Factors Influencing Mobility During the COVID-19 Pandemic in Community-Dwelling Older Adults.

OBJECTIVE: To describe and identify factors influencing mobility among older adults during the first 5 months of the COVID-19 pandemic. DESIGN: A cross-sectional telesurvey. SETTING: Community dwelling older adults, situated within the first 5 months of the COVID-19 pandemic, in Hamilton, Canada. PARTICIPANTS: A random sample of 2343 older adults were approached to be in the study, of which 247 completed the survey (N=247). Eligible participants were aged ≥65 years. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Mobility was measured using global rating of change items and the Late Life Function Instrument (LLFI). Multivariate linear regression models were used to examine the association between mobility and related factors based on Webber's model. RESULTS: 247 older adults (29% male, mean age 78±7.3 years) completed surveys between May and August 2020. Respectively, 26%, 10%, and 9%, rated their ability to engage in physical activity, housework, and move around their home as worse compared with the start of the pandemic. The mean LLFI score was 60.9±13.4. In the model, walking volume (ß=0.03 95% confidence interval 0.013, 0.047), fall history (ß=-0.04, 95% confidence interval -0.08, -0.04), male sex (ß=0.06, 95% confidence interval 0.02, 0.09), unpleasant neighborhood (ß=-0.06, 95% confidence interval -0.11, -0.02), musculoskeletal pain (ß=-0.07, 95% confidence interval -0.11, -0.03), and self-reported health (ß=0.08, 95% confidence interval 0.03, 0.13) had the strongest associations with LLFI scores and explained 64% of the variance in the LLFI score. CONCLUSIONS: Physical and environmental factors may help explain poorer mobility during lockdowns. Future research should examine these associations longitudinally to see if factors remain consistent over time and could be targeted for rehabilitation.

Developing the Driving and Dementia Roadmap: a knowledge-to-action process.

OBJECTIVES: Despite three decades of research, gaps remain in meeting the needs of people with dementia and their family/friend carers as they navigate the often-tumultuous process of driving cessation. This paper describes the process of using a knowledge-to-action (KTA) approach to develop an educational web-based resource (i.e. toolkit), called the Driving and Dementia Roadmap (DDR), aimed at addressing some of these gaps. DESIGN: Aligned with the KTA framework, knowledge creation and action cycle activities informed the development of the DDR. These activities included systematic reviews; meta-synthesis of qualitative studies; interviews and focus groups with key stakeholders; development of a Driving and Dementia Intervention Framework (DD-IF); and a review and curation of publicly available resources and tools. An Advisory Group comprised of people with dementia and family carers provided ongoing feedback on the DDR's content and design. RESULTS: The DDR is a multi-component online toolkit that contains separate portals for current and former drivers with dementia and their family/friend carers. Based on the DD-IF, various topics of driving cessation are presented to accommodate users' diverse stages and needs in their experiences of decision-making and transitioning to non-driving. CONCLUSION: Guided by the KTA framework that involved a systematic and iterative process of knowledge creation and translation, the resulting person-centered, individualized and flexible DDR can bring much-needed support to help people with dementia and their families maintain their mobility, community access, and social and emotional wellbeing during and post-driving cessation.

The trajectories of depressive symptoms among working adults during the COVID-19 pandemic: a longitudinal analysis of the InHamilton COVID-19 study.

BACKGROUND: Longitudinal studies examining the impact of changes in COVID-19 pandemic-related stressors and experiences, and coping styles on the mental health trajectory of employed individuals during the lockdown are limited. The study examined the mental health trajectories of a sample of employed adults in Hamilton, Ontario during the initial lockdown and after the re-opening following the first wave in Canada. Further, this study also identified the pandemic-related stressors and coping strategies associated with changes in depressive symptoms in employed adults during the COVID-19 pandemic. METHODS: The InHamilton COVID-19 longitudinal study involved 579 employees aged 22-88 years from a large public university in an urban area of Hamilton, Ontario at baseline (April 2020). Participants were followed monthly with 6 waves of data collected between April and November 2020. A growth mixture modeling approach was used to identify distinct groups of adults who followed a similar pattern of depressive symptoms over time and to describe the longitudinal change in the outcome within and among the identified sub-groups. RESULTS: Our results showed two distinct trajectories of change with 66.2% of participants displaying low-consistent patterns of depressive symptoms, and 33.8% of participants displaying high-increasing depressive symptom patterns. COVID-19 pandemic-related experiences including health concerns, caregiving burden, and lack of access to resources were associated with worsening of the depressive symptom trajectories. Frequent use of dysfunctional coping strategies and less frequent use of emotion-focused coping strategies were associated with the high and increasing depressive symptom pattern. CONCLUSIONS: The negative mental health impacts of the COVID-19 pandemic are specific to subgroups within the population and stressors may persist and worsen over time. Providing access to evidence-informed approaches that foster adaptive coping, alleviate the depressive symptoms, and promote the mental health of working adults is critical.

