Older Adults' Perceptions of the 2019 Canada's Food Guide: A Qualitative Study.

Purpose: Major changes were made to Canada's Food Guide (CFG) in 2019. This study aimed to understand the perceptions of older adults toward this newest version.Methods: Older adults were invited to participate via newsletters sent to older adults and retirees' organizations in the Province of Quebec. Participants completed an online survey about their baseline familiarity with the 2019 CFG using a 5-point Likert scale and took part in an individual semi-structured online interview, which explored their perceptions toward the 2019 CFG. A thematic qualitative analysis of the interview transcripts was performed.Results: Fifty-eight older adults (>65 years, 30 women, 28 men, including 19 consumers and 39 non-consumers of plant-based protein (PBP) foods) participated in the study. Older adults were mostly familiar with the 2019 CFG and had a positive perception of its features. They appreciated the design, proposed recipes, and healthy eating recommendations. Perceptions about the three food groups were mixed, mainly regarding the decreased emphasis on dairy products. Some appreciated that animal proteins were less prominent, while others raised issues on how to integrate PBP into their diet. Perceptions appeared to be influenced by sex and PBP consumption.Conclusion: Older adults in the Province of Quebec view most of the 2019 CFG recommendations positively. Our observations may be useful to dietitians and public health practitioners when developing strategies to improve adherence.

Social factors associated with changes in nutrition risk scores measured using SCREEN-8: data from the Canadian Longitudinal Study on Aging.

Purpose: To examine the social network factors associated with changes in nutrition risk scores, measured by SCREEN-8, over three years, in community-dwelling Canadians aged 45 years and older, using data from the Canadian Longitudinal Study on Aging (CLSA).Methods: Change in SCREEN-8 scores between the baseline and first follow-up waves of the CLSA was calculated by subtracting SCREEN-8 scores at follow-up from baseline scores. Multivariable linear regression was used to examine the factors associated with change in SCREEN-8 score.Results: The mean SCREEN-8 score at baseline was 38.7 (SD = 6.4), and the mean SCREEN-8 score at follow-up was 37.9 (SD = 6.6). The mean change in SCREEN-8 score was -0.90 (SD = 5.99). Higher levels of social participation (participation in community activities) were associated with increases in SCREEN-8 scores between baseline and follow-up, three years later.Conclusions: Dietitians should be aware that individuals with low levels of social participation may be at risk for having their nutritional status decrease over time and consideration should be given to screening them proactively for nutrition risk. Dietitians can develop and support programs aimed at combining food with social participation.

Oasis Senior Supportive Living: Description of a Novel Aging-in-Place Model in Ontario.

Older adults are the fastest-growing demographic group in Canada, and the majority of older adults want to age-in-place within their communities. Many older adults live in naturally occurring retirement communities (NORCs), unplanned communities with a high proportion of older residents. NORC supportive services programs can help older adults successfully age-in-place. One such program is Oasis Senior Supportive Living, a partnership between older adults, building owners and managers, community partners, funders, and researchers. Using a qualitative approach, interviews were conducted with Oasis participants to understand their experiences of Oasis. This article will describe the three pillars upon which Oasis programming is based and provide insights from Oasis participants. It will discuss nutrition programming implemented in these NORCs and suggest how dietitians can support NORC residents.

The Evidence for Screening Older Adults for Nutrition Risk in Primary Care: An Umbrella Review.

It is not known if nutrition risk screening of older adults should be a standard practice in primary care. The evidence in support of nutrition risk screening of older adults in primary care was examined and critically analyzed using an umbrella review. The peer reviewed and grey literature were searched for clinical practice guidelines (CPGs) and systematic reviews (SRs). Titles and abstracts were independently screened by the two authors. Resources were excluded if they did not apply to older adults, did not discuss nutrition/malnutrition risk screening, or were in settings other than primary care. Full texts were independently screened by both authors, resulting in the identification of six CPGs and three SRs that met the review criteria. Guidelines were appraised with the AGREE II tool and SRs with the AMSTAR 2 tool. The quality of the CPGs was high, while the quality of the SRs was low. The CPGs and SRs acknowledged a lack of high-quality research on the benefits of regular nutrition risk screening for older adults in primary care; however, CPGs recommended annual screening for older adults in primary care practices or other community settings. High-quality research investigating nutrition risk screening of older adults in primary care is needed.

