Older Adults In Canada Research Articles

Design characteristics and inclusion of evidence-based exercise recommendation in fall prevention community exercise programs for older adults in Canada: a national descriptive self-report study

BackgroundTraining balance through exercise is an effective strategy to reduce falls in community-dwelling older adults. Evidence-based fall prevention exercise recommendations have been proposed, specifying that exercise programs should: (1) provide a high challenge to balance, (2) be offered for a least three hours per week, (3) be provided on an ongoing basis. Community exercise programs have the potential to deliver effective fall prevention exercise; however, current design characteristics and whether they include the recommendations is not known. This study described design characteristics of fall prevention community exercise programs for older adults (50 years and older) across Canada, and explored whether these programs included the three evidence-based exercise recommendations.MethodsInstructors of fall prevention community exercise programs completed electronic self-report questionnaires following a modified Dillman recruitment approach. Questions explored program characteristics, exercise content, target population, and program and instructor demographic information. Using a previously developed coding scheme based on recommendations, exercises were coded for balance challenge.ResultsOne hundred fourty completed eligible questionnaires were analyzed (74% response rate). One hundred thirty-three programs (95%) included the challenge recommendation by prescribing mostly moderate or high challenge balance exercises, 16 programs (11%) included at least three hours of exercise a week, and 59 programs (42%) were offered on an ongoing basis. Eight programs (6%) included all three recommendations.ConclusionsMost programs included at least one recommendation for effective fall prevention exercise. Future studies should examine organizational barriers and facilitators to incorporating evidence-based exercise recommendations and explore the use of mixed home/in-class strategies to include the recommendations.

Dynamics of Multimorbidity Resilience and Health Outcomes Over Time in Community-Residing Older Adults

Multimorbidity resilience may mitigate the adverse effects of multiple chronic diseases on older adults’ health. Wister et al.’s (2018) multimorbidity resilience index was developed and tested in a cross-sectional sample of older adults in Canada. Building on these findings, we examined the reciprocal relationships of resilience on outcomes to test these potentially mitigating effects in a community-based, U.S. sample of older adults over time. The study sample includes 1,054 older adults from waves 2 and 3 of the National Social Life, Health, and Aging Project (NSHAP) study (Waite et al 2020). Wister et al.’s (2018) index was mapped to NSHAP measures, and reciprocal relationships of multimorbidity resilience and health outcomes over a 5-year period was tested using structural equation modeling (SEM). Results indicated significant effects of multimorbidity resilience on self-rated physical health and pain. Interestingly, a better functional resilience at baseline conferred better self-rated physical health at follow-up, while better psychological resilience predicted lower pain level. By contrast, the influence of health outcomes on any domain of multimorbidity resilience was not detectable at all, supporting the direction of these associations from resilience to outcomes. The study systematically investigated the dynamic hypotheses between multimorbidity resilience and health outcomes. That is, whether they are determinants or consequences, or both. Our findings suggest multimorbidity resilience predicts subsequent 5-year change in health outcomes, especially self-rated physical health and pain level, but not vice versa, strengthening the evidence of the importance of resilience in the health of older adults.

Internet non-use among Canadian Indigenous older adults: Aboriginal Peoples Survey (APS)

BackgroundOlder adults benefit considerably from Internet use, as it can improve their overall health and quality of life, for example through accessing healthcare services and reducing social isolation. The aim of this study is to assess the prevalence and characteristics of Indigenous older adults in Canada who do not use the Internet.MethodsThe Aboriginal Peoples Survey (APS) 2017 was used and analysis was restricted to those above 65 years of age. The main outcome variable was non-use of the internet in a typical month. Multivariable logistic regression was conducted to assess the relationship between each of the sociodemographic, socioeconomic, lifestyle and health factors and internet non-use.ResultsThe prevalence of Indigenous older adults who reported never using the Internet in a typical month was 33.6% with the highest prevalence reported by residents of the Canadian territories while the lowest prevalence was reported in British Columbia. After adjustment, results indicated that older age (OR = 4.02, 95% CI 3.54–4.57 comparing 80+ to 65–69 years of age), being a male (OR = 1.52, 95% CI 1.41–1.63), married (OR = 1.34, 95% CI 1.25–1.44), and living in rural areas (OR = 1.95, 95% CI 1.79–2.13) increased the odds of not using the Internet. First Nation individuals and those who have a strong sense of belonging to the Indigenous identity were more likely to not use the Internet compared to their counterparts. In addition, those who were less educated (OR = 8.74, 95% CI 7.03–1 0.87 comparing less than secondary education to Bachelor’s Degree and above), unemployed (OR = 1.41, 95% CI 1.26–1.57), smoked cigarettes, used marijuana and those with lower self-perceived mental health and unmet health needs were at increased odds of Internet non-use compared to their counterparts.ConclusionsFindings from this study show that a large proportion of the Indigenous older adults in Canada do not use the internet. It is necessary to address Indigenous communities’ lack of internet access and to create interventions that are consistent with Indigenous values, traditions, and goals.

