Participatory action research: An exploration from a Freirean perspective of research involving people with dementia.

BACKGROUND: Researchers are increasingly being called upon to involve people with dementia in research that pertains to them. Participatory Action Research (PAR) has been one of the approaches that has been utilized to do this. How people understand and apply the ideas behind this approach however has often been atheoretical and diverse. This has implications for how purpose, power, voice and agency are conceived and actualized. OBJECTIVES: This paper will examine how theoretical construction of PAR can inform the process of meaningfully involving people living with dementia in research. Specifically, drawing on the work of Paulo Freire, this paper will articulate a way of conceptualizing PAR that is explicitly critical and then demonstrate how these ideas informed a PAR study focused on addressing stigma and discrimination with people living with dementia. CONCLUSION: The purpose of the paper is to engage researchers and people with lived expertise in critical reflection of what it actually means to involve people with dementia in research.

Social isolation and loneliness among older adults living in rural areas during the COVID-19 pandemic: a scoping review.

BACKGROUND: The causes and consequences of social isolation and loneliness of older people living in rural contexts during the COVID-19 pandemic were systematically reviewed to describe patterns, causes and consequences. METHODS: Using the Arksey and O'Malley (2005) scoping review method, searches were conducted between March and December 2022, 1013 articles were screened and 29 were identified for data extraction. RESULTS: Findings were summarized using thematic analysis separated into four major themes: prevalence of social isolation and loneliness; rural-only research; comparative urban-rural research; and technological and other interventions. Core factors for each of these themes describe the experiences of older people during the COVID-19 pandemic and related lockdowns. We observed that there are interrelationships and some contradictory findings among the themes. CONCLUSIONS: Social isolation and loneliness are associated with a wide variety of health problems and challenges, highlighting the need for further research. This scoping review systematically identified several important insights into existing knowledge from the experiences of older people living in rural areas during the COVID-19 pandemic, while pointing to pressing knowledge and policy gaps that can be addressed in future research.

"I didn't know it was going to be like this.": unprepared for end-of-Life care, the experiences of care aides care in long-term care.

BACKGROUND: Care aides provide up to 70-90% of the direct care for residents in long-term care (LTC) and thus hold great potential in improving residents' quality of life and end-of-life (EoL) care experiences. Although the scope and necessity of the care aide role is predicted to increase in the future, there is a lack of understanding around their perceptions and experiences of delivering EoL care in LTC settings. The aim of this study was to gain an understanding of the perspectives, experiences, and working conditions of care aides delivering end-of-life care in LTC in a rural setting, within a high-income country. METHODS: Data were collected over ten months of fieldwork at one long-term care home in western Canada; semi-structured interviews (70 h) with 31 care aides; and observation (170 h). Data were analysed using Reflexive Thematic Analysis. RESULTS: Two themes were identified: (i) the emotional toll that delivering this care takes on the care aids and; (ii) the need for healing and support among this workforce. Findings show that the vast majority of care aides reported feeling unprepared for the delivery of the complex care work required for good EoL care. Findings indicate that there are no adequate resources available for care aides' to support the mental and emotional aspects of their role in the delivery of EoL care in LTC. Participants shared unique stories of their own self-care traditions to support their grief, processing and emotional healing. CONCLUSIONS: To facilitate the health and well-being of this essential workforce internationally, care aides need to have appropriate training and preparation for the complex care work required for good EoL care. It is essential that mechanisms in LTC become mandatory to support care aides' mental health and emotional well-being in this role. Implications for practice highlight the need for greater care and attention played on the part of the educational settings during their selection and acceptance process to train care aides to ensure they have previous experience and societal awareness of what care in LTC settings entails, especially regarding EoL experiences.

'I wouldn't choose this work again': Perspectives and experiences of care aides in long-term residential care.