Telephone Administration of the Automated Self-Administered 24-hour Dietary Assessment in Older Adults: Lessons Learned.

Automated Self-Administered 24-hour Dietary Assessment (ASA24) is an economical method of estimating dietary intake as nutrient analysis is automated, but its use in older adults is limited. The purpose of this work was to guide dietitians and future researchers on how to use the ASA24 with older adults, considering potential barriers encountered and strategies used to support completion based on our experience using this tool in a pilot clinical trial. ASA24 was completed by phone interview with 39 older adults. Challenges included: recalling food intake in detail, recording frequent eating occasions and complicated recipes, and general problems with communication. Strategies to support collection included making morning phone calls and suggesting that seniors write down the food consumed. Phone interviews were acceptable to older adults, but sufficient time was required. Dietitians and future researchers can use these findings to obtain dietary intake data from this hard-to-reach group.

Shadows and Sunshine: What Metaphors Reveal about Aging with HIV.

Using narrative inquiry, the researchers interviewed 5 older adults on 5 occasions over a period of 3.5 years about their experiences of aging with HIV. The participants' stories were analyzed for metaphors. Individual metaphors reveal a complex, unique struggle: living between tensions of uncertainty and hope, facing death and living in the moment, and suffering hurt amidst the joys of evolving identity. The tensions are fluid, although time and life experience facilitate a shift towards reconciliation. An overarching metaphor across this group of survivors is shadows and sunshine: to survive and live in a fragile state, balancing multiple shadows such as stigma and side effects with joyful experiences of support and belonging. The findings suggest that when nurses invite stories of life experience and listen for language used, they build compassion and gain understanding of what support is most needed to honour the personhood of older adults who are HIV-positive.

Utilisant une approche axée sur l'enquête narrative, les chercheuses ont réalisé des entrevues auprès de cinq aînés, à cinq reprises, sur une période de 3,5 années. Les entrevues portaient sur leurs expériences en tant que personnes vieillissantes vivant avec le VIH. Les récits des participants ont fait l'objet d'une analyse en vue de relever les métaphores. Les métaphores individuelles révélaient une lutte complexe et unique issue de tensions provoquées par le fait de vivre de l'in certitude et de l'espoir, de côtoyer la mort, de vivre dans l'instant présent et d'éprouver une souffrance parmi les joies découlant d'une identité en évolution. Les tensions sont fluides, bien que le temps et le vécu facilitent un virage vers une réconciliation. Une métaphore commune présente dans le groupe de survivants était celle de l'ombre et de la lumière, qui traduisait l'expérience de survivre et de vivre dans un état de fragilité, de composer avec plusieurs côtés sombres, comme le stigmate et les effets secondaires, et de vivre des expériences heureuses, comme le soutien et le sentiment d'appartenance. Les résultats de l'étude indiquent que les infirmières qui invitent les patients à partager leur vécu et qui portent attention au langage utilisé acquièrent un sentiment de compassion et comprennent davantage le type de soutien qu'elles doivent dispenser pour honorer l'identité individuelle des aînés séropositifs.

[L'impossible quête des préposées aux bénéficiaires pour actualiser la bientraitance visée dans les politiques publiques du Québec.The impossible quest of health care aides to actualize the good treatment targeted in Quebec's public policies.]

Notre recherche visait à mettre en lumière les pratiques bientraitantes des préposées aux bénéficiaires en milieux d'hébergement pour aînés au Québec. L'objet de l'article est de faire ressortir la dichotomie entre les définitions de la bientraitance et son opérationnalisation. Dans la première partie, la notion de bientraitance dans le cadre de deux politiques gouvernementales québécoises est présentée. Ensuite, il est question du travail des préposées aux bénéficiaires en tant que vectrices de cette bientraitance dans la pratique. La troisième partie présente les résultats de notre recherche qui viennent soulever trois constats remettant en cause l'applicabilité des politiques publiques en cette matière : l'absence de reconnaissance d'un métier par définition bientraitant; les injonctions normatives à l'encontre du sens attribué à la bientraitance, et les obstacles organisationnels et sociopolitiques à la bientraitance. Ces constats sont réexaminés à la lumière des écrits dans la discussion, laquelle ouvre sur la notion de maltraitance organisationnelle.