Between loneliness and belonging: narratives of social isolation among immigrant older adults in Canada

AbstractResearch points to a higher risk for social isolation and loneliness among new immigrant and refugee older adults. Our article draws from a research project that explored the everyday stories of ageing among 19 diverse immigrant older adults in Canada. To capture their experiences of loneliness and social isolation, we use four illustrative cases derived from a structural approach to life-story narrative. To these we apply the intersectional lifecourse analytical lens to examine how life events, timing and structural forces shape our participants’ experiences of social isolation and loneliness. We further explore the global and linked lives of our participants as well as the categories of difference that influence their experiences along the continua of loneliness to belonging, isolation to connection. Finally, we discuss how an understanding of sources of domination and expressions of agency and resistance to these forces might lead us to solutions.

Canadian Occupational Therapists' Use of Technology With Older Adults: A Nationwide Survey.

As rehabilitation specialists, occupational therapy practitioners play a gateway role regarding recommendation of various technologies for homecare. However, no study has investigated current occupational therapy practices concerning information and communication technology (ICT) for older adults in Canada. The objective of this study was to identify Canadian occupational therapists' (OTs) knowledge and practices of ICT with older adults as well as factors associated with its recommendation. A Canada-wide, cross-sectional, online survey was conducted. Of 387 OTs, only 12.4% reported recommending ICT in practice. ICTs supporting communication and cognition were the main types recommended. The reported barriers to use in practice differed between ICT familiar users and nonusers. Multivariate logistic regression analyses showed that clinicians with more years of clinical experience were more likely to recommend ICT. Clinicians' services, work environments, and client diagnosis were also factors associated with ICT recommendation. Additional research is needed to understand how to overcome barriers to ICT recommendation in OT practice.

Scoping Review of Clinical Practice Guidelines for Fall Risk Screening and Assessment in Older Adults across the Care Continuum.

Given the rising numbers of older adults in Canada experiencing falls, evidence-based identification of fall risks and plans for prevention across the continuum of care is a significant priority for health care providers. A scoping review was conducted to synthesize published international clinical practice guidelines (CPGs) and recommendations for fall risk screening and assessment in older adults (defined as 65 years of age and older). Of the 22 CPGs, 6 pertained to multiple settings, 9 pertained to community-dwelling older adults only, 2 each pertained to acute care and long-term care settings only, and 3 did not specify setting. Two criteria, prior fall history and gait and balance abnormalities, were applied either independently or sequentially in 19 CPG fall risk screening algorithms. Fall risk assessment components were more varied across CPGs but commonly included: detailed fall history; detailed evaluation of gait, balance, and/or mobility; medication review; vision; and environmental hazards assessment. Despite these similarities, more work is needed to streamline assessment approaches for heterogeneous and complex older adult populations across the care continuum. Support is also needed for sustainable implementation of CPGs in order to improve health outcomes.

Poverty and food insecurity of older adults living in social housing in Ontario: a cross-sectional study

