Physical Activity and Social Interaction among Rural Older Adults in Saskatchewan during COVID-19.

Physical activity and social interaction among rural older adults are important, particularly during the COVID-19 pandemic when restrictions on physical gatherings were placed. The purpose of this qualitative study was to gain a deeper understanding of rural older adults' experience with physical activity and social interaction during the COVID-19 pandemic. An interpretative phenomenological approach was used to explore the experience of 10 older adults, 67-82 years of age, from rural communities throughout Saskatchewan. Findings revealed that many rural older adults acknowledged the health benefits of physical and social activities and experienced loneliness when COVID-19 restrictions were placed, even when living with a partner. For some, the restrictions placed on physical and social activity provided a welcome break from daily responsibilities. Rural communities, often at a disadvantage, were also perceived by participants as being protected against COVID-19. The resilience demonstrated among rural participants to persevere and adapt to their changing environment during the pandemic was evident in the findings.

How Do We Build the Human Capital for a True Learning Healthcare System?

Our healthcare systems depend on human capital for effectiveness. The Canadian Institutes of Health Research - Institute of Health Services and Policy Research has prioritized building capacity for "solution-oriented research and evidence-informed health care system transformation" (CIHR IHSPR 2021a: 20) as a core strategic direction. In this commentary, we articulate strategies for positioning PhD-trained scientists at the forefront of this transformation, including refreshing a competency framework that outlines the skill set required for maximum impact, exploring opportunities to expand embedded research career pathways and considering new ways to support the evolution of learning health systems. We conclude highlighting the need to modernize how real-world research impact is recognized.

Social Interaction and Physical Activity Among Rural Older Adults: A Scoping Review.

Social interaction and physical activity are critical components in supporting health among older adults, yet rates of activity are low in rural communities. There is significant merit in exploring the relationship between these interrelated concepts. A scoping review was conducted to synthesize existing literature. Search results identified 26 studies meeting inclusion criteria. Findings indicated that social interaction and physical activity were important for many older adults to maintain health; however, not all older adults preferred the social aspect of group-based exercise. Opportunities for physical activity and social interaction were limited based on geographical location and other socioeconomic factors. This was evident in rural communities where populations were lower and education and income levels varied. Differences on the defining role and meaning of physical activity also emerged. Increasing physical activity and social interaction must account for negative associations to address the lower rates of participation among rural older adults.

Stigma Reduction Interventions of Dementia: A Scoping Review.

Despite its global importance and the recognition of dementia as an international public health priority, interventions to reduce stigma of dementia are a relatively new and emerging field. The purpose of this review was to synthesize the existing literature and identify key components of interventions to reduce stigma of dementia. We followed Arksey and O'Malley's scoping review process to examine peer-reviewed literature of interventions to reduce dementia-related stigma. A stigma-reduction framework was used for classifying the interventions: education (dispel myths with facts), contact (interact with people with dementia), mixed (education and contact), and protest (challenge negative attitudes). From the initial 732 references, 21 studies were identified for inclusion. We found a variety of education, contact, and mixed interventions ranging from culturally tailored films to intergenerational choirs. Findings from our review can inform the development of interventions to support policies, programs, and practices to reduce stigma and improve the quality of life for people with dementia.

Patients' choice of healthcare providers and predictors of modern healthcare utilisation in Bangladesh: Household Income and Expenditure Survey (HIES) 2016-2017 (BBS).

OBJECTIVES: The number of modern healthcare providers in Bangladesh has increased and they are well equipped with modern medical instruments and infrastructures. Despite this development, patients seeking treatment from alternative healthcare providers are ongoing. Hence, this study aims to determine the underlying predictors of patients' choosing modern healthcare providers and health facilities for getting treatments. SETTING: Data from the nationally representative Household Income and Expenditure Survey 2016-2017 conducted by the Bangladesh Bureau of Statistics were used. PARTICIPANTS: 34 512 respondents sought treatment for their illnesses from different types of available healthcare providers. PRIMARY AND SECONDARY OUTCOME MEASURE: Patients' choice of healthcare providers (primary) and predictors of patients' choice of modern healthcare providers (secondary). RESULTS: The study found that 40% of the patients visit modern healthcare providers primarily on having symptoms of illness, and the remainder goes to alternative healthcare providers. Patients living in urban areas (adjusted OR (AOR)=1.11, 95% CI 1.05 to 1.17, p<0.01), and if the travel time was between 1 and 2 hours (AOR=1.11, 95% CI 1.00 to 1.22, p<0.05) compared with travel time less than 1 hour, were positively associated to utilisation of modern healthcare facilities for their first consultation. The statistical models show that the predisposing and need factors do not significantly impact patients' choice of modern healthcare providers. CONCLUSIONS: The distribution of modern healthcare providers should be even across the country to eliminate the rural-urban divide in modern healthcare utilisation. Enhancing the digital provision of modern healthcare services could reduce travel time, omit transportation costs and save waiting time for treatment by the modern healthcare providers. Policymakers can think of introducing a national health insurance programme in Bangladesh as a potential policy instrument.