[Le programme Participe-présent auprès d'aînés vivant avec une problématique de santé mentale ou des difficultés psychosociales affectant leur participation communautaire : résultats d'une étude pilote sur sa faisabilité].

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

Drug and Natural Health Product Data Collection and Curation in the Canadian Longitudinal Study on Aging.

This study aimed to develop an efficient data collection and curation process for all drugs and natural health products (NHPs) used by participants to the Canadian Longitudinal Study on Aging (CLSA). The three-step sequential process consisted of (a) mapping drug inputs collected through the CLSA to the Health Canada Drug Product Database (DPD), (b) algorithm recoding of unmapped drug and NHP inputs, and (c) manual recoding of unmapped drug and NHP inputs. Among the 30,097 CLSA comprehensive cohort participants, 26,000 (86.4%) were using a drug or an NHP with a mean of 5.3 (SD 3.8) inputs per participant user for a total of 137,366 inputs. Of those inputs, 70,177 (51.1%) were mapped to the Health Canada DPD, 20,729 (15.1%) were recoded by algorithms, and 44,108 (32.1%) were manually recoded. The Direct algorithm correctly classified 99.4 per cent of drug inputs and 99.5 per cent of NHP inputs. We developed an efficient three-step process for drug and NHP data collection and curation for use in a longitudinal cohort.

Non-surgical treatment of aseptic olecranon bursitis: A systematic review.

OBJECTIVE: Olecranon bursitis (OB), characterized by inflammation and fluid collection in the olecranon bursa is a commonly encountered out-patient condition. The data is heterogeneous regarding a stepwise and standardized approach to aseptic OB treatment and the efficacy of intra-bursal corticosteroid injections (CSI). The objective of this review is to systematically evaluate the non-surgical treatment options for aseptic OB. METHODS: This systematic review was conducted in accordance with PRISMA recommendations. The English and non-English literature search was performed in 5 medical databases to identify studies evaluating the treatment of OB. All included studies were evaluated for risk of bias (RoB) using the revised Cochrane RoB tool for randomized control trials (RCTs) and the Newcastle-Ottawa Scale (NOS) for case-control and cohort studies. RESULTS: For the final analyses, 2 RCTs and 2 observational studies were included. The RoB for the RCTs was high and both failed to demonstrate a significant difference in terms of the resolution of OB and bursal tenderness among various invasive and non-invasive treatment options. Corticosteroid injection (CSI) was associated with a significant decline in the duration of symptoms. However, it was associated with a higher number of complications including bursal infection and skin atrophy. CONCLUSION: Based on the available data, it appears that the clinical resolution of aseptic OB can occur with conservative methods if implemented earlier in the disease course. Although CSI is more effective than other treatments, it should be reserved for refractory cases because of a higher complication rate.

[Implantation de l'Accompagnement-citoyen personnalisé d'intégration communautaire (APIC) : vers l'optimisation de la mise en œuvre de cette approche novatrice visant la participation sociale des aînés].

La présente étude visait à documenter l'implantation de l'Accompagnement-citoyen personnalisé d'intégration communautaire (APIC), lors duquel des bénévoles soutiennent la participation sociale d'aînés, dans des organismes communautaires en identifiant les facteurs favorables et défavorables ainsi que ses conditions essentielles. Soutenu par un devis qualitatif descriptif de type recherche clinique, une rencontre et six entretiens semi-dirigés ont été réalisés afin de documenter cette implantation dans six organismes communautaires œuvrant en milieu urbain au Québec (Canada). Selon les six coordonnatrices de l'APIC, les cinq directeurs généraux et l'agente de recherche, le principal facteur favorable est la conviction des responsables de l'implantation en la valeur ajoutée de l'intervention, incluant sa concordance avec la mission et les valeurs des organismes et les besoins de la population qu'ils desservent. Les facteurs défavorables sont principalement la répartition aléatoire et le temps accordé pour l'implantation. Ces résultats permettront de mieux guider l'implantation de l'APIC à plus grande échelle.