Challenges to Human Drivers in Increasingly Automated Vehicles.

OBJECTIVE: We examine the relationships between contemporary progress in on-road vehicle automation and its coherence with an envisioned "autopia" (automobile utopia) whereby the vehicle operation task is removed from all direct human control. BACKGROUND: The progressive automation of on-road vehicles toward a completely driverless state is determined by the integration of technological advances into the private automobile market; improvements in transportation infrastructure and systems efficiencies; and the vision of future driving as a crash-free enterprise. While there are many challenges to address with respect to automated vehicles concerning the remaining driver role, a considerable amount of technology is already present in vehicles and is advancing rapidly. METHODS: A multidisciplinary team of experts met to discuss the most critical challenges in the changing role of the driver, and associated safety issues, during the transitional phase of vehicle automation where human drivers continue to have an important but truncated role in monitoring and supervising vehicle operations. RESULTS: The group endorsed that vehicle automation is an important application of information technology, not only because of its impact on transportation efficiency, but also because road transport is a life critical system in which failures result in deaths and injuries. Five critical challenges were identified: driver independence and mobility, driver acceptance and trust, failure management, third-party testing, and political support. CONCLUSION: Vehicle automation is not technical innovation alone, but is a social as much as a technological revolution consisting of both attendant costs and concomitant benefits.

A Scoping Review of Environmental Factors That Impact Driving with Arthritis: Considerations for Occupational Therapy.

Using the International Classification of Functioning, Disability, and Health, this scoping review mapped environmental barriers and facilitators that can influence driving with arthritis. A search of research databases located 2445 studies from which 19 were included. The predominant diagnosis researched was rheumatoid arthritis. The most common facilitators were vehicle adaptations (e.g., supplemental mirrors, seat cushions). Barriers included a lack of knowledge among clinicians to address behind-the-wheel concerns and nonuse/abandonment of such adaptions. Results highlight key clinical and research opportunities to support drivers with arthritis.

Interventions that support major life transitions in older adulthood: a systematic review.

ABSTRACTBackground:Major life transitions can negatively impact the emotional well-being of older people. This study examined the effectiveness of interventions that target the three most common transitions in later life, namely bereavement, retirement, and relocation. METHODS: A systematic search was performed via MEDLINE, EMBASE, CINAHL, Cochrane Library, PsycINFO, and reference lists of retrieved non-randomized and randomized controlled trials (RCTs) in English that studied the effectiveness of interventions addressing the three transitions in those >50 years of age. Two researchers independently selected the publications, piloted the data extraction form, and critically appraised studies specific to transition type and study design. RESULTS: A total of 11 studies (bereavement: 7; retirement: 2; relocation: 2) of 8 unique interventions met the inclusion criteria of which nine were RCTs and two were of quasi-experimental designs were reviewed. Six studies were group-based interventions, three studies used individualized sessions, and one intervention used a combination of group and individualized programming. Group size varied (20-32 participants), as did qualifications of those administering the interventions. The methodological quality of included studies was weak. Findings suggest that group-based approaches provided by trained personnel can mitigate the negative health-related consequences associated with major transitions in later life. CONCLUSION: Evidence concerning interventions that address mental health challenges associated with these major transitions is limited. Future research should better characterize participants at study outset and use validated measures to capture effectiveness. Use of peer mentorship to navigate such transitions is promising, but given the small number of studies and their methodological weaknesses, further research on effectiveness is warranted.