BackgroundPoverty and food insecurity have been linked to poor health and morbidity, especially in older adults. Housing is recognized as a social determinant of health, and very little is known about subjective poverty and food insecurity in the marginalized population of older adults living in subsidized social housing. We sought to understand poverty and food insecurity, as well as the risk factors associated with both outcomes, in older adults living in social housing in Ontario.MethodsThis was a cross-sectional study using data collected from the Community Paramedicine at Clinic (CP@clinic) program. A total of 806 adult participants residing in designated seniors’ or mixed family-seniors’ social housing buildings attended CP@clinic within 14 communities across Ontario, Canada.ResultsThe proportion of older adults reporting poverty and food insecurity were 14.9 and 5.1%, respectively. Statistically significant risk factors associated with poverty were being a smoker (AOR = 2.38, 95% CI: 1.23–4.62), self-reporting feeling extremely anxious and/or depressed (AOR = 3.39, 95% CI: 1.34–8.62), and being food insecure (AOR = 23.52, 95% CI: 8.75–63.22). Statistically significant risk factors associated with food insecurity were being underweight (AOR = 19.79, 95% CI: 1.91–204.80) and self-reporting experiencing poverty (AOR = 23.87, 95% CI: 8.78–64.90). In those who self-reported being food secure, the dietary habits reported were consistent with a poor diet.ConclusionThe poverty rate was lower than expected which could be related to the surrounding environment and perceptions around wealth. Food insecurity was approximately twice that of the general population of older adults in Canada, which could be related to inaccessibility and increased barriers to healthy foods. For those who reported being food secure, dietary habits were considered poor. While social housing may function as a financial benefit and reduce perceived poverty, future interventions are needed to improve the quality of diet consumed by this vulnerable population.

Barriers and Facilitators That Influence Social Participation in Older Adults With Dual Sensory Impairment

Introduction: The proportion of older adults with combined acquired vision and hearing impairments (referred to as Dual Sensory Impairment/DSI) is growing, and their unique care needs are beginning to receive increased attention. Considering the age-related demographic shift, one million older adults in Canada are expected to experience DSI by 2036, and evidence suggests that DSI is associated with communication difficulties, cognitive decline, depression, functional decline, and participation challenges. Given that the goal of sensory rehabilitation is to improve participation, the study explored perceived contextual barriers and facilitators of social participation among older adults with DSI to better understand their lived experience. Methods: The International Classification of Functioning, Disability and Health (ICF) was used as a framework to identify and describe the contextual factors (environmental and personal) that influence the social participation of older adults with DSI. Sixteen older adults with DSI (mean age = 86 years, SD = 7; 9 female; registered with an urban sensory rehabilitation organization) were interviewed using a semi-structured qualitative interview guide. Interviews were audio-recorded, transcribed, and then analyzed using a content analysis approach. Results: Environmental factors, such as societal attitudes towards disability, access to technology aids, and availability of transportation services emerged as the most important factors influencing participation. The onset and type of the impairments and attitude towards one’s disability were important personal factors affecting the participation. The availability of social support and the use of assistive devices (e.g., magnifiers, glasses, and hearing aids) were reported to be facilitators. In contrast, the inaccessibility of the built environment and the cost and limited availability of accessible transportation were key barriers to their social participation. Discussion: Our study indicated that assistive devices facilitate older adults with DSI in their day-to-day functioning and improve social participation, while expensive and inadequate transportation services may deter their participation. For rehabilitation professionals working with older adults with DSI, it is crucial to consider the barriers to and facilitators of social participation when designing interventions. Future research is warranted to investigate the role of assistive devices and transportation in improving the social participation of older adults with DSI.

Conducting a Mixed-Methods Study with Older Adults in Five Languages: Lessons from the Field.

One third of older adults in Canada are foreign-born, yet there is a dearth of literature on this population. When our team set out to engage in a mixed-methods study on the physical activity and mobility of foreign-born older adults (FBOAs), we found limited guidance. The objective of this Research Note is to share the lessons that we learned in implementing a mixed-methods study in five languages, with 49 visible minority FBOAs from diverse ethno-cultural groups. With an emphasis on practical implementation, here we share our reflections on early community engagement, linguistic accessibility and literacy considerations, facilitating communication with the research team, creating a support role for multilingual family members, organisational suggestions, and working with interpreters and monolingual transcribers. The older Canadian population is projected to become increasingly diverse in the coming decades, and it is our hope that this note will further facilitate research in this understudied area.

Interdisciplinary and Collaborative Approaches Needed to Determine Impact of COVID-19 on Older Adults and Aging: CAG/ACG and CJA/RCV Joint Statement.

