Afin de mieux comprendre la distribution géographique des facilitateurs et des obstacles à la participation sociale des Québécois âgés, cette étude visait à documenter l’Indice du potentiel de participation sociale (IPPS) selon les zones métropolitaines, urbaines et rurales. Des analyses de données secondaires, dont l’Enquête transversale sur la santé des collectivités canadiennes, ont permis de développer et de cartographier un indice composé de facteurs environnementaux associés à la participation sociale, pondérés par une analyse factorielle. En zones métropolitaines, l’IPPS était supérieur au centre qu’en périphérie, compte tenu d’une concentration accrue d’aînés et des transports. Bien qu’atténuée, la configuration était similaire en zones urbaines. En zone rurale, un IPPS élevé était associé à une concentration d’aînés et un accès aux ressources accru, sans configuration spatiale. Pour favoriser la participation sociale, l’IPPS soutient que les transports et l’accès aux ressources doivent respectivement être améliorés en périphérie des métropoles et en zone rurale.

Les aînés qui vivent avec des problèmes de santé mentale ou des difficultés psychosociales sont souvent isolés et marginalisés. Le programme Participe-présent a été développé dans le but de promouvoir leur participation communautaire. Les objectifs de cette étude étaient de 1) décrire la pertinence, l’acceptabilité, et la faisabilité du programme lors de sa mise à l’essai et 2) d’explorer les bienfaits et les effets à court-terme du programme pour les participants. Vingt-trois aînés, quatre animateurs et trois responsables provenant de quatre organismes ont participé à l’étude. Les aînés ont été satisfaits de leur expérience de participation au programme et ont rapporté une meilleure connaissance des ressources et une plus grande satisfaction à l’égard de leur vie sociale. Les animateurs et les responsables d’organismes ont souligné l’adaptabilité de Participe-présent aux besoins de leur clientèle et à leur contexte de pratique, et ont identifié les facilitateurs et les obstacles à sa mise en œuvre. D’autres études mèneront à des recommandations favorisant le succès de la mise en œuvre de Participe-présent dans différents contextes.

The former South West Local Health Integration Network (SW LHIN) of Ontario, which is in a predominantly rural region, regularly reports the lowest rates of caregiver distress in the province. Caregivers from rural communities regularly face challenges related to the access, applicability, and availability of supports and services, This qualitative case study describes perspectives of caregiving from the region, and explores how role construction and expectations of caregivers might both mitigate distress and influence service support use. Thematic analysis identified five themes: anticipated care, gendered caring, service support assumptions, confidence in community, and the “line in the sand”: care decisions for evolving needs. Using the lens of caregiver identity theory, the findings suggest that these caregivers conceptualize identity as an extension of their primary role, to include caregiving obligations and responsibilities. We also noted a steadfast confidence in community and perceived service support assumptions across the region, with no notable rural–urban divide.

Social participation has tremendous implications for the physical and mental health of older adults. A growing body of Canadian literature has examined social participation among older adults, including frequency of participation; gender, age, and regional differences in participation; and associations with self-perceived health, loneliness, and life dissatisfaction. The current study adds to this important body of research, using a large, nationally representative sample of adults 45–85 years of age (Canadian Longitudinal Study on Aging [CLSA] baseline data [n = 51,338]), to examine nuanced characteristics associated with social participation (socio-demographics, social support, cognitive ability, mental health, physical conditions), frequency of participation, and the relationship between the aforementioned characteristics and frequency of participation. Findings indicated that compared with those who reported infrequent/no participation, more frequent participation was associated with greater social support, higher cognitive abilities, increased satisfaction with life, fewer depressive symptoms, reduced odds of self-reported mood and anxiety disorders, and fewer self-reported physical conditions. Findings highlight the importance of active social participation, and have important implications for the development and implementation of accessible community programs across Canada.