Risk of Motor Vehicle Collision or Driving Impairment After Traumatic Brain Injury: A Collaborative International Systematic Review and Meta-Analysis.

OBJECTIVE: To synthesize knowledge of the risk of motor vehicle collision (MVC) following a traumatic brain injury (TBI) and the associated risk of driving impairment, as measured by on-road tests, computerized simulators, and self-reported or state-recorded driving records. METHODS: Our international team searched 7 databases for studies published between 1990 and 2015 of people with TBI, controls, and data concerning either MVC or driving impairment. The included articles examined the risk of MVC among people with TBI; we excluded studies that examined the risk of having a TBI associated with being involved in an MVC. RESULTS: From 13 578 search results, we included 8 studies involving 1663 participants with TBI and 4796 controls. We found no significant difference in the risk of MVC (odds ratio = 1.24, 95% confidence interval = 0.80-1.91, P = .34). When we restricted the analysis to self-report, the risk of MVC was higher for those without a TBI (odds ratio = 1.63, 95% confidence interval = 1.21-2.22, P = .002). In contrast, participants with TBI consistently performed worse during on-road assessments and had more problems with vehicular control. CONCLUSION: Limitations of reviewed studies included small sample sizes, failure to specify TBI severity or time postinjury, and absence of objective measures of risk. Findings concerning the relationship between TBIs from non-MVC causes and crash risk are, therefore, inconclusive and do not provide evidence for major changes to existing clinical guidelines for driving with TBI.

Creating an intergenerational university hub: Engaging older and younger users in the shaping of space and place.

Intergenerational initiatives in post-secondary settings have demonstrated health and social benefits. However, there is a lack of detail with regard to the process by which such initiatives are conceptualized and the role of older and younger users in their development. Guided by the principles of an Age-Friendly University (AFU) alongside elements from a 'Design Thinking' approach, this project outlines the process undertaken to design a new intergenerational space to promote intergenerational connectivity. An online student survey (n = 504; 72.2% female) and focus groups were conducted with older adults (n = 22; 12 females; aged 70-95), which found similar themes across age groups with respect to: 1) past intergenerational experiences; 2) perceived benefits/challenges of accessing the space, and; 3) activity suggestions. Using these findings, alongside direct stakeholder input, Occupational Therapy students developed programming and design suggestions for the space in question aimed at strengthening interactions across age and ability. Results from this process indicate consulting with older and younger users can circumvent potential challenges and inform the design of campus-based initiatives that can promote intergenerational exchange.

Computer-Based Driving in Dementia Decision Tool With Mail Support: Cluster Randomized Controlled Trial.

BACKGROUND: Physicians often find significant challenges in assessing automobile driving in persons with mild cognitive impairment and mild dementia and deciding when to report to transportation administrators. Care must be taken to balance the safety of patients and other road users with potential negative effects of issuing such reports. OBJECTIVE: The aim of this study was to assess whether a computer-based Driving in Dementia Decision Tool (DD-DT) increased appropriate reporting of patients with mild dementia or mild cognitive impairment to transportation administrators. METHODS: The study used a parallel-group cluster nonblinded randomized controlled trial design to test a multifaceted knowledge translation intervention. The intervention included a computer-based decision support system activated by the physician-user, which provides a recommendation about whether to report patients with mild dementia or mild cognitive impairment to transportation administrators, based on an algorithm derived from earlier work. The intervention also included a mailed educational package and Web-based specialized reporting forms. Specialists and family physicians with expertise in dementia or care of the elderly were stratified by sex and randomized to either use the DD-DT or a control version of the tool that required identical data input as the intervention group, but instead generated a generic reminder about the reporting legislation in Ontario, Canada. The trial ran from September 9, 2014 to January 29, 2016, and the primary outcome was the number of reports made to the transportation administrators concordant with the algorithm. RESULTS: A total of 69 participating physicians were randomized, and 36 of these used the DD-DT; 20 of the 35 randomized to the intervention group used DD-DT with 114 patients, and 16 of the 34 randomized to the control group used it with 103 patients. The proportion of all assessed patients reported to the transportation administrators concordant with recommendation did not differ between the intervention and the control groups (50% vs 49%; Z=-0.19, P=.85). Two variables predicted algorithm-based reporting-caregiver concern (odds ratio [OR]=5.8, 95% CI 2.5-13.6, P<.001) and abnormal clock drawing (OR 6.1, 95% CI 3.1-11.8, P<.001). CONCLUSIONS: On the basis of this quantitative analysis, in-office abnormal clock drawing and expressions of concern about driving from caregivers substantially influenced physicians to report patients with mild dementia or mild cognitive impairment to transportation administrators, but the DD-DT tool itself did not increase such reports among these expert physicians. TRIAL REGISTRATION: ClinicalTrials.gov NCT02036099; https://clinicaltrials.gov/ct2/show/NCT02036099 (Archived by WebCite at http://www.webcitation.org/6zGMF1ky8).