Age-Friendly Communities: Are they also "Friendly" for Death, Dying, Grief, and Bereavement?

The age-friendly movement aims to ensure that people can live healthy and meaningful lives as they age. It is committed to activity and inclusion, with policies, services, and structures that enable older adults to remain engaged in activities that they value. We suggest that there is further opportunity for communities to increase inclusion and reduce ageism by improving their "death-friendliness". A death-friendly approach could lay the groundwork for a community in which people do not fear getting old or alienate those who have. To this end, we consider the merits of the compassionate communities framework which has emerged out of palliative care and critical public health. Compassionate communities focus on end-of-life planning, bereavement support, and improved understandings about aging, dying, death, loss, and care. The age-friendly and compassionate communities initiatives are complementary in their objectives but have not yet converged in practice. We suggest that they should.

[Importance de la nature, des opportunités d'activités, de leur accessibilité et de leur publicisation pour favoriser la santé positive, la participation sociale et l'équité en santé d'Estriens âgés].

Cette étude visait à explorer comment les composantes clés de l'environnement des communautés favorisent les résultantes de santé d'Estriens âgés, plus précisément leur santé positive, leur participation sociale et leur équité en santé. Une étude de cas multiples a été réalisée auprès de cinq communautés estriennes (cas) à l'aide de groupes de discussion focalisée (1/communauté) regroupant un total de 49 participants connaissant bien les communautés respectives, soit 47 aînés, 1 conseillère municipale et 1 technicienne en loisir. En rendant accessible et équitable la réalisation d'activités importantes pour les aînés, la nature, une offre d'activités variée, des moyens de communication efficace et les mesures favorisant l'équité avaient une influence positive sur les résultantes de santé. Des facteurs individuels tels qu'un niveau élevé de scolarité et un statut socioéconomique favorable avaient aussi une influence positive. Ces résultats permettent d'outiller les décideurs souhaitant favoriser un vieillissement actif et en santé.

Interventions for Caregivers of Older Adults with Dementia Living in the Community: A Rapid Review of Reviews.

This rapid review of systematic reviews examines non-professional interventions that have been implemented to support family caregivers of older adults with dementia who are living in the community. There is a robust body of empirical literature examining such interventions for family caregivers; therefore, this rapid review includes only systematic reviews. MEDLINE, CINAHL, and EMBASE databases were searched from September 2020 to December 2020, and 19 systematic reviews were selected for a full review. Psychosocial, psychoeducational, social support, and multicomponent interventions consistently show positive impacts on a variety of outcomes. The evidence suggests that multicomponent interventions that are tailored to the needs of individual caregivers are the most impactful interventions and should be utilized in future program development. The most effective combination of interventions is unknown and warrants further investigation. However, the repeated success of psychoeducational, psychosocial, and social support interventions suggests that when used together, they may be a successful combination that contributes to positive impacts on caregivers. This multicomponent intervention should be flexible, as interventions are most effective when they are tailored to the individual needs of caregivers and adapted over time as the needs of the caregiver and person living with dementia change with disease progression.

Barriers to Help Seeking among Victims of Elder Abuse: A Scoping Review and Implications for Public Health Policy in Canada.

Elder abuse is a serious public health concern requiring immediate intervention; however, the under-reporting of elder abuse by victims to formal and informal networks remains a major obstacle. This scoping review aims to identify barriers to help seeking that older adults experiencing abuse confront. The goal is to inform public policies and practices in the Canadian context and identify research gaps in the extant literature. Seven scholarly databases were searched from which 12 articles met the inclusion criteria and were extracted for analysis. The findings from this scoping review revealed three levels at which barriers exist: individual focused, abuser/family focused, and community/culture focused barriers. The results suggest that there are several complex obstacles that older adults face when contemplating disclosure of abuse. Future research into help seeking in the Canadian context should more readily incorporate the voices of elder abuse victim-survivors to develop effective assessment strategies and responsive service provisions.

