, its early differential diagnostic is still complex. The objective of this study was to illustrate why a fine evaluation of speech and language is essential for the differential diagnosis of PPAoS. This longitudinal case study presents the progression of a PPAoS patient over a period of 5 years. Periodic neurological and speech-language assessments were carried out to follow the progression of neurological, memory, language and speech symptoms. The different diagnostic labels established over time were also reported. The evolution of the patient’s communication profile was characterized by a preservation of language components and episodic memory, in parallel with a progressive deterioration of speech which gradually reduced intelligibility, and was associated with signs of spasticity, resulting in a complete anarthria. This case study sheds light upon the evolution of a patient with PPAoS. A better understanding of the clinical profile and progression of PPAoS is necessary in order to improve early diagnosis and adequate care for these patients.

Availability of health professionals is fundamental to population health. Multiple trends contribute to provider shortages. Purpose: Develop and validate conceptual models of early and involuntary retirement among registered nurses (RNs) and allied health professionals (AHPs). Method: A review of retirement literature (n = 23 studies). Any factor reported as predictive of early or involuntary retirement was incorporated into a model. To achieve face validity, we conducted interviews with Canadian RNs/AHPs (n = 14). Results: The conceptual model of early retirement had eight categories (38 variables): workplace characteristics, socio-demographics, attitudes/beliefs, broader context, organizational factors, family, lifestyle/health, and work-related. The model of involuntary retirement had four categories (eight variables): broader context, socio-demographics, lifestyle/health, and family. Caregiving responsibilities (variable) was added based on interview data. Discussion: RNs/AHPs consider many factors when contemplating retirement; some are sensitive to intercession, which generates possibilities for extending the work lives of older RNs and AHPs.

Integrated care is a promising approach for improving care transitions for older adults, but this concept is inconsistently defined and applied. This scoping review describes the size and nature of literature on integrated care initiatives for transitions from hospital to community care for older adults (aged 65 and older) and how this literature conceptualizes integrated care. A systematic search of literature from the past 10 years yielded 899 documents that were screened for inclusion by two reviewers. Of the 48 included documents, there were 26 journal articles and 22 grey literature documents. Analysis included descriptive statistics and a content analysis approach to summarize features of the integrated care initiatives. Results suggest that clinical and service delivery integration is being targeted rather than integration of funding, administration, and/or organization. To promote international comparison of integrated care initiatives aiming to improve care transitions, detailed descriptions of organizational context are also needed.

Senior centres have been identified as a “focal point” for delivering services to the rapidly growing older adult populations in Canada and the United States. Despite this important role, academic research studying senior centres has been limited. This scoping review identified English-language empirical research studies focusing on senior centres that were published in an academic journal in 2000 or later. A total of 58 studies were identified (n = 51 American and n = 7 Canadian). The majority of the articles focused on themes related to the participation of individuals at senior centres; a smaller number focused on themes related to the senior centre environment. Based on the findings, it is suggested that future research focus on benefits of senior centre programming, with specific focus on needs of baby boomers; key factors related to funding, space, and staffing; and the characteristics and role of senior centres in the Canadian context.