Guidance for Health Care Leaders During the Recovery Stage of the COVID-19 Pandemic: A Consensus Statement.

Importance: The COVID-19 pandemic is the greatest global test of health leadership of our generation. There is an urgent need to provide guidance for leaders at all levels during the unprecedented preresolution recovery stage. Objective: To create an evidence- and expertise-informed framework of leadership imperatives to serve as a resource to guide health and public health leaders during the postemergency stage of the pandemic. Evidence Review: A literature search in PubMed, MEDLINE, and Embase revealed 10 910 articles published between 2000 and 2021 that included the terms leadership and variations of emergency, crisis, disaster, pandemic, COVID-19, or public health. Using the Standards for Quality Improvement Reporting Excellence reporting guideline for consensus statement development, this assessment adopted a 6-round modified Delphi approach involving 32 expert coauthors from 17 countries who participated in creating and validating a framework outlining essential leadership imperatives. Findings: The 10 imperatives in the framework are: (1) acknowledge staff and celebrate successes; (2) provide support for staff well-being; (3) develop a clear understanding of the current local and global context, along with informed projections; (4) prepare for future emergencies (personnel, resources, protocols, contingency plans, coalitions, and training); (5) reassess priorities explicitly and regularly and provide purpose, meaning, and direction; (6) maximize team, organizational, and system performance and discuss enhancements; (7) manage the backlog of paused services and consider improvements while avoiding burnout and moral distress; (8) sustain learning, innovations, and collaborations, and imagine future possibilities; (9) provide regular communication and engender trust; and (10) in consultation with public health and fellow leaders, provide safety information and recommendations to government, other organizations, staff, and the community to improve equitable and integrated care and emergency preparedness systemwide. Conclusions and Relevance: Leaders who most effectively implement these imperatives are ideally positioned to address urgent needs and inequalities in health systems and to cocreate with their organizations a future that best serves stakeholders and communities.

Competing challenges for immigrant seniors: Social isolation and the pandemic.

The pandemic has exposed and amplified complex and complicated health and societal challenges while offering immense opportunities to transform societies to improve health for all. Social isolation is a challenging and persistent issue experienced by many older adults, especially among immigrant and refugee seniors. Unique risk factors such as racism, discrimination, language barriers, weak social networks, and separation from friends and family predispose immigrant and refugee seniors to a higher risk of social isolation. The pandemic has magnified the unique risks and has highlighted the differential health and economic impacts. This article examines social isolation among immigrant and refugee seniors in Canada by focusing on the policy context, available programs and services to reduce social isolation, and the conceptualization and measurement considerations for advancing research to address social isolation among this growing population. Drawing on specific examples, we discuss immigration, aging, and social isolation within the context of Canada. While our article focuses on Canada as a case study, our discussion has relevancy and implications for other high-income countries with aging immigrant and refugee populations. In moving forward, we argue that a more complete and targeted understanding of social isolation is essential to informing program and policy development to support immigrant and refugee seniors in Canada and beyond. The transformation needed in our societies to create health for all requires strong equity and determinants of health perspective and a systems approach beyond health to ensure lasting change.

Barriers and facilitators to meeting recommended physical activity levels among new immigrant and refugee children in Saskatchewan, Canada.

Newcomers are often healthy when they arrive in Canada, yet experience health declines shortly thereafter, possibly due to lifestyle changes. As part of the Healthy Immigrant Children study, this mixed-methods study aims to analyze possible predictors of physical activity among 300 newcomer children, and explore their lived experiences using a sub-sample of 19 parents and 24 service providers. Data collection involved questionnaires concerning socioeconomic status and physical activity, anthropometric measurements, and in-depth interviews. Participants aged 5 years and older largely met physical activity recommendations (82.9%), while none of the 3-4-year-olds did. Males were more active than females, especially among older ages. Many participants engaged in too much screen time (53.4-90.0%). Age and income predicted physical activity among males, while parents' education level was the only significant predictor among females. Barriers to physical activity included: recreational physical activity being an unfamiliar concept, gender limitations, financial resources, safety concerns, and children's preference for screen time. Schools played a central role in newcomer children's health by providing accessible opportunities for physical activity. Newcomer families preferred to have their children involved in culturally relevant physical activities. Given the growing newcomer population, it is important to support active lifestyle practices among them. Novelty: About 83% of newcomer children aged 5 years and older met physical activity recommendations, while none of the 3-4-year-olds did. Age and income predicted males' physical activity, while parents' education level predicted females' physical activity. Schools provide accessible opportunities for newcomer children to engage in physical activity.