Limited research exists on the experiences of older adults participating in community rehabilitation. Our longitudinal, collective case study explored older adults’ experiences while they engaged in community rehabilitation and home care services, as well as family caregivers’ concurrent experiences. Drawing on interpretive description, we inductively analysed interview data gathered at three points over 3–6 months from six family dyads. Questions focused on activities of daily living, instrumental activities of daily living and other meaningful activities affected by changes in the older adult’s health. From our thematic analysis, three themes emerged: (a) Centring community rehabilitation and home care services around the older adult and family; (b) Understanding the intricate interface of formal and informal supports; and (c) Supporting the meaningful aspects of life. Our findings suggest a metaphor of re-braiding, a reconfiguration of activities that requires increased integration of formal and informal supports within home care and community rehabilitation.

Based on findings from a study examining the lived experiences of dementia carers in their neighbourhoods, this article offers a vision of what dementia-friendly communities could look like from a carer perspective and in a Canadian context. Twelve carers in Ottawa and its surrounding regions were interviewed using a combination of social network maps, mobile interviews, and participant-driven photography. The findings, organized according to the categories “relationships”, “places”, and “everyday practices”, reveal that many of the carers’ choices regarding businesses, services, home location, outings, and everyday practices, are based on a desire to maintain social connections and social citizenship. The article concludes with recommendations for consideration in the planning of dementia-friendly neighbourhood initiatives.

L’Équipe Mobile d’Argelès Psychiatrique (EMAP) a vu le jour le 1er septembre 2011. Elle a été financée dans un cadre expérimental, par l’Agence Régionale de Santé du Languedoc-Roussillon. Le projet s’inscrivait dans les travaux du Conseil Local de Santé Mentale (CLSM) d’Argelès-sur-Mer (66700). Il faisait suite à plusieurs constats. Pour de multiples raisons, et notamment du fait de l’augmentation considérable des soins ambulatoires, le nombre des visites à domicile a régulièrement diminué ces dernières années et s’est progressivement recentré sur le suivi de patients connus. D’autre part, il existe un nombre d’hospitalisation d’office historiquement bien plus élevé dans les Pyrénées Orientales que la moyenne nationale (88 hospitalisations d’office pour 100 000 habitants âgés de 20 ans et plus dans les PO contre 25 pour 100 000 habitants au niveau national en 2007. Ce nombre était de 83 pour notre secteur géographique). Les représentants des usagers et des familles étaient très en demande d’interventions rapides dans la communauté. Cette attente faisait écho à celle d’un grand nombre des partenaires du réseau sanitaire (médecins généralistes) mais également social ou médicosocial pour évaluer certaines situations orientées par défaut vers le service des urgences psychiatriques au centre hospitalier de Perpignan. Malgré les efforts de communication et d’information entrepris de longue date, il était noté, dans la pratique quotidienne, l’insuffisance des liens avec les services municipaux, la police, la gendarmerie, les pompiers et parfois les services sociaux pour prévenir les situations de crise. Enfin, l’existence d’une Équipe Mobile Psychiatrie Précarité rattachée au service depuis une quinzaine d’années permettait de s’appuyer sur une expérience déjà solide. Par opposition à notre EMPP qui est intersectorielle, l’EMAP s’est inscrite d’emblée dans une dimension sectorielle, rattachée à part entière à un CMP desservant un territoire de 40 000 habitants. Il s’agit d’une équipe rapidement mobilisable, à la demande des patients, des familles ou des différents partenaires du champ médical, social et judiciaire pour anticiper et évaluer les situations de crise de nature psychiatrique. Au-delà de l’évaluation, elle organise, si besoin, les soins de la manière la plus adaptée. Cette équipe spécialisée, pluridisciplinaire, va :

– développer les relations de réseau entre des acteurs pouvant recevoir les mêmes publics mais se connaissant peu ;

– intervenir sur signalement pour évaluer les situations de crise susceptibles de relever de réponses psychiatriques ou, ce qui est préférable, pouvant les anticiper.

L’expérience des deux premières années de fonctionnement permet de retenir un bilan intéressant, notamment la diminution très sensible des hospitalisations en SDRE sur l’aire géographique desservie et une complémentarité naturelle avec l’activité de CMP classique. Ce bilan sera détaillé dans cette publication.