Age-Friendly Cities and Older Indigenous People: An Exploratory Study in Prince George, Canada.

Cities around the world are responding to aging populations and equity concerns for older people by developing age-friendly communities plans, following the World Health Organization's guidelines. Such plans, however, often fail to account for the wide diversity of older people in cities, with the result that some older people, including Indigenous older people, do not see their needs reflected in age-friendly planning and policies. This article reports on a study involving 10 older First Nations and Métis women in the city of Prince George, Canada, comparing the expressed needs of these women with two age-friendly action plans: that of the city of Prince George, and that of the Northern Health Authority. Four main categories were raised in a group discussion and interview with these women at the Prince George Native Friendship Centre: availability of health care services, accessibility and affordability of programs and services, special roles of Indigenous Elders, and experiences of racism and discrimination. There are many areas of synergy between the needs expressed by the women and the two action plans; however, certain key areas are missing from the action plans; in particular, specific strategies for attending to the needs of Indigenous and other older populations who often feel marginalized in health care and in age-friendly planning.

Potentially Inappropriate Prescribing in Hospitalized Older Adult High-Cost Health Care Users: A Pilot Study.

Background: High-cost health care users use disproportionate amounts of health care resources relative to the typical patient. It is unclear to what extent poor-quality prescribing, including potentially inappropriate prescribing (PIP), may be contributing to their adverse outcomes and health utilization costs. Objectives: To evaluate the prevalence of PIP and to explore its impact in older adult high-cost health care users. Methods: The charts of older adult high-cost health care users admitted to 2 academic hospitals in Ontario, Canada, in fiscal year 2015/16 were reviewed. Eligible patients were at least 66 years old with at least 5 emergency department visits and 3 hospital admissions in the previous year. A total of 243 patients met these criteria, of whom 100 were randomly selected for review. Cases of PIP were identified using explicit prescribing quality indicators, including the STOPP/START criteria. Types of PIP included potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs). Log-linear regression was used to characterize the relationship between PIP and future health care utilization. Medications were reconciled to determine the proportion of PIP addressed by the time of discharge. Results: Eighty-nine of the 100 patients had at least 1 instance of PIP. In total, 276 PIMs and 54 PPOs were identified. Of the 271 instances of PIP identified on admission, only 38 (14%) were resolved by the time of hospital discharge. Each additional PPO was associated with a 1.43-fold increase in the rate of future emergency department visits (p < 0.001). Conclusions: The rate of PIP among older adult high-cost health care users was high. Despite frequent interactions with the health care system, many opportunities to improve the quality of prescribing for this vulnerable population were missed. Greater attention to medication optimization is needed.

Contexte: Les grands utilisateurs de soins de santé consomment une proportion disproportionnée des ressources par rapport aux patients moyens. On ne sait pas vraiment dans quelle mesure la prescription de mauvaise qualité, notamment la prescription potentiellement inappropriée (PPI), contribue aux effets indésirables et aux coûts d'utilisation des soins de santé. Objectifs: Évaluer la prévalence des PPI et étudier ses effets chez les grands utilisateurs des soins de santé âgés. Méthodes: Les dossiers des grands utilisateurs de soins de santé âgés admis dans 2 hôpitaux universitaires en Ontario, au Canada, pendant l'exercice 2015­2016 ont été examinés. Les patients admissibles étaient âgés d'au moins 66 ans, avaient effectué au moins 5 visites à l'urgence et avaient été admis 3 fois à l'hôpital au cours de l'année précédente. Au total, 243 patients répondaient à ces critères, dont 100 ont été sélectionnés au hasard pour un examen. Les cas de PPI ont été identifiés à l'aide d'indicateurs explicites de la qualité de prescription, notamment les critères STOPP/START. Les types de PPI comprenaient des médicaments potentiellement inappropriés (MPI) et les omissions potentielles de prescription (OPP). La régression log-linéaire a été utilisée pour caractériser la relation entre la PPI et l'utilisation future des soins de santé. Un bilan comparatif des médicaments prescrits a été effectué pour déterminer la proportion de PPI traités au moment de la sortie de l'hôpital. Résultats: Quatre-vingt-neuf (89 %) des patients présentaient au moins 1 cas de PPI. Au total, 276 MPI et 54 OPP ont été identifiées. Sur les 271 cas de PPI identifiés au moment de l'admission, seuls 38 (14 %) étaient résolus au moment de la sortie de l'hôpital. Chaque OPP supplémentaire était associée à une augmentation de 1,43 fois du taux de futures visites à l'urgence (p < 0,001). Conclusions: Le taux de PPI chez les grands utilisateurs de soins de santé âgés était élevé. Malgré des interactions fréquentes avec le système de santé, de nombreuses occasions d'amélioration de la qualité des prescriptions pour cette population vulnérable ont été manquées. Une plus grande attention doit être portée à l'optimisation des médicaments.