Development of a decision-making tool for reporting drivers with mild dementia and mild cognitive impairment to transportation administrators.

BACKGROUND: Driving in persons with dementia poses risks that must be counterbalanced with the importance of the care for autonomy and mobility. Physicians often find substantial challenges in the assessment and reporting of driving safety for persons with dementia. This paper describes a driving in dementia decision tool (DD-DT) developed to aid physicians in deciding when to report older drivers with either mild dementia or mild cognitive impairment to local transportation administrators. METHODS: A multi-faceted, computerized decision support tool was developed, using a systematic literature and guideline review, expert opinion from an earlier Delphi study, as well as qualitative interviews and focus groups with physicians, caregivers of former drivers with dementia, and transportation administrators. The tool integrates inputs from the physician-user about the patient's clinical and driving history as well as cognitive findings, and it produces a recommendation for reporting to transportation administrators. This recommendation is translated into a customized reporting form for the transportation authority, if applicable, and additional resources are provided for the patient and caregiver. CONCLUSIONS: An innovative approach was needed to develop the DD-DT. The literature and guideline review confirmed the algorithm derived from the earlier Delphi study, and barriers identified in the qualitative research were incorporated into the design of the tool.

Developing physician consensus on the reporting of patients with mild cognitive impairment and mild dementia to transportation authorities in a region with mandatory reporting legislation.

OBJECTIVE: To establish consensus among dementia experts about which patients with mild cognitive impairment (MCI) or mild dementia should be reported to transportation authorities. METHODS: We conducted a literature review of predictors of driving safety in patients with dementia and combined these into 26 case scenarios. Using a modified Delphi technique, case scenarios were reviewed by 38 dementia experts (geriatric psychiatrists, geriatricians, cognitive neurologists and family physicians with expertise in elder care) who indicated whether or not they would report the patient in each scenario to regional transportation authorities and recommend a specialized on-road driving test. Scenarios were presented up to five times to achieve consensus, defined as 85% agreement, and discrepancies were discussed anonymously online. RESULTS: By the end of the fifth iteration, there was cumulative consensus on 18 scenarios (69%). The strongest predictors of decision to report were the combination of caregiver concern about the patient's driving and abnormal Clock Drawing Test, which accounted for 62% of the variance in decision to report at the same time as or without a road test (p <0.01). Based on these data, an algorithm was developed to guide physician decision-making about reporting patients with MCI or mild dementia to transportation authorities. CONCLUSION: This study supports existing international guidelines that recommend specialized on-road testing when driving safety is uncertain for patients with MCI and emphasizes the importance of assessing executive dysfunction and caregiver concern about driving.

Co-designing a participatory evaluation of older adult partner engagement in the mcmaster collaborative for health and aging.