AIMS: To provide insight into the everyday realities facing care aides working in long-term residential care (LTRC), and how they perceive their role in society. DESIGN: A qualitative ethnographic case study. METHODS: Data were collected over. 10 months of fieldwork at one LTRC setting [September 2015 to June 2016] in Western Canada; semi-structured interviews (70 h) with 31 care aides; and naturalistic observation (170 h). Data were analysed using reflexive thematic analysis. RESULTS: The findings in this work highlight the underpinned ageism of society, the gendered work of body care, and the tension between the need for relational connections - which requires time and economic profit. Four themes were identified, each relating to the lack of training, support, and appreciation care aides felt about their role in LTRC. CONCLUSION: Care aides remain an unsupported workforce that is essential to the provision of high-quality care in LTRC. To support the care aide role, suggestions include: (i) regulate and improve care aide training; (ii) strengthen care aides autonomy of their care delivery; and (iii) reduce stigma by increasing awareness of the care aide role. IMPACT: What problem did the study address? The unsupportive working conditions care aides experience in LTRC and the subsequent poor quality of care often seen delivered in LTRC settings. What were the main findings? Although care aides express strong affection for the residents they care for, they experience insurmountable systemic and institutional barriers preventing them from delivering care. Where and on whom will the research have impact? Care aides, care aide educators, care aide supervisors and managers in LTRC, retirement communities, and home care settings.

The association of eating challenges with energy intake is moderated by the mealtime environment in residential care homes.

OBJECTIVES: Given the increased risk of malnutrition in residential care homes, we studied how specific aspects of the mealtime environment are associated with residents' eating challenges and energy intake in general and dementia care units of these homes. DESIGN: Cross-sectional study. PARTICIPANTS: 624 residents and 82 dining rooms. SETTING: 32 residential care homes across Canada. MEASUREMENTS: Eating challenges were measured using the Edinburgh Feeding Evaluation in Dementia Questionnaire (Ed-FED-q). Energy intake was estimated over nine meals. Physical, social, person-centered, functional, and homelike aspects of the mealtime environment were scored using standardized, valid measures. Effects of interactions between dining environment scores and eating challenges on daily energy intake were assessed using linear regression. RESULTS: More eating challenges were associated with decreased energy intake on the general (ß = -36.5, 95% confidence interval [CI] = -47.8, -25.2) and dementia care units (ß = -19.9, 95% CI = -34.6, -5.2). Among residents living on general care units, the functional (ß = 48.5, 95% CI = 1.8, 95.2) and physical (ß = 56.9, 95% CI = 7.2, 106.7) environment scores were positively and directly associated with energy intake; the social and person-centered aspects of the mealtime environment moderated the relationship between eating challenges and energy intake. CONCLUSIONS: Resident eating challenges were significantly associated with energy intake on both dementia care and general care units; however on general care units, when adjusting for eating challenges, the functional and physical aspects of the environment also had a direct effect on energy intake. Furthermore, the social and person-centered aspects of the dining environment on general care units moderated the relationship between eating challenges and energy intake. Dementia care unit environments had no measurable effect on the association between resident eating challenges and energy intake.

Association between environmental stimulation and apathy in nursing home residents with dementia.

OBJECTIVES: Prior research and theories established the link between care environments and apathy. Yet, empirical evidence on how environmental stimulation impacts apathy is lacking. This study examined the association between environmental stimulation and apathy in nursing home residents with dementia. DESIGN: This repeated-measure study analyzed 104 video observations of staff caregiver-resident interactions. SETTING: 12 nursing homes. PARTICIPANTS: 63 unique staff caregiver-resident dyads that involved 42 caregivers and 44 residents with moderate to severe dementia. MEASUREMENTS: Second-by-second behavioral coding using Noldus Observer software was conducted to assess apathy and environmental stimulation, using the Person-Environment Apathy Rating scale. The environment subscale includes six items: stimulation clarity, stimulation strength, stimulation specificity, interaction involvement, physical accessibility, and environmental feedback. The apathy subscale includes six items: facial expression, eye contact, physical engagement, purposeful activity, verbal tone, and verbal expression. Multilevel linear models were used for analysis. RESULTS: Results showed that apathy was not associated with the overall quality of environmental stimulation but was significantly associated with stimulation specificity (coefficient = -2.23, p = 0.049). However, the association was not significant after controlling for resident characteristics (p = 0.082). In addition, higher levels of environmental feedback were associated with lower apathy levels (coefficient = -2.14, p = 0.001). The association remained significant after controlling for resident characteristics (coefficient = -1.65, p = 0.014). CONCLUSION: Findings reveal that when environmental stimulation is individually tailored and prompts engagement, residents are less apathetic. This study highlights the effect of environmental stimulation on apathy. Future research should explore interventions that modify environmental stimulation to reduce apathy and improve dementia care.

