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International studies have demonstrated associations between sleep problems and poor psychological well-being; however, Canadian data are limited. This study investigated this association using cross-sectional baseline data from the Canadian Longitudinal Study on Aging, a national survey of 30,097 community-dwelling adults, 45–85 years of age. Short sleep duration, sleep dissatisfaction, insomnia symptoms, and daytime impairment were consistently associated with a higher prevalence of dissatisfaction with life, psychological distress, and poor self-reported mental health. Long sleep duration was associated with a higher prevalence of psychological distress and poor self-reported mental health, but not with dissatisfaction with life. Associations between sleep problems and psychological distress were 11–18 per cent stronger in males. With each 10-year increase in age, the association between daytime impairment and life dissatisfaction increased by 11 per cent, and insomnia symptoms and poor mental health decreased by 11 per cent. Sleep problems in middle-aged and older adults warrant increased attention as a public health problem in Canada.
During the coronavirus (COVID-19) pandemic, long-term care homes (LTCHs) imposed visitor restrictions that prevented essential family caregivers (EFCs) from entering the homes. Under these policies, EFCs had to engage in virtual, window, and outdoor visits, prior to the re-initiation of indoor visits.
To understand EFCs’ visitation experiences with LTCH residents during COVID-19.
Seven virtual focus groups with EFCs were conducted and analysed using a thematic approach.
Six themes were identified: (a) inconsistent and poor communication; (b) lack of staffing and resources; (c) increasing discord between EFCs and staff during COVID-19; (d) shock related to reunification; (e) lack of a person-centred or family-centred approach; and, (f) EFC and resident relationships as collateral damage.
Our findings reflect how EFCs’ visitation experiences were affected by factors at the individual, LTCH, and health-system levels. Future sectoral responses and visitation guidelines should recognize EFCs as an integral part of the care team.
Community support services are an integral enabler of aging in place. In social housing, older adult tenants struggle to access these services because of the siloed nature of housing and health services. This study examined the provision of government-funded community support services to 83 seniors’ social housing buildings in Toronto, Ontario. Although there were 56 different agencies operating within the buildings, only about one third of older tenants were actually receiving services. There was a subset of services that were available in more than 80 per cent of the buildings, and the most widely accessed services were food supports, crisis intervention, transportation, caregiver support, and hearing/vision care. There were also many cases in which multiple agencies offered duplicative services within the same building, suggesting that there are opportunities for improving service coordination. Practice recommendations for increasing access to community support services among low-income older adults in social housing are provided.
To examine the association between leisure activity (LA) frequency and cognitive trajectories over 5 years across adulthood, and whether gender and age moderate these associations.
A total of 234 cognitively healthy adults (21–80 years) completed a LA questionnaire at baseline and neuropsychological measures at baseline and after 5 years. Latent change score analysis was applied to generate latent variables estimating changes in different cognitive domains. For a secondary analysis, LA components’ scores were calculated, reflecting cognitive-intellectual, social, and physical activities. Regression analysis examined the association between baseline LA and cognitive change, and potential moderation of gender and age. In addition, we tested the influence of cortical gray matter thickness on the results.
We found that higher LA engagement was associated with slower cognitive decline for reasoning, speed, and memory, as well as better vocabulary across two time points. Regarding LA components, higher Social-LA and Intellectual-LA predicted slower rates of cognitive decline across different domains, while Physical-LA was not associated with cognitive change. Gender, but not age, moderated some of the associations observed. Our results remained the same after controlling for cortical gray matter thickness.
We demonstrated a protective effect of LA engagement on cognitive trajectories over 5 years, independent from demographics and a measure of brain health. The effects were in part moderated by gender, but not age. Results should be replicated in larger and more diverse samples. Our findings support cognitive reserve hypothesis and have implications for future reserve-enhancing interventions.
With increasing numbers of persons living with dementia and their higher rates of hospitalizations, it is necessary to ensure they receive appropriate and effective acute care; yet, acute care environments are often harmful for persons with dementia. There is a lack of dementia education for acute health care providers in Canada. Scotland presently delivers a dementia education program for health care providers, known as the Scottish National Dementia Champions Programme. The objective of this Policy and Practice Note is to present the collaborative work of Scottish experts and Canadian stakeholders to adapt the Dementia Champions Programme for use in Canada. This work to date includes: (a) an environmental scan of Canadian dementia education for acute health care providers; (b) key informant interviews; and, (c) findings from a two-day planning meeting. The results of this collaborative work can and are being used to inform the next steps to develop and pilot a Canadian dementia education program.