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.

Cross-Sectional Examination of Musculoskeletal Pain and Physical Function in a Racially and Socioeconomically Diverse Sample of Adults.

BACKGROUND: Musculoskeletal pain alters physiological function, which may be evidenced as early as middle age. Previous research has concluded that middle-aged adults are a high-risk group for musculoskeletal pain and report functional limitations similar to older adults. However, few studies have examined the relationships between musculoskeletal pain and physical function, using objective performance measures in a sample of racially and socioeconomically diverse adults. Thus, this study examined musculoskeletal pain in relation to physical function in middle-aged (30-64 years) White and Black adults and investigated whether the relationship varied by sociodemographic characteristics. METHODS: This cross-sectional examination incorporated data from the Healthy Aging in Neighborhoods of Diversity across the Life-Span Study. Participants (n = 875) completed measures of musculoskeletal pain and objective measures of physical performance (ie, lower and upper body strength, balance, and gait abnormalities). Physical performance measures were standardized to derive a global measure of physical function as the dependent variable. RESULTS: Approximately, 59% of participants identified at least 1 pain sites (n = 518). Multivariable regression analyses identified significant relationships between greater musculoskeletal pain and poorer physical function (ß = -0.07, p = .031), in mid midlife (ß = -0.04, p = .041; age 40-54) and late midlife (ß = -0.05, p = .027; age 55-64). CONCLUSIONS: This study observed that musculoskeletal pain was associated with poorer physical function within a diverse group of middle-aged adults. Future research should longitudinally explore whether chronic musculoskeletal pain identified at younger ages is associated with greater risk for functional limitation and dependence in later life.

Addressing the needs of rural and remote people in a national dementia strategy for Canada.

A number of organizations such as the Canadian Academy of Health Sciences have identified the growing need for a National Dementia Strategy in Canada to improve the quality of life for people with dementia. This commentary highlights the necessity of addressing stigma, social inclusion, and supports for people affected by dementia, specifically those living in rural and remote communities. Drawing on Saskatchewan-based examples, we discuss the importance of recognizing the unique needs of rural and remote communities in developing a National Dementia Strategy for Canada. We believe that a national strategy needs to be built from the ground up and not imposed from the top down. Only through the development of evidence-informed research and collaborative partnerships can we ensure that there is equitable access to services and supports for people with dementia in rural and remote communities.

Physical activity programs for older people in the community receiving home care services: systematic review and meta-analysis.

The proportion of older adults is increasing around the world and most wish to live in their home until they die. To achieve this, many will require services in the home to remain living independently. To maintain function (ie, strength, balance, and endurance), physical activity needs to be undertaken on a regular basis, and is essential as a person ages. Unfortunately, as people age there is a tendency to reduce activity levels, which often leads to loss of function and frailty, and the need for home care services. This updated systematic review includes a mix of study methodologies and meta-analysis, and investigated the effectiveness of physical activity/exercise interventions for older adults receiving home care services. Eighteen studies including ten randomized controlled trials meeting the selection criteria were identified. Many of the studies were multi-factorial interventions with the majority reporting aims beyond solely trying to improve the physical function of home care clients. The meta-analysis showed limited evidence for effectiveness of physical activity for older adults receiving home care services. Future exercise/physical activity studies working with home care populations should consider focusing solely on physical improvements, and need to include a process evaluation of the intervention to gain a better understanding of the association between adherence to the exercise program and other factors influencing effectiveness.

Supporting older adults' engagement in health-care programs and policies: Findings from a rural cognitive health study.

Although rural seniors are important users of health-care services, their perspectives and input remain largely absent from health programs and policies. This article explores rural seniors' perspectives to support their engagement in patient-oriented research. Guided by lay theory and cultural schema theory, participant observation, concept maps, and semi-structured interviews were conducted with 42 rural seniors in Saskatchewan, Canada. Three themes were identified: community outreach through trust and partnership-building; using flexible data collection methods such as moving to open-ended interviews rather than closed-ended surveys; and developing community-relevant dissemination strategies such as local newspaper articles, posters, and community workshops. In moving forward, collaborative research with seniors is essential to improving health programs and policies for older adults in rural communities and beyond.

Dietary Service Staffing Impact Nutritional Quality in Nursing Homes.

OBJECTIVE: To examine the relationship between dietary service staff and dietary deficiency citations in nursing homes (NHs). METHOD: 2007-2011 Online Survey and Certification and Reporting data for 14,881 freestanding NHs were used to examine the relationship between dietary service staff and the probability of receiving a dietary service-related deficiency citation. An unconditional logit model with random effects was employed. RESULTS: Findings suggest that higher staffing levels for dietitians (odds ratio [OR] = .955; p < .01), dietary service personnel (OR = .996; p < .01), and certified nursing assistants (CNAs; OR = .981; p < .05) decrease the likelihood of receiving a dietary service deficiency citation. CONCLUSION: Higher levels of dietary service and CNA staffing levels have the potential to improve the quality of nutritional care in NHs. Findings help substantiate the Centers for Medicare and Medicaid Services' proposed rules for more stringent Food and Nutrition Services in the NH setting and signify the need for further research relative to the impact of dietary service staff on nutritional and clinical outcomes.