Engagement of patients and the public in health research is crucial for ensuring research relevance and alignment with community needs. However, there is a lack of nuanced evaluations and examples that promote collaborative and reflective learning about partnerships with partners. The aim of this paper is to provide a case example of a participatory evaluation of the engagement of older adult partners in an aging-focused research centre. We outline our process of co-planning and implementing an evaluation of the McMaster Collaborative for Health and Aging's engagement strategy through the use of multiple methods, including a standardized tool and qualitative approaches. The team chose to explore and capture the engagement experiences and perspectives of the older adult partners within the Collaborative using a survey (the Public and Patient Engagement Evaluation Tool (PPEET)), an art-based method (photovoice), and a focus group. We present a brief summary of the findings but primarily focus this paper on the experiences of using each methodology and tool, with an emphasis on promoting dialogue on the benefits, limitations, and challenges. We reflect on the process of co-planning and the integration of both standardized tools and qualitative approaches to adopt a holistic approach to evaluating partnership within the Collaborative. Ultimately, this case example aims to provide practical guidance for other research groups navigating the complexities of partnership engagement and evaluation, thereby promoting meaningful partnerships in research.

Engaging older adults in research is important to match research study goals with older adult needs and interests and can lead to better health outcomes and a more equitable healthcare system. Yet, older adults are often excluded from research due to the idea that they can be a challenging group with whom to work. The McMaster Collaborative for Health and Aging is a provincial research centre established to engage patients, researchers, and other key partners to improve the health of and the healthcare system for older adults. The Collaborative partners with older adults and caregivers in all its activities and projects. For example, older adults mentor students and advise on patient-partnered research projects and co-facilitate workshops. There are many frameworks and models to support research partnerships with people with lived experience. Yet, evaluating the quality and impacts of these partnerships is less common. This paper presents a case example of a participatory evaluation of older adult partners' engagement in the Collaborative. Together, older adult partners and researchers decided on the project goals and methods. The evaluation used multiple methods to capture partners' experiences and perspectives on the process and impact of their engagement in research. First, a survey called the Public and Patient Engagement Evaluation Tool (PPEET) was completed. Second, photovoice was used (a method involving photography for self-expression). Finally, a focus group was conducted (discussions with partners facilitated by researchers). We reflect on the benefits and limitations of each method and make recommendations for future evaluations. The paper underscores considering partner preferences and abilities when choosing evaluation methods for patient-partnered research.

Older Drivers Reduced Engagement in Distracting Behaviors Over a Six-Year Period: Findings From the Candrive Longitudinal Study.

OBJECTIVES: Baltes and Baltes' "selective optimization with compensation" model is pertinent to driving but evidence about the use of compensation using longitudinal designs is scarce. Therefore, we sought to determine if older drivers reduced their engagement in distracting behaviors while driving, over a 6-year period. METHODS: We used data captured over several annual assessments from a cohort of 583 drivers aged 70 and older to determine if their engagement in 12 distracting behaviors (e.g., listening to the radio, talking with passengers) declined over time. We adjusted our multivariable model for several potential confounders of the association between our outcome variable and time. RESULTS: Overall, and after adjustment for potential confounders, the participants reduced their engagement in distracting behaviors over the study period (odds ratio [OR] = 0.96, 95% confidence interval [CI] = 0.95-0.97). Baseline age was negatively associated with engagement in distracting behaviors (OR = 0.95, 95% CI = 0.94-0.96). Men engaged in more distracting behaviors than women (OR = 1.15, 95% CI = 1.03-1.27), as did participants living in the largest urban centers compared to participants living in the smallest areas (OR = 1.21, 95% CI = 1.04-1.41). The number of kilometers driven per year (for every 10,000 km) was positively associated with the proportion of distracting behaviors drivers engaged in (OR = 1.13, 95% CI = 1.08-1.19). DISCUSSION: Drivers in our cohort reduced their engagement in distracting behaviors over the study period. This suggests that older drivers adjust their driving over time, which aligns with age-related theories and models about compensation.

A systematic review of yoga for state anxiety: considerations for occupational therapy.

BACKGROUND: State anxiety can result from a variety of life situations. This type of anxiety can disrupt occupational engagement and performance, thereby affecting rehabilitation and recovery. Occupational therapists need to address the connection between mind-body-spirit and its relationship to performance and engagement in meaningful occupations. Yoga, when used as an adjunct to therapy, has the potential to address state anxiety. PURPOSE: The aim was to systematically review the evidence concerning the effectiveness of yoga as a treatment approach for state anxiety. METHODS: Six electronic databases, the authors' own files, and the references of included studies from 1990 to July 2011 were searched. FINDINGS: A total of 25 unique studies represented by 26 publications made up the sample: two systematic reviews; 16 randomized controlled trials, and seven prospective, controlled, non-randomized studies. Evidence suggests yoga can be a viable therapeutic option for reducing state anxiety in certain situations. IMPLICATIONS: In making the determination to recommend yoga as an intervention, occupational therapists should consider the client's circumstances and values as well as the type and intensity of the yoga program.