The response to the COVID-19 pandemic in long-term care (LTC) has threatened to undo efforts to transform the culture of care from institutionalized to de-institutionalized models characterized by an orientation towards person- and relationship-centred care. Given the pandemic’s persistence, the sustainability of culture-change efforts has come under scrutiny. Drawing on seven culture-change models implemented in Canada, we identify organizational prerequisites, facilitatory mechanisms, and frontline changes relevant to culture change that can strengthen the COVID-19 pandemic response in LTC homes. We contend that a reversal to institutionalized care models to achieve public health goals of limiting COVID-19 and other infectious disease outbreaks is detrimental to LTC residents, their families, and staff. Culture change and infection control need not be antithetical. Both strategies share common goals and approaches that can be integrated as LTC practitioners consider ongoing interventions to improve residents’ quality of life, while ensuring the well-being of staff and residents’ families.
A scoping review was conducted to identify patterns, effects, and interventions to address social isolation and loneliness among community-dwelling older adult populations during the COVID-19 pandemic. We also integrated (1) data from the Canadian Longitudinal Study on Aging (CLSA) and (2) a scan of Canadian grey literature on pandemic interventions. CLSA data showed estimated relative increases in loneliness ranging between 33 and 67 per cent depending on age/gender group. International studies also reported increases in levels of loneliness, as well as strong associations between loneliness and depression during the pandemic. Literature has primarily emphasized the use of technology-based interventions to reduce social isolation and loneliness. Application of socio-ecological and resilience frameworks suggests that researchers should focus on exploring the wider array of potential pandemic age-friendly interventions (e.g., outdoor activities, intergenerational programs, and other outreach approaches) and strength-based approaches (e.g., building community and system-level capacity) that may be useful for reducing social isolation and loneliness.
This study aimed to identify patterns of anthropometric trajectories throughout life and to analyze their association with the occurrence of sarcopenia in people from the Longitudinal Study on Adult Health (ELSA-Brasil). It is a cross-sectional study involving 9,670 public servants, aged 38 to 79, who answered the call for new data collection and exams, conducted approximately four years after the study baseline (2012-2014). Data sequence analysis was used to identify patterns of anthropometric trajectory. A theoretical model was elaborated based on the Directed Acyclic Graph (DAG) to select the variables of minimum adjustment in the analysis of the causal effect between trajectory and sarcopenia. Poisson regression with robust variance was adopted for data analysis. The patterns of change in the anthropometric trajectory were classified in: stable weight (T1); change to normal weight (T2); change to excess weight (T3); weight fluctuation (T4); and change to low weight (T5). The prevalence of sarcopenia in men and women who changed the anthropometric path for the low weight was twice as large when compared to participants with a stable weight trajectory. A protective effect of the excess weight trajectory was observed for the occurrence of sarcopenia in them. The results pointed to the need for health policies that encourage the proper management of body components in order to prevent and control obesity, as well as to preserve the quantity and quality of skeletal muscle mass throughout life, especially in older adults.
One remarkable feature of market imperialism as it has affected welfare provision is just how deep it has become entrenched in the act of caring for people. Here, Clotworthy describes how the provision of eldercare in Denmark has been taken over by a system that aims to create idealized, active, and independent older people. Eldercare is thus increasingly subject to a “competition state” focused on optimizing costs by “responsibilizing” both care providers and senior citizens as rational and independent decision-makers. What Clotworthy shows, though, is that creating a welfare system with this sort of ideal in place runs the risk of ignoring the actual person sitting in front of you. The system acts more as a gatekeeper than a care provider, and thus leaves people alienated in their old age. Clotworthy contrasts this with eldercare systems that make a direct provision of care in order to show another way of caring for older adults.
Important worldwide changes in human aging are developing rapidly. Life expectancy has doubled during the past century. Due to advances in public health, vaccines, and science, people are living longer. The increase in the elderly population is happening in varying degrees all over the world. Although heart disease and cancer rates are falling, Alzheimer’s is increasing because of its strong link to aging and lack of disease-modifying therapies. It is important to consider what can be done about the expansion of aged populations. A forward-looking approach to health care will provide resources to people throughout life to keep them healthy and enhance their four reserve factors. This is ethically and economically preferable to a health care system which only takes care of people when they’re sick and doesn’t strive to prevent illness. Recent advances in diagnosis, metagenomics (studies of gut bacteria), and artificial intelligence will hopefully assist in the growth of preventive measures. Advances in public policy and technology can help people to enhance their four reserve factors and help them to avoid disease and remain fit as they age.