The benefits of and barriers to using a social robot PARO in care settings: a scoping review.

BACKGROUND: Given the complexity of providing dementia care in hospitals, integrating technology into practice is a high challenge and an important opportunity. Although there are a growing demand and interest in using social robots in a variety of care settings to support dementia care, little is known about the impacts of the robotics and their application in care settings, i.e., what worked, in which situations, and how. METHODS: Scientific databases and Google Scholar were searched to identify publications published since 2000. The inclusion criteria consisted of older people with dementia, care setting, and social robot PARO. RESULTS: A total of 29 papers were included in the review. Content analysis identified 3 key benefits of and 3 barriers to the use of PARO. Main benefits include: reducing negative emotion and behavioral symptoms, improving social engagement, and promoting positive mood and quality of care experience. Key barriers are: cost and workload, infection concerns, and stigma and ethical issues. This review reveals 3 research gaps: (a) the users' needs and experiences remain unexplored, (b) few studies investigate the process of how to use the robot effectively to meet clinical needs, and (c) theory should be used to guide implementation. CONCLUSIONS: Most interventions conducted have been primarily researcher-focused. Future research should pay more attention to the clinical needs of the patient population and develop strategies to overcome barriers to the adoption of PARO in order to maximize patient benefits.

Prevalence of inadequate micronutrient intakes of Canadian long-term care residents.

This study determines the prevalence of inadequate micronutrient intakes consumed by long-term care (LTC) residents. This cross-sectional study was completed in thirty-two LTC homes in four Canadian provinces. Weighed and estimated food and beverage intake were collected over 3 non-consecutive days from 632 randomly selected residents. Nutrient intakes were adjusted for intra-individual variation and compared with the Dietary Reference Intakes. Proportion of participants, stratified by sex and use of modified (MTF) or regular texture foods, with intakes below the Estimated Average Requirement (EAR) or Adequate Intake (AI), were identified. Numbers of participants that met these adequacy values with use of micronutrient supplements was determined. Mean age of males (n 197) was 85·2 (sd 7·6) years and females (n 435) was 87·4 (sd 7·8) years. In all, 33 % consumed MTF; 78·2 % (males) and 76·1 % (females) took at least one micronutrient pill. Participants on a MTF had lower intake for some nutrients (males=4; females=8), but also consumed a few nutrients in larger amounts than regular texture consumers (males=4; females =1). More than 50 % of participants in both sexes and texture groups consumed inadequate amounts of folate, vitamins B6, Ca, Mg and Zn (males only), with >90 % consuming amounts below the EAR/AI for vitamin D, E, K, Mg (males only) and K. Vitamin D supplements resolved inadequate intakes for 50-70 % of participants. High proportions of LTC residents have intakes for nine of twenty nutrients examined below the EAR or AI. Strategies to improve intake specific to these nutrients are needed.

Construct validity of the Dining Environment Audit Protocol: a secondary data analysis of the Making Most of Mealtimes (M3) study.