No Place Like Home: A Systematic Review of Home Care for Older Adults in Canada.

ABSTRACTGiven 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.

Review of Nutrition Screening and Assessment Practices for Long-Term Care Residents.

The older adult population in Canada is growing, creating a greater demand for long-term care (LTC) facilities. Seniors living in LTC are more vulnerable to malnutrition, making it important to implement nutrition screening tools on a routine basis. The purpose of this study was to explore the practices of Registered Dietitians (RDs) related to nutritional screening, nutritional assessment, and follow-ups conducted within LTC facilities. This study also explored possible barriers hindering the application of these practices. Nine RDs from two health regions in Southern Saskatchewan completed a phone interview to address nutrition care practices/policies and barriers in LTC facilities. Results showed a considerable amount of variability in nutrition care practices for screening and assessment with lack of time identified as the greatest barrier. These findings highlight the importance of having consistent policies and a sufficient amount of RDs available in LTC facilities to provide the expected level of nutrition care for residents.

Understanding complex care for older adults within Canadian home care: a systematic literature review.

In the context of an aging population, both the need for home care services and its complexity of care have increased in many high-income countries. Yet, the definition of what constitutes complex care is largely elusive. This systematic review examined the conceptual definition of complex care within the home care environment using several social and health science databases for research published from 2000 to 2017. Of the 25 articles and reports identified, only 16 addressed complex care specifically and included older adults, aging, and/or home care. The results showed that complex care for older adults is primarily defined from a biomedical approach focusing on chronic disease and management and less commonly from the perspective of the social determinants of health. Future studies should consider the importance of the continuum of care needs from both the biomedical and the social determinants to adequately plan and provide care for older adults.

Examining Rural Older Adults' Perceptions of Cognitive Health.

Existing cognitive health literature focuses on the perspectives of older adults with dementia. However, little is known about the ways in which healthy older adults without dementia understand their cognitive health. In rural communities, early dementia diagnosis may be impeded by numerous factors including transportation challenges, cultural obstacles, and inadequate access to health and support services. Based on participant observation and two waves of 42 semi-structured interviews, this study examined healthy, rural older adults' perceptions of cognitive health. By providing an innovative theoretical foundation informed by local perspectives and culture, findings reveal a complex and multidimensional view of cognitive health. Rural older adults described four key areas of cognitive health ranging from independence to social interaction. As policy makers, community leaders, and researchers work to address the cognitive health needs of the rural aging demographic, it is essential that they listen to the perspectives of rural older adults.

Bone mineral density screening and its accordance with Canadian clinical practice guidelines from 2000-2013: an unchanging landscape in Saskatchewan, Canada.

UNLABELLED: We examined the clinical characteristics of patients who underwent initial dual energy X-ray absorptiometry (DXA) testing at a primary care facility from 2000 to 2013, and whether these factors changed over time in accordance with Canadian clinical practice guidelines. The burden of osteoporosis remains high and largely unchanged and clinical practice guidelines are not being followed, overall. PURPOSE: This study examined the clinical risk factors, therapeutic health behaviors, and bone mineral density (BMD) status of patients who underwent initial DXA testing at a primary care facility in Saskatchewan, Canada, and whether these factors changed over time from 2000 to 2013 in accordance with Canadian clinical practice guidelines. METHODS: We conducted a retrospective cross-sectional medical chart audit of 800 patients 50 years of age and older who underwent their first DXA test to assess BMD status. Data was extracted from 2000 to 2013 and further stratified into four periods (2000-2001, 2002-2006, 2007-2009, and 2010-2013; n = 200 each period) based on the years when practice guidelines were implemented. Extracted data included BMD outcomes, clinical risk factor indicators for DXA testing, and recommendations for therapeutic health behaviors outlined in the clinical practice guidelines. RESULTS: There were no differences in BMD status across the four time stratas (p = 0.430). Overall, most clinical risk factors had little change over time. The number of males screened significantly increased over time (p < 0.05), and osteoporosis drug therapy use decreased from 2000-2001 to 2010-2013 (p < 0.001). Increasing age, body mass <60 kg, and history of adult fracture were significant independent predictors of osteoporosis diagnosis. CONCLUSIONS: The burden of osteoporosis remains high and largely unchanged in Saskatchewan, Canada. These results serve to inform strategies to enhance health-care provider awareness and compliance with practice guidelines, as well as improve screening rates and patient health behaviors.