Our attitude is something we carry around with us at all times. As the psychiatrist Victor Frankl said, “Our greatest freedom is the freedom to choose our attitude.” Our attitude is determined in large part by the focusing of our attention. If our attention is focused on losses and regrets, our attitude will be gloomy. If our attention is focused on opportunities, such as the opportunity of aging, our attitude will be more positive. This is a fundamental daily choice. Because the world is too multifaceted for us to process all possible perceptions, it is our attention which is critical for the quality of our experience. Our attitude is determined by the object of our attention. And our capacity of paying attention can be exercised and practiced every day. Viewing aging as an opportunity helps to focus the reality that what happens to us is determined in large part by what we do. Paying attention can enhance all of our reserves. Diet, physical and mental activities, and social and family contacts are all critical. Our enhancement of the four reserve factors will increase our chance to be healthy and fit as we age.
We need to have three goals for aging. The first two are clear; survival and avoiding disease. Equally important is a third goal, to maintain fitness and a high level of four reserve factors. These reserve factors allow us to successfully respond to the challenges we face as we age. Cognitive reserve is the capacity to maintain effective cognitive function despite age-related changes in the brain. Maintaining high cognitive reserve is not our only goal. We must also maintain high physical, psychological, and social reserves. Physical reserve reflects the capacity of all our body systems. Psychological reserve is our ability to maintain healthy mental function, and social reserve describes our interpersonal network and supports. With aging, our ability to function is dependent upon the interaction of these four reserve factors. Our capacity to respond well to adversity is called resilience and is a fundamental goal of aging. It is important to realize the critical nature of these four reserve factors because through our actions we can enhance our capacity for resilience and enhanced fitness with aging.
For most of human history few people got to be old. Older persons are not as well pepared to face stresses as younger persons because of evolutionary factors. So, it is necessary for older persons to consider the effects of their lifestyle choices on their ability to age successfully. Awareness of these factors is important for our appreciation of the impact which our activities have on our aging. For most of the past 100,000 years of human history we were living in a different environment than the one we have today. The genes we have now were chosen through natural selection because they enhanced the survival of our ancestors who were living in these different environments. This view provides valuable insights into the role environmental factors have in determining maintenance of function with aging. This chapter presents the vital perspective that what we do affects the accomplishment of our goals for aging. These goals must go beyond survival and avoidance of disease and also strive for maintenance of the highest level of fitness and resistance to loss of function (reserve capacities) so that we can resist the declines with aging, as well as the challenges which inevitably occur.
As women age, their response to ovulation induction is progressively diminished due to the continuous depletion of primordial follicles and to changes in the ovarian endocrine/paracrine microenvironment. While many couples faced with the reality of a diagnosis of low functional ovarian reserve may turn to the use of donor gametes to achieve a pregnancy, some still feel the need to try on their own, despite a poor prognosis. For such women careful preparation and hormonal priming in the months prior to beginning an IVF cycle can increase their chance of a successful outcome. Optimal treatment of these patients differs from the usual treatment of women with normal ovarian reserve in every aspect and needs to be highly individualized.
Il est essentiel d’utiliser des tests cognitifs ayant été validés et détenant des normes de référence auprès de la population cible, puisque les réalités culturelles et linguistiques différentes entre l’échantillon de validation ou auprès duquel les normes ont été créées et la population cible peuvent affecter les résultats. Cette revue systématique vise à recenser et décrire les tests cognitifs (incluant tests, questionnaires et grilles d’observation) validés et/ou présentant des normes sur la population âgée canadienne francophone. Au total, 46 articles ont été sélectionnés. Cette revue recense 9 tests validés, 20 tests avec normes de référence et 18 tests validés et avec normes, couvrant la majorité des domaines cognitifs (fonctions mnésiques, attentionnelles, exécutives, perceptivo-motrices et langagières), excepté la cognition sociale. La quasi-totalité des échantillons ont été recrutés au Québec. Les tests relevés présentent majoritairement des indices psychométriques satisfaisants et généralement des normes considérant l’âge, le sexe et l’éducation. Cette revue systématique permettra aux cliniciens et chercheurs canadiens en vieillissement d’orienter optimalement leurs choix de tests cognitifs.
Aging is a subject of concern to everyone, but is widely misunderstood. If we view it as inevitable, we miss the fact that not everyone is able to grow to an old age. Realization of this reality helps us to understand that aging presents a wonderful opportunity - an opportunity to make choices about how we live which can enhance the aging process and offer a chance to live to our potential. This book clearly presents the four, multiple reserve, factors (cognitive, physical, psychological and social) which impact our ability to have healthy responses to the stresses of aging. By giving the biological basis for the advice given, you will learn the steps to take in your activities, diet and mental outlook to grasp the opportunity that aging offers. Everyone must know that what we do makes a difference.