BACKGROUND: Research has demonstrated the importance of physical environments at mealtimes for residents in long term care (LTC). However, a lack of a standardized measurement to assess physical dining environments has resulted in inconsistent research with potentially invalid and unreliable conclusions. The development of a standardized, construct valid instrument that assesses dining rooms is imperative to systematically examine physical environments in LTC. The purpose of this study was to determine the construct validity of the new Dining Environment Audit Protocol (DEAP) tool. METHODS: Secondary data collected from the Making Most of Mealtimes (M3) study was used for this analysis. Data were collected in 32 long term care homes, which included 82 dining rooms and 639 residents. A variety of resident and dining room level constructs were compared to the summative scales found on the DEAP using Spearman correlations and Student t-tests. A regression analysis identified individual characteristics assessed with DEAP that were associated with the summative scales of homelikeness and functionality. RESULTS: Regression analysis (p < 0.05) identified that the DEAP homelikeness scale was positively associated with a view of the garden/green space, presence of a clock and a posted menu. The functionality scale was positively associated with number of chairs and lighting, while negatively associated with furniture with rounded edges and clutter. Additionally, the functionality scale was positively associated (p < 0.05) with the Mealtime Scan physical scale (ρ = 0.52), the dining room Mealtime-Relational Care Checklist (M-RCC) (ρ = 0.25), the DEAP total score (ρ = 0.56), and the Mini Nutritional Assessment- Short Form (ρ = 0.26). Homelikeness was positively associated (p < 0.05) with the DEAP total score (ρ = 0.53), staff Person Directed Care score (ρ = 0.49) and the resident Cognitive Performance Scale (t = 2.56), while negatively associated with energy (ρ = -0.26) and protein intake (ρ = -0.24). The homelikeness and functionality scales were also associated with one another (ρ = 0.26). CONCLUSION: The construct validity of the DEAP was supported through significant correlations with a variety of measures that are theoretically related to the homelikeness and functionality of LTC dining rooms. This secondary analysis supports the use of the DEAP in future research to quantify the physical environment of LTC dining rooms. Protocol registered with ClinicalTrials.gov ID: NCT02800291; Registered retrospectively June 7, 2016.

Making the Most of Mealtimes (M3): protocol of a multi-centre cross-sectional study of food intake and its determinants in older adults living in long term care homes.

BACKGROUND: Older adults living in long term care (LTC) homes are nutritionally vulnerable, often consuming insufficient energy, macro- and micronutrients to sustain their health and function. Multiple factors are proposed to influence food intake, yet our understanding of these diverse factors and their interactions are limited. The purpose of this paper is to fully describe the protocol used to examine determinants of food and fluid intake among older adults participating in the Making the Most of Mealtimes (M3) study. METHODS: A conceptual framework that considers multi-level influences on mealtime experience, meal quality and meal access was used to design this multi-site cross-sectional study. Data were collected from 639 participants residing in 32 LTC homes in four Canadian provinces by trained researchers. Food intake was assessed with three-days of weighed food intake (main plate items), as well as estimations of side dishes, beverages and snacks and compared to the Dietary Reference Intake. Resident-level measures included: nutritional status, nutritional risk; disease conditions, medication, and diet prescriptions; oral health exam, signs of swallowing difficulty and olfactory ability; observed eating behaviours, type and number of staff assisting with eating; and food and foodservice satisfaction. Function, cognition, depression and pain were assessed using interRAI LTCF with selected items completed by researchers with care staff. Care staff completed a standardized person-directed care questionnaire. Researchers assessed dining rooms for physical and psychosocial aspects that could influence food intake. Management from each site completed a questionnaire that described the home, menu development, food production, out-sourcing of food, staffing levels, and staff training. Hierarchical regression models, accounting for clustering within province, home and dining room will be used to determine factors independently associated with energy and protein intake, as proxies for intake. Proportions of residents at risk of inadequate diets will also be determined. DISCUSSION: This rigorous and comprehensive data collection in a large and diverse sample will provide, for the first time, the opportunity to consider important modifiable factors associated with poor food intake of residents in LTC. Identification of factors that are independently associated with food intake will help to develop effective interventions that support food intake. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT02800291 , retrospectively registered June 7, 2016.

Reminiscence functions and the health of Israeli Holocaust survivors as compared to other older Israelis and older Canadians.

OBJECTIVES: Existing research with English-speaking samples indicates that various ways in which older adults recall their past affect both their physical and mental health. Self-positive reminiscence functions (i.e. identity, problem-solving, death preparation) correlate and predict mental health in later life whereas self-negative functions (i.e. bitterness revival, boredom reduction, intimacy maintenance) correlate and predict the physical health of older adults. METHOD: For this study, we recruited 295 Israeli Holocaust survivors to ascertain if early life trauma affects these associations between reminiscence and health. In order to distinguish cross-national differences from survivor-specific effects, we also recruited two comparative samples of other older Israelis (not Holocaust survivors; n = 205) and a second comparative sample of 335 older Canadians. Three separate structural equation models were computed to replicate this tripartite reminiscence and health model. RESULTS: Coefficients for self-negative functions significantly differed between survivors and both Canadians and other older Israelis, and between Canadians and both Israeli samples. However, no differences were found between prosocial and self-positive functions. Moreover, the higher order structure of reminiscence and health appears largely indistinguishable across these three groups. CONCLUSION: Early life trauma does not appear to fundamentally affect associations between reminiscence and health. These findings underscore the resilience of Holocaust survivors.