Interdisciplinary research using qualitative methods was employed to investigate the barriers to and facilitators of cultural participation for First Nations Elders who use wheeled mobility and live on reserve in Ontario, Canada. Themes were extracted into three broad categories: (1) impact of Elder participation in cultural activities, (2) usefulness of wheeled mobility devices, and (3) barriers to participating in cultural events. Barriers included lack of transportation, inability to access the outdoors safely and independently, challenging reserve terrain, stigma of being “disabled”, and feeling like a burden. Findings suggest that wheeled mobility can increase the active participation of Elders in cultural events, but demonstrate a need to facilitate the use of wheeled mobility on reserves in Ontario, Canada.

The purpose of this study was to identify the self-report physical activity (PA) tool best suited for assessment of PA in community-dwelling older adults with multiple chronic conditions (MCC). PA can positively influence physical and psychological health in this population. Although self-report PA tools exist, little is known about the psychometric properties and feasibility of using these tools in older adults with MCC. A systematic literature review from 2000 to 2018 was conducted of studies reporting on the psychometric properties and feasibility of 18 self-report PA tools for community-dwelling older adults (≥ 65 years) to determine the suitability of these tools for use in older adults with MCC. Based on an assessment of the available evidence for the psychometric properties and feasibility of 18 different self-report PA tools, the Physical Activity Assessment Scale for the Elderly (PASE) is recommended as the best-suited self-report PA tool for older adults with MCC.

Given the rapidly expanding older adult population, finding health care approaches that support older adults to age in their choice of place, with an accompanying philosophical re-orientation of health services, is becoming more urgent. We studied the Home Care Home First – Quick Response Project to understand how clients over age 75 and their family caregivers perceived the enhanced community-based services delivered through Home First. Using interpretive description as the methodological design, we explored the experiences of eight older adults and 11 family caregivers; all older adults were enrolled in Home First due to a significant change in their health status. We identified four themes: growing older in chosen places with support, philosophy of care, processes of Home First, and the significance of Home First for clients. Overall, clients and family caregivers responded positively to the Home First services. Clients valued their independence and growing older in places they had specifically chosen.

Cette étude visait à identifier les facilitateurs, les obstacles et la faisabilité d’implanter un Accompagnement-citoyen personnalisé d’intégration communautaire (APIC) pour des aînés en perte d’autonomie et vivant dans la communauté. L’APIC est un suivi hebdomadaire de trois heures réalisé par un accompagnateur non professionnel formé et supervisé qui vise à optimiser la réalisation d’activités sociales et de loisirs de personnes ayant des incapacités. Une recherche-action a permis de réaliser des entretiens semi-dirigés auprès de 16 participants de la communauté. Les principaux facilitateurs de l’implantation sont l’adaptabilité de l’APIC et son appui scientifique, la reconnaissance d’un besoin, l’expertise et la collaboration. La présence de leaders ouverts à la nouveauté et d’individus offrant du soutien est favorable. Le financement de l’implantation, associé à un contexte économique défavorable, est un obstacle. La majorité des participants perçoivent qu’il serait faisable d’implanter l’APIC en l’intégrant à des structures bénévoles déjà existantes. Ces connaissances permettront d’optimiser l’implantation de l’APIC ou d’interventions similaires dans la communauté.

Nous avons documenté et comparé les caractéristiques environnementales potentiellement associées à la participation sociale de Québécois âgés, selon le niveau de ruralité. Une enquête a été réalisée auprès de Québécois âgés de 65 ans et plus recrutés par différents regroupements d’aînés et les réseaux sociaux. Les répondants ont rempli le Questionnaire du potentiel de participation sociale, développé à partir d’une recension systématique des écrits. Selon les 515 aînés, âgés en moyenne de 71,5 ans, les caractéristiques environnementales liées à la participation sociale, ainsi que la convivialité des villes et des quartiers, sont perçues plus favorablement dans les milieux métropolitains et urbains que dans les milieux ruraux. Toutefois, l’accès à l’autobus ainsi que l’accueil et l’ouverture des gens du quartier sont davantage appréciés par les aînés ruraux. Ces résultats témoignent de la présence d’inégalités de participation sociale selon le niveau de ruralité et permettent d’envisager de nouvelles pistes d’action.