The COVID-19 pandemic and subsequent state of public emergency have significantly affected older adults in Canada and worldwide. It is imperative that the gerontological response be efficient and effective. In this statement, the board members of the Canadian Association on Gerontology/L'Association canadienne de gérontologie (CAG/ACG) and the Canadian Journal on Aging/La revue canadienne du vieillissement (CJA/RCV) acknowledge the contributions of CAG/ACG members and CJA/RCV readers. We also profile the complex ways that COVID-19 is affecting older adults, from individual to population levels, and advocate for the adoption of multidisciplinary collaborative teams to bring together different perspectives, areas of expertise, and methods of evaluation in the COVID-19 response.

Nutrition, Immigration and Health Determinants Are Linked to Verbal Fluency among Anglophone Adults in the Canadian Longitudinal Study on Aging (CLSA).

Later-life cognitive impairment is an important health issue; however, little is known about the condition among diverse groups such as immigrants. This study aims to examine whether the healthy immigrant effect exists for verbal fluency, an indicator of cognitive functioning, among anglophone middle-aged and older adults in Canada. Using from the baseline data of the Canadian Longitudinal Study on Aging (CLSA), multiple linear regression was employed to compare associations among immigrants (recent and long-term) and Canadian-born residents without dementia for two verbal fluency tests, the Controlled Oral Word Association Test (COWAT) and the Animal Fluency (AF) task. Covariates included socioeconomic, physical health, and dietary intake. Of 8,574 anglophone participants (85.7% Canada-born, 74.8% aged 45-65 years, 81.8% married, 81.9% with a post-secondary degree), long-term immigrants (settled in Canada >20 years) performed significantly better than Canadian-born residents for the COWAT (42.8 vs 40.9) but not the AF task (22.4 vs 22.4). Results of the multivariable adjusted regression analyses showed that long-term immigrants performed better than Canadian-born peers in both the COWAT (B=1.57, 95% CI: 0.80-2.34) and the AF test (B=0.57, 95% CI: 0.19-0.95), but this advantage was not observed among recent immigrants. Other factors associated with low verbal fluency performance included being single, socioeconomically disadvantaged, having hypertension, excess body fat, and consuming low amounts of pulses/nuts or fruit/vegetables. Long-term immigrants had higher verbal fluency test scores than their Canadian-born counterparts. Immigration status, social, health and nutritional factors are important considerations for possible intervention and prevention strategies for cognitive impairment.

Older Adult Education

Abstract Interest in older adult education (OAE) is intensifying for several reasons. The number of older adults in Canada is growing; increasing the proportion of older people in the population. Older adults are now more active, and want creative challenges, opportunities to learn, and chances to contribute to their community. In turn, cognitive and social activities, including educational activities, benefit the health and well-being of older adults and their communities. Adults face multiple role changes as they age, which can motivate them to participate in education to inform and support life transitions. Universities are well positioned to engage the growing and changing population of older adults in creative and interesting ways, and in doing more fully serve their communities. The paper provides a perspective on how OAE is currently understood and practiced in Canadian universities, identifies issues facing educators in sustaining/developing these types of educational programs, and poses considerations on future directions for university-based OAE.

Barriers and facilitators to nutritional risk screening of older adults in primary care

AbstractIntroduction:Over one-third of these community-dwelling older adults in Canada are at increased nutritional risk. Worldwide, two-thirds of older adults are at increased nutritional risk, although this figure includes those who are hospitalized or in long term care. Nutritional risk can lead to malnutrition; this occurs when an individual's food intake has an imbalance of energy, protein, or other nutrients. Nutritional risk and malnutrition are associated with poor quality of life, increased hospitalization, and premature mortality. Since malnutrition starts in the community, primary care is the ideal location for nutritional risk screening. If nutritional risk is identified early, before it progresses to malnutrition, it can be more easily treated. It is therefore important to understand barriers and facilitators to nutritional risk screening in primary care.Materials and Methods:The peer-reviewed and grey literature were searched. The databases CINAHL, Embase, Medline, and Google Scholar were used to identify articles related to barriers and facilitators to nutritional risk screening of older adults in primary care. A Google search identified publications from the grey literature related to nutritional risk screening of older adults. Key informants consisting of health care professionals working in primary care were asked to identify additional barriers. The Theoretical Domains Framework (TDF) was used to classify the barriers and facilitators.Results:Nine barriers and nine facilitators relating to nutritional risk screening of older adults in primary care were identified. These barriers and facilitators were located within the following domains of the TDF: knowledge; skills; social/professional role and identity; beliefs about capabilities; beliefs about consequences; motivation and goals; memory, attention and decision processes; environmental context and resources; social influences; emotions; behavioural regulation; and nature of the behaviours.Discussion:The TDF can be used to examine the barriers and facilitators to nutritional risk screening of older adults in primary care. Identification and classification of these barriers and facilitators can aid in the development and implementation of interventions designed to improve rates of nutritional risk screening in primary care. Identifying older adults at nutritional risk can help to prevent malnutrition, by intervening early when poor dietary intake may still be relatively easy and inexpensive to address. Screening is the first step in this identification.