Dementia care and prevention in community settings: a built environment framework for cognitive health promotion.

PURPOSE OF REVIEW: Most people with dementia live in the community. As lifespan increases, one in three persons aged 85+ are expected to live with dementia. We conduct a systematic search to identify frameworks for dementia care and prevention in community settings. This is important to ensure quality of life for people living with cognitive decline (PLCD). RECENT FINDINGS: 61 frameworks are synthesized into the dementia care and prevention in community (DCPC) framework. It highlights three levels of provision: built environment and policy supports, access and innovation, and inclusion across stages of decline. Domains of intervention include: basic needs; built environment health and accessibility; service access and use; community health infrastructure; community engagement; mental health and wellbeing; technology; end-of-life care; cultural considerations; policy, education, and resources. Personhood is not adequately represented in current built environment frameworks. This is supplemented with 14 articles on lived experiences at home and social practices that contribute to PLCD's social identity and psychological safety. SUMMARY: Policy makers, health and built environment professionals must work together to promote "personhood in community" with PLCD. Clinicians and community staff may focus on inclusion, social identity and a sense of at-homeness as attainable outcomes despite diagnosis.

Dementia-Friendly Transportation Services: A Scoping Review.

BACKGROUND AND OBJECTIVES: Transportation is an important component of dementia-friendly communities. People living with dementia have the right to access transportation services to keep their mobility in their community, which is essential for independence, well-being, and quality of life. This scoping review maps the literature on dementia-friendly transportation services and explores their characteristics to inform future development and research. RESEARCH DESIGN AND METHODS: Empirical quantitative and qualitative studies in English or French that informed on transportation services for people living with dementia in the community were searched in 15 databases. Two authors independently screened records and charted relevant characteristics from selected publications. Important findings were summarized with a narrative synthesis approach. RESULTS: Thirty-five studies informed on important dimensions of transportation services in urban and/or rural context: availability, accessibility, acceptability, adaptability, and affordability. Important insights were identified: the importance of staff training and attitude, and the challenges of availability of affordable services in the rural context. Emerging policy and program intervention areas include the need for access to quiet areas in transit hubs, training to use mass public transit and mobility management. DISCUSSION AND IMPLICATIONS: The literature on dementia-friendly transportation services is important in the expansion and maintenance of mobility for people living with dementia in the community. The scope of the existing scientific literature remains limited. Although several studies indicated a clear need for better access to dementia-friendly transportation services, the best practices still need to be demonstrated in the scientific literature.

Monitoring and Evaluation of Dementia-Friendly Neighborhoods Using a Walkshed Approach: Protocol for a Scoping Review.