Given the urgency of finding cost-effective and innovative solutions to providing community services for aging in place, novel solutions that take advantage of existing infrastructure are clearly needed. In this sequential mixed-method study, we chose to explore the role that nursing homes could play in offering services to a non-traditional target population, namely seniors with loss of independence living in the community. Forty-two (n = 42) nursing homes in the province of New Brunswick completed an online survey, and 10 agreed to participate in face-to-face interviews. Results show that 100 per cent of participants agreed that nursing homes could offer services to seniors in their communities for aging in place. Results suggest that nursing homes are cost-effective, innovative solutions for aging in place.

Using the example of pottery imported into the Channel ports of southern England, an approach to examining the role of pottery in the emergence and mediation of coastal communities is proposed here. Building on recent scholarship, it is argued that it is no longer tenable to see pottery as a carrier of identity, or as part of a ‘cultural package’, with meaning emerging with identity as people interact with pottery within and without port environments. The study proposes that imported pottery found meaning in different ways, depending on the context of acquisition and use. Hence it mediated different forms of community and identity. The article ends with a consideration of the wider implications of this approach for ongoing studies of material culture, trade, and urban identities in medieval Europe.

New surveillance technologies like those included in ambient assisted living – such as body-worn and passive environmental sensors, smart interfaces, and communications networks – are being developed to improve the security and safety of “at risk” older people, but ethical questions have been raised about the extent to which they compromise the rights and privacy of the people being monitored. The qualitative study we conducted was designed to help us understand the ways these novel surveillance technologies would influence individuals’ everyday experiences of home. Participants felt new forms of surveillance would influence their sense of security, autonomy, and self-confidence, and would alter perceptions of home. The findings emphasize the need to improve our understanding of how ambient assisted living will affect the lives of those being monitored.

Canadians are experiencing increased life expectancy and chronic illness requiring end-of-life care. There is limited research on the multiple roles for family members providing home-based palliative care. Based on a larger ethnographic study of client-family-provider relationships in home-based palliative care, this qualitative secondary analysis explores the enactment of multiple roles for family members providing home-based palliative care to seniors with advanced cancer. Family members had multiple expectations to provide care but felt their expectations of services were unmet. The process of enacting multiple roles was depicted by three interrelated themes: balancing, re-prioritizing, and evolving. Positive and negative health responses resulted from attempts to minimize personal health while simultaneously maintaining health. “True” family-centred care was found to be lacking, but should be a goal of health professionals involved in end-of-life care.

Aim: This study was undertaken to determine the care needs of Canadian seniors living at home with advanced chronic obstructive pulmonary disease (COPD).

Background: COPD is a leading cause of morbidity and mortality worldwide. Although hospitalizations for illness exacerbations and end-stage care may be common, most persons with COPD live out their lives in the community. Little is known about the care needs of this significant population.

Methods: This study was guided by the research question: “What are the care needs and care priorities of senior citizens with end-stage COPD?” An ethnographic qualitative approach was used to address this question. Twelve community-dwelling seniors living in a Canadian city and diagnosed with advanced COPD were interviewed three times in their homes over an eight-month period in 2006.

Findings: Three themes emerged, each with concrete care needs: (a) self-reliance and independence through adaptation, (b) stable health through maintenance, and (c) living with constraints. The predominant theme was that all participants wanted to maintain their independence. This required considerable adaptation, as well as assistance from others.

Conclusions: Ensuring and improving assistance is important to prevent additional suffering and reduce exacerbations requiring hospitalization, a particularly important aim given the high and rising incidence of advanced COPD. A number of other insightful findings reveal the significance of learning directly from the persons who live with chronic illnesses about their lives.