Evaluating medically at-risk drivers: a survey of assessment practices in Canada.

BACKGROUND: Assessing medical fitness to drive (FTD) can include both off- and on-road testing, although consistency of practice is unclear. PURPOSE: To examine actual practices being used to assess FTD at driver assessment centres (DACs) across Canada. METHOD: Surveys e-mailed to 90 DACs were returned by 47 assessors. FINDINGS: The majority of respondents (89%) were occupational therapists. Assessors reported doing an average of eight FTD assessments per month (range = I to 40) at an average cost of $366 (SD = $225; range = $40 to $985). Referrals came from physicians (96%), other health professionals (70%), and licensing authorities (66%). Clients with stroke, dementia, traumatic brain injury, mild cognitive impairment, and multiple sclerosis composed 62% of estimated caseloads. Assessments took 3 hr on average (range = 1.24 to 4.5 hr); 64% reported they always took clients on road regardless of clinic results. IMPLICATIONS: Evidence-based guidelines for training and assessment are clearly needed given the inconsistency in practice.

Posture Evaluation of Firefighters During Simulated Fire Suppression Tasks.

BACKGROUND: Posture mechanics during fire suppression tasks are associated with musculoskeletal injuries in firefighters. METHODS: This study uses the Ovako Working Posture Analyzing System (OWAS) ergonomics tool to describe and evaluate the postures of 48 firefighters during 3 simulated tasks: (a) hose drag, (b) hose pull, and (c) high-rise pack lift. Ergonomics intervention prioritizations based on the OWAS action classification (AC) scores were identified using Wilcoxon signed-rank tests. Chi-square analyses identified associations between firefighter characteristics and OWAS AC scores. FINDINGS: The initial hose pick-up phase of each task was identified as a high priority for ergonomics intervention (OWAS AC = 4) in 45.8%, 54.2%, and 45.8% of cases for Tasks 1, 2, and 3, respectively. Lower BMI was associated with higher AC scores for the initial hose pick-up during Task 3 (likelihood ratio = 9.20, p value = .01). CONCLUSION: The results inform ergonomics priorities for firefighter training based on the tasks analyzed. Application to Practice: This study evaluates the posture mechanics of three commonly performed firefighting tasks. The results help inform an ergonomics training intervention focused on posture mechanics during occupational activities for firefighters.

Nurse practitioners' preferences for online learning regarding driving and dementia.

ABSTRACT: With a growing population of older adults living with dementia in the community, nurse practitioners (NPs) are increasingly expected to address issues of medical fitness to drive (MFTD) and driving cessation within their clinical practice. With their expertise in clinical assessment and communication skills, NPs are well suited to this area of practice. Studies that examined MFTD and/or driving cessation suggest that NPs want and need further knowledge and training with this population. As part of our aim to develop an online educational program on driving and dementia for health care providers, including NPs, this mixed-methods study explored NPs' preferences regarding the format and content for the proposed online program. Results from an online survey completed by 90 NPs and interviews with six NPs highlighted key areas of focus for virtual modules, where communication strategies, tools to assess MFTD, and the reporting process for medically unfit drivers were emphasized. Reflecting on their team approach to care, participants in this study preferred a hybrid approach of asynchronous and synchronous learning delivery for this educational program. The next step will be to evaluate this program and its impact on both NP knowledge and skills in terms of its real-world application.

Loneliness and resilience are associated with nutrition risk after the first wave of COVID-19 in community-dwelling older Canadians.