BACKGROUND: The number of people in society living with dementia is growing. In Canada, most people who live with dementia live at home, often in a neighborhood setting. Neighborhood environments can be a source of independence, social engagement, and well-being. They can also contain barriers that limit physical activity, social engagement, and well-being. A dementia-friendly neighborhood includes assets that support persons living with dementia and their caregivers in multiple life domains, including those that support walking within the neighborhood environment. OBJECTIVE: The objectives for this scoping review are twofold. First, focusing on walkshed analysis, we aim to extend scholarly understandings of methodological practices used in the monitoring and evaluation of dementia-friendly neighborhoods. Second, we aim to provide clear and practical guidance for those working in planning, design, and public health fields to assess the neighborhood context in support of evidence-based action to improve the lives of persons living with dementia. METHODS: The study design follows Arksey and O'Malley's scoping review framework and PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) guidelines. We will conduct a search of peer-reviewed studies in 6 electronic databases to identify the use of Geographic Information System analysis to measure the walkshed of persons living with dementia in a community setting. As age is a primary risk factor associated with dementia, we will also include studies that focus more broadly on community-dwelling older adults aged 65 years and older. Data will be extracted, analyzed, and represented according to 3 domains. This includes study details, walkshed analysis methods, and criteria and indicators used to measure dementia-friendly neighborhoods. RESULTS: The results of the study and the submission of a manuscript for peer review are expected in June 2024. The results of the review are expected to contribute to an understanding of methods for monitoring and evaluating dementia-friendly neighborhoods. Expected findings will include a detailed breakdown of current parameters and routines used to conduct walkshed analysis. Findings will also convey criteria that can be operationalized in a Geographic Information System as indicators to assess barriers and facilitators to walking in a neighborhood setting. CONCLUSIONS: As far as we are aware, the proposed scoping review will be the first to provide comprehensive methodological or technical guidance for conducting walkshed analysis specific to persons living with dementia. Both the scalability and objective nature of walkshed analysis are likely to be of direct interest to public health practitioners, planners, and allied professionals. Clearly documenting methods used in walkshed analysis can spur increased collaboration across these disciplines to enable an evidence-informed approach to improving neighborhood environments for persons living with dementia. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/50548.

Understanding the experiences, needs, and strengths of people with incomplete spinal cord injury who can ambulate.

PURPOSE: To identify the experiences, needs, and strengths of people with incomplete spinal cord injury who can ambulate and to explore and discuss potential supports, services, and programs that would best assist them in the community. MATERIAL AND METHODS: In this qualitative descriptive study, interviews were the primary means of data collection. These were supplemented with descriptive standardized measures of function and life satisfaction. Qualitative data were analyzed thematically. RESULTS: Twenty-four participants were interviewed, their average age was 55 years and 46% were female. We identified three themes: 'I really couldn't go there', described the physical and social barriers experienced by participants, 'It'd be really nice to let the public know there are people out there like me' expressed the desire for greater social understanding of incomplete spinal cord injury, and 'I just don't quit', displayed the perseverance that participants demonstrated following their injury. CONCLUSION: Findings indicate service providers to improve the inclusion of ambulatory individuals with incomplete spinal cord injury in their programs. Suggestions include designing programs (community, healthcare, return to work, peer support), environments using the principles of universal design for people with incomplete spinal cord injury who ambulate, and increasing consideration of their perspectives.Implication for rehabilitation:People with incomplete spinal cord injury who can ambulate live with invisible impairments, which are often not acknowledged by family, friends, health professionals, and people with complete spinal cord injuryThey may feel excluded from activities (organized by spinal cord injury associations) that were originally designed for people with complete spinal cord injuryGreater awareness among health professionals, friends, family, and people with complete spinal cord injury of the needs of people with incomplete spinal cord injury who can ambulate is needed to increase their inclusion.

Staff Turnover Intention at Long-Term Care Facilities: Implications of Resident Aggression, Burnout, and Fatigue.

OBJECTIVES: Staff shortages and the high turnover rate of nursing assistants pose great challenges to long-term care. This study examined the effects of aggression from residents of long-term care facilities, burnout, and fatigue on staff turnover intention. The findings will help managers to devise effective measures to retain their staff. DESIGN: Cross-sectional descriptive study design. SETTING AND PARTICIPANTS: A total of 800 nursing assistants were recruited from 70 long-term care facilities using convenience sampling. METHODS: The participants were individually interviewed and provided information about their turnover intention, resident aggression witnessed and experienced, self-efficacy, neuroticism, burnout, fatigue, and personal and facility characteristics. RESULTS: Hierarchical multiple regression analysis revealed that the size and organizational practices of long-term care facilities were not associated with staff turnover intention. Staff who spent less time in the industry reported witnessing resident-to-resident aggression, experienced resident-to-staff aggression, reported high levels of burnout, had acute or chronic fatigue, and had low levels of inter-shift recovery were more likely than others to report a high turnover intention. CONCLUSIONS AND IMPLICATIONS: Staff turnover poses great challenges to staff, residents, and organizations. This study identified important factors that may help support staff in long-term care facilities. Specific measures, such as person-centered care to diminish resident aggression by addressing residents' unmet needs, work-directed programs to mitigate burnout and improve staff mental health, and flexible schedules to prevent fatigue should also be advocated to prevent staff turnover.