Sexy till I die: What applied theatre can offer in approaches to sexual health

Abstract For older adults in Canada, too often shame and silence describe their experiences of sexual health. With more citizens over the age of 65 than ever before and increasing rates of Sexually Transmitted Infections (STIs) in older adults, we are facing a serious issue. Applied theatre offers an innovative approach to deconstructing social stigma in sexuality across the life course, whereby new understandings and perceptions may emerge for people of all ages. The usefulness, gaps and application of three different approaches to sexual health issues are examined to highlight innovations in addressing sexual health and critique ageist, sexist and heteronormative assumptions through a feminist, critical pedagogy lens. The analysis culminates in a proposed outline for an intergenerational, community-based theatre project to address the social stigma of sexuality across the life course entitled You're Doing What?! At Your Age?!

"Growing Old is not for the Weak of Heart": Social isolation and loneliness in Muslim immigrant older adults in Canada.

The increase in global migration means more immigrants are ageing in host countries with unique experiences and needs. Muslim immigrants in Canada are from diverse ethnocultural communities and experience unmet health and social needs in older age. A community-based participatory research project was conducted in Alberta, Canada, in 2017-2018 to understand the experiences and needs of healthy ageing in this population. A community advisory committee participated in all phases of the research project including initial framing of the research focus, recruitment, data collection and data analysis. In total, 67 older adults and stakeholders from South Asian, Arab and African Muslim communities participated in one of 23 individual interviews or seven focus group discussions over a 1-year period. Participants were asked about their experiences of growing old in Canada, unmet health and social needs, and community perspectives on healthy ageing. All data were audio-taped and transcribed verbatim. Interpreters were used for non-English speaking participants. Data were thematically analysed with a focus on social isolation and loneliness. Using an exclusion lens two major themes were identified: (a) intersections of exclusion: ageism, sexism, racism, and; (b) strategies for inclusion: local, national, transnational. Findings highlight both the vulnerability of Muslim immigrant older adults and their capacity for agency. The study findings point to the intersectinginfluences of exclusionary practices on social isolation and loneliness in immigrant older adults and the need to incorporate an exclusion lens in developing social policies and programs for healthy ageing.

Sleep and Mental Health Among Older Adults in the Canadian Longitudinal Study on Aging

Abstract Background Global studies have demonstrated consistent associations between sleep problems and mental health and well-being in older adults, however Canadian data are lacking. We investigated associations between sleep quantity and quality with both mental illness symptoms and well-being among older adults in Canada. Methods We used cross-sectional baseline data from the Canadian Longitudinal Study on Aging, a national survey of 30,097 community-dwelling adults aged 45 years and older. Self-reported sleep measures included average past-week sleep duration (short [<6h], normal [6-8h], long [>8h]), and sleep quality (satisfied or dissatisfied vs neutral). Mental illness outcomes included depressive symptoms and psychological distress. Mental well-being outcomes included self-rated mental health and satisfaction with life. We used modified Poisson regression models with adjustment for sociodemographic, behavioural, and clinical factors, and stratification by sex and age to explore effect modification. Results In the unadjusted analysis, short and long sleep duration and sleep dissatisfaction were associated with higher mental illness symptoms and lower well-being across all outcomes. Sleep satisfaction was associated with a lower likelihood of mental illness symptoms and better well-being. Short sleep duration was associated with the largest effects on mental health outcomes. Self-rated mental health and depressive symptoms had the largest associations with sleep measures. Effects were larger in males and the 45 to 54 year age group. Conclusions Preliminary evidence suggests sleep duration and quality are associated with symptoms of depression, psychological distress, and poor mental well-being among older adults. We are unable to determine whether sleep problems are a cause or consequence of poor mental health. Nonetheless, sleep may be an important target for public health initiatives to improve mental health and well-being among older adults. Key messages Our findings contribute further evidence that sleep difficulties are associated with adverse health outcomes including higher mental illness symptoms and lower well-being among older adults. Sleep disturbances are an unmet public health problem, and may be an important target for public health initiatives to improve mental health and well-being among older adults.