Nutrition risk is linked to hospitalization, frailty, depression, and death. Loneliness during the coronavirus disease 2019 (COVID-19) pandemic may have heightened nutrition risk. We sought to determine prevalence of high nutrition risk and whether loneliness, mental health, and assistance with meal preparation/delivery were associated with risk in community-dwelling older adults (65+ years) after the first wave of COVID-19 in association analyses and when adjusting for meaningful covariates. Data were collected from 12 May 2020 to 19 August 2020. Descriptive statistics, association analyses, and linear regression analyses were conducted. For our total sample of 272 participants (78 ± 7.3 years old, 70% female), the median Seniors in the Community: Risk evaluation for Eating and Nutrition (SCREEN-8) score (nutrition risk) was 35 [1st quartile, 3rd quartile: 29, 40], and 64% were at high risk (SCREEN-8 < 38). Fifteen percent felt lonely two or more days a week. Loneliness and meal assistance were associated with high nutrition risk in association analyses. In multivariable analyses adjusting for other lifestyle factors, loneliness was negatively associated with SCREEN-8 scores (-2.92, 95% confidence interval [-5.51, -0.34]), as was smoking (-3.63, [-7.07, -0.19]). Higher SCREEN-8 scores were associated with higher education (2.71, [0.76, 4.66]), living with others (3.17, [1.35, 4.99]), higher self-reported health (0.11, [0.05, 0.16]), and resilience (1.28, [0.04, 2.52]). Loneliness, but not mental health and meal assistance, was associated with nutrition risk in older adults after the first wave of COVID-19. Future research should consider longitudinal associations among loneliness, resilience, and nutrition.

Exploring Distress and Occupational Participation Among Older Canadians During the COVID-19 Pandemic.

Background. The coronavirus disease 2019 (COVID-19) pandemic disrupted daily life with corresponding implications on levels of distress. Purpose. To describe factors associated with high distress among community-dwelling older adults during the first lockdown and explore how occupational participation was managed. Methods. A mixed methods design whereby multivariate regression analysis of a survey (N = 263) identified factors associated with high distress, as per the Impact of Events of Scale-Revised (IES-R). Follow-up interviews with a sub-sample of those surveyed who reflected a range of IES-R scores were conducted (N = 32). Findings. Those with lower resilience and anxiety/depression had 6.84 and 4.09 greater odds respectively of high distress. From the interviews, the main theme, "Lost and Found," and subthemes (Interruption and Disruption; Surving, not Thriving; Moving Forward, Finding Meaning) highlighted the process and corresponding stages, including adaptive strategies, by which participants navigated changes in their occupational participation. Implications. While the results suggest that many older adults, including those with high distress, were able to manage daily life under lockdown, some experienced ongoing challenges in doing so. Future studies should focus on those who experienced or who are at-higher risk for such challenges to identify supports that mitigate adverse consequences if another event of this magnitude occurs again.

Feasibility, Usability, and Acceptability of Online Mind-Body Exercise Programs for Older Adults: A Scoping Review.

Objectives: Engaging in mind-body exercises (MBEs: e.g., Tai Chi and yoga) can have physical and mental health benefits particularly for older adults. Many MBEs require precise timing and coordination of complex body postures posing challenges for online instruction. Such challenges include difficulty viewing instructors as they demonstrate different movements and lack of feedback to participants. With the shift of exercise programs to online platforms during the COVID-19 pandemic, we conducted a scoping review to examine the feasibility, usability, and acceptability of online MBE classes for older adults. Materials and Methods: We followed the scoping review methodology and adhered to the PRISMA reporting checklist. We searched five databases: Medline, Embase, CINHAL, Web of Science, and ACM digital library. Screening of articles and data extraction was conducted independently by two reviewers. Settings/Location: Online/virtual. Subjects: Older adults ≥55 years of age. Outcome Measures: Feasibility measures. Results: Of 6711 studies retrieved, 18 studies were included (715 participants, mean age 66.9 years). Studies reported moderate to high retention and adherence rates (mean >75%). Older adults reported online MBE classes were easy to use and reported high satisfaction with the online format. We also identified barriers (e.g., lack of space and privacy and unstable internet connection) and facilitators (e.g., convenience and technical support) to the online format. Opinions related to social connectedness were mixed. Conclusion: Online MBE programs for older adults appear to be a feasible and acceptable alternative to in-person programs. It is important to consider the type of exercise (e.g., MBE), diverse teaching styles, and learner needs when designing online exercise classes.