Measuring the Impact of Bedroom Privacy on Social Networks in a Long-Term Care Facility for Hong Kong Older Adults: A Spatio-Social Network Analysis Approach.

This study aims to measure the impact of bedroom privacy on residents' social networks in a long-term care (LTC) facility for older adults. Little is known about how the architectural design of bedrooms affects residents' social networks in compact LTC facilities. Five design factors affecting privacy were examined: bedroom occupancy, visual privacy, visibility, bedroom adjacency, and transitional space. We present a spatio-social network analysis approach to analyse the social network structures of 48 residents. Results show that residents with the highest bedroom privacy had comparatively smaller yet stronger groups of network partners in their own bedrooms. Further, residents who lived along short corridors interacted frequently with non-roommates in one another's bedrooms. In contrast, residents who had the least privacy had relatively diverse network partners, however, with weak social ties. Clustering analyses also identified five distinct social clusters among residents of different bedrooms, ranging from diverse to restricted. Multiple regressions showed that these architectural factors are significantly associated with residents' network structures. The findings have methodological implications for the study of physical environment and social networks which are useful for LTC service providers. We argue that our findings could inform current policies to develop LTC facilities aimed at improving residents' well-being.

Modifiable Sociostructural and Environmental Factors That Impact the Health and Quality of Life of People With Spinal Cord Injury: A Scoping Review.

Objective: The objective of this scoping review was to identify the modifiable factors that impact the health and quality of life (QOL) of community-dwelling people with spinal cord injury (SCI). Methods: Empirical journal articles were identified using three academic databases: CINAHL Complete, MEDLINE with Full Text, and PsycINFO. Full-text journal articlesincluded studies of participants who were community-dwelling with traumatic or nontraumatic SCI and were over the age of 18 years without cognitive impairment; published between 2000 and 2021; focused on modifiable factors impacting health and QOL; and conducted inAustralia, Europe, orNorth America. A data table was used to extract article information including authors, year of publication, country, sample, design and methods, purpose/objectives, and main findings. Qualitative data analysis software was used to categorize major findings inductively through content analysis. Results: Thirty-one peer-reviewed articles consisting of qualitive, quantitative, and mixed-methods study design were included. This scoping review revealed modifiable factors that impact the health and QOL of community-dwelling people with SCI: sociostructural factors (social attitudes, health care access, information access, and funding and policies) and environmental factors (built environment, housing, transportation, assistive technology, and natural environment). Conclusion: Future research should examine the influence of the modifiable factors on health and QOL using qualitative inquiry, adopting a community-based participatory research approach, and considering the implications of individual characteristics and resources.

Correction: Mahmood et al. Aging in the Right Place for Older Adults Experiencing Housing Insecurity: An Environmental Assessment of Temporary Housing Program. Int. J. Environ. Res. Public Health 2022, 19, 14857.

Table Correction [...].

Long-term care physical environments--effect on medication errors.

PURPOSE: Few studies examine physical environmental factors and their effects on staff health, effectiveness, work errors and job satisfaction. To address this gap, this study aims to examine environmental features and their role in medication and nursing errors in long-term care facilities. DESIGN/METHODOLOGY/APPROACH: A mixed methodological strategy was used. Data were collected via focus groups, observing medication preparation and administration, and a nursing staff survey in four facilities. FINDINGS: The paper reveals that, during the medication preparation phase, physical design, such as medication room layout, is a major source of potential errors. During medication administration, social environment is more likely to contribute to errors. Interruptions, noise and staff shortages were particular problems. RESEARCH LIMITATIONS/IMPLICATIONS: The survey's relatively small sample size needs to be considered when interpreting the findings. Also, actual error data could not be included as existing records were incomplete. PRACTICAL IMPLICATIONS: The study offers several relatively low-cost recommendations to help staff reduce medication errors. Physical environmental factors are important when addressing measures to reduce errors. ORIGINALITY/VALUE: The findings of this study underscore the fact that the physical environment's influence on the possibility of medication errors is often neglected. This study contributes to the scarce empirical literature examining the relationship between physical design and patient safety.