Serial position scores on verbal memory tests are sensitive to early Alzheimer’s disease (AD)-related neuropathological changes that occur in the entorhinal cortex and hippocampus. The current study examines longitudinal change in serial position scores as markers of subtle cognitive decline in older adults who may be in preclinical or at-risk states for AD.
This study uses longitudinal data from the Religious Orders Study and the Rush Memory and Aging Project. Participants (n = 141) were included if they did not have dementia at enrollment, completed follow-up assessments, and died and were classified as Braak stage I or II. Memory tests were used to calculate serial position (primacy, recency), total recall, and episodic memory composite scores. A neuropathological evaluation quantified AD, vascular, and Lewy body pathologies. Mixed effects models were used to examine change in memory scores. Neuropathologies and covariates (age, sex, education, APOE e4) were examined as moderators.
Primacy scores declined (β = −.032, p < .001), whereas recency scores increased (β = .021, p = .012). No change was observed in standard memory measures. Greater neurofibrillary tangle density and atherosclerosis explained 10.4% of the variance in primacy decline. Neuropathologies were not associated with recency change.
In older adults with hippocampal neuropathologies, primacy score decline may be a sensitive marker of early AD-related changes. Tangle density and atherosclerosis had additive effects on decline. Recency improvement may reflect a compensatory mechanism. Monitoring for changes in serial position scores may be a useful in vivo method of tracking incipient AD.
In behavioral variant frontotemporal dementia (bvFTD) neuropsychiatric symptoms are a significant concern as they impact care management and caregiver wellbeing.
To describe change in individual neuropsychiatric symptoms and associated caregivers’ distress assessed by the Neuropsychiatry Inventory (NPI) in patients diagnosed with bvFTD and Alzheimer’s disease (AD) from baseline to a 12-month follow-up.
The sample consisted of 31 patients diagnosed with bvFTD and 28 patients with AD and their caregivers. The NPI and the Addenbrooke´s Cognitive Examination Revised (ACE-R) were applied. Descriptive statistics, Mann-Whitney U test, Wilcoxon test, Chi square (χ2) were used.
At baseline, significantly higher scores were observed for the bvFTD group for: agitation, disinhibition and eating disturbances. The latter two were also higher in the NPI Distress subdomains. At followup, there were significantly higher scores for the bvFTD group in agitation, disinhibition, eating disturbances, hallucination and irritability. For the NPI Distress subdomains, agitation, eating disturbances and hallucination scores were significantly higher for the bvFTD group.
In 12 months, neuropsychiatric symptoms increased in both bvFTD and AD groups. However, NPI subdomain and caregiver distress scores were statistically higher among bvFTD patients at both assessment points. Neuropsychiatric symptoms may be associated with care burden in bvFTD and should be a focal point in care management decisions.
COVID-19 has had a disproportionate and devastating impact on older adults. As health care resources suddenly shifted to emergency response planning, many health and community support services were cancelled, postponed, or shifted to virtual care. This rapid transformation of geriatric care resulted in an immediate need for practical guidance on decision making, planning and delivery of virtual care for older adults and caregivers. This article outlines the rapid co-design process that supported the development of a guidance document intended to support health and community support services providers. Data were collected through consultation sessions, surveys, and a rapid literature review, and analyzed using appropriate qualitative and quantitative methods. Although this work took place within the context of the COVID-19 pandemic, the resulting resources and lessons learned related to collective impact, co-design, population-based planning, and digital technologies can be applied more broadly.
If interRAI home care information were shared with primary care providers, care provision and integration could be enhanced. The objective of this study was to co-develop an interRAI-based clinical information sharing tool (i.e., the Patient Falls Risk Report) with a sample of primary care providers. This mixed-methods study employed semi-structured interviews to inform the development of the Patient Falls Risk Report and online surveys based on the System Usability Scale instrument to test its usability. Most of the interview sample (n = 9) believed that the report could support patient care by sharing relevant and actionable falls-related information. However, criticisms were identified, including insufficient detail, clarity, and support for shared care planning. After incorporating suggestions for improvement, the survey sample (n = 27) determined that the report had excellent usability with an overall usability score of 83.4 (95% CI = 78.7–88.2). By prioritizing the needs of end-users, sustainable interRAI interventions can be developed to support primary care.