La participation sociale dans les résidences privées pour aînés.

Le vieillissement de la population invite à étudier les résidences privées pour aînés, notamment sous l'angle du lien social. Après leur emménagement en résidence, plusieurs aînés veulent continuer de participer activement à la société. Cette recherche qualitative exploratoire a pour objectif de mieux comprendre les perceptions et les expériences d'aînés vivant dans une résidence privée par rapport à leur participation sociale, sur le plan de leurs relations interpersonnelles et de leurs activités de loisirs. Onze entrevues individuelles ont été menées auprès de personnes vivant dans des résidences privées pour aînés de la région de la ville de Québec, au Canada. Sur le plan personnel, les facteurs centraux pour la participation sociale sont l'adaptation au nouveau milieu de vie, l'implication dans ce milieu, notamment par le biais du bénévolat, ainsi que l'état de santé de la personne. En ce qui concerne l'environnement social, les facteurs importants sont la proximité géographique de l'entourage, une offre variée d'activités et la stabilité du personnel. Au final, des recommandations sont formulées au sujet des stratégies d'intervention et des pistes de recherche, lesquelles donnent suite aux constats énoncés, et ce, afin de mieux soutenir la participation sociale en résidence privée pour aînés.

Vivre sans ma voiture : une intervention pour soutenir les Canadiens-francophones âgés.

The cessation of driving is a difficult transition for the elderly, but it can be facilitated through interventions. The purpose of this study was to explore the satisfaction, usefulness and applicability of the CarFreeMe intervention in the French-Canadian context. A qualitative clinical research device was used on ten older adults aged between 61 and 90 years. The participants had stopped driving within the last twelve months or were planning to stop driving in the near future and did not have cognitive impairments. After the intervention, the participants were generally satisfied and reported on its usefulness and applicability in a French-Canadian context. In addition, they identified the positive impacts related to their social involvement as they re-engaged in or pursued their significant activities. Further research is required to assess the intervention's effects and the practicability of implementing it in Canada.

Culturally Responsive Supports for Metis Elders and Metis Family Caregivers.

Malgré une attention académique considérable au rôle de la famille des soignants avec la population générale, peu de recherches ont été menées avec les familles autochtones. Cette étude qualitative vise à combler cette lacune en se concentrant sur l'expérience des soignants Metis, fournir des soins aux adultes Metis plus âges. Des groupes de discussions et des entrevues ont été menés avec des aidants familiaux Metis (n - 79), aînés Metis (n - 11), et soignants officiels (n - 8). Bien qu'il existe de parallèles considérables dans les expériences des soins identifiés dans cette étude sur les Metis avec celles déjà documentées dans la littérature, il existe néanmoins des différences importantes pour la prestation des soins culturellement adaptés aux aînés Metis.Despite considerable academic attention to the role of family caregivers within the general population, little research has been conducted with Indigenous families. This qualitative study aims to fill that gap by focusing on the experiences of Metis caregivers providing care for older Metis adults. Focus groups and interviews were conducted with Metis family caregivers (n = 79), Metis Elders (n = 11) and formal caregivers (n = 8). Although there are considerable parallels in the caregiving experiences identified in this Metis study with those already documented in the literature, there are nonetheless important differences for providing culturally responsive care to Metis seniors.