Social Determinants of Racial Disparities in Cognitive Functioning in Later Life in Canada.

Objective: The objectives of this study were (a) to assess the nature and extent of racial disparities in cognitive functioning among older adults in Canada, and (b) to assess the role of socioeconomic factors and patterned health behaviors as social determinants of racial disparities in cognitive functioning. Method: Data were drawn from the 2009-2010 Canadian Community Health Survey. The study sample included 20,646 people aged 60 years or older. Ordered logistic regression analyses were carried out to test hypotheses linking race, socioeconomic factors, and patterned health behaviors, and cognitive functioning. Results: Our findings revealed a racial gap in cognitive functioning among older adults in Canada. This gap was, in part, mediated by socioeconomic inequalities (in income and food security) and socially patterned behaviors (i.e., drinking, physical activity levels). However, socioeconomic status (SES) and behavioral factors appeared to operate independently of one another. Discussion: The findings suggest a need to focus on the direct effects of race as well as its indirect effects, through socioeconomic factors and patterned health behaviors, for an understanding of racial disparities in cognitive functioning.

Self-Rated Health by Sexual Orientation Among Middle-Aged and Older Adults in Canada.

This article examines patterns of self-rated physical and mental health by sexual orientation among middle-aged and older adults in Canada, a rapidly growing subpopulation shown to be at risk of poor health. We use the Canadian Community Health Survey (CCHS 2015-2016) to estimate logit models predicting fair/poor self-rated physical and mental health by sexual orientation among middle-aged and older adults, stratifying by sex and age group. We find no differences in physical health for gay men and lesbian women compared with their heterosexual counterparts. However, middle-aged gay men are disadvantaged in terms of mental health, but not women. Bisexual women are disadvantaged in terms of physical health, and for mental health in some model specifications. Respondents who did not know their sexual orientation have poorer health across some measures of health and age groups. Our findings add to the paucity of research on older sexual minorities in Canada. They highlight the importance of separating out sexual minority groups because bisexual women have distinct health profiles. In addition, this is the first study to examine the health of respondents who "do not know" their sexual orientation, and future research should distinguish between different explanations for their poor health.

Living Alone Among Older Adults in Canada and the U.S.

Increasing proportions of people, including older adults, live alone. Studying living arrangements of the elderly is important because these affect and reflect general well-being of the elderly and inform communities’ response to elderly housing needs. We analyze data from the 2006 Canadian Census and the 2006 American Community Survey to examine living alone among non-married older adults aged 55 and older in Canada and the U.S. The paper has two parts. First, we compare native- and foreign-born elderly to see if immigrants are less likely to live alone. Second, we examine factors associated with living alone among older immigrants. While older immigrants in both countries are less likely to live alone, the large differences are substantially reduced once various explanatory variables are considered. Comparisons of four gender/country groups of older immigrants show the positive role of economic and acculturation factors on living alone among older immigrants. With few exceptions, predictors of living alone are similar for older immigrants in Canada and the U.S.: living alone is mainly explained by a combination of economic and acculturation factors, taking demographic variables into account. Findings underline the need for age-friendly housing with innovative design and technology that can accommodate older people who live alone, including older immigrants who may have different needs and cultural preferences.

Later Life Care Planning and Concerns of Transgender Older Adults in Canada.

While the particular health-care concerns of transgender people have been documented and transgender aging is an emerging area of scholarship, little is known about planning for later and end-of-life care among transgender older adults. As part of a larger project, focus groups and interviews were conducted with 24 transgender older adults (average age 70 years) living in five cities in Canada exploring their concerns and explicit plans for later life care. Three primary themes emerged: (a) “dealing with the day-to-day” reflecting economic precarity and transitioning in later life, (b) fractures and support within family and community, and (c) “there’s a huge gap between principle and practice” reflecting mixed experiences and perceptions of health-care services. These themes suggest that effective promotion of care planning among older transgender persons requires an appreciation of the daily exigencies of their lives and the extent and nature of social support available to them.