Immigrant Older Adults' Experiences of Aging in Place and Their Neighborhoods: A Qualitative Systematic Review.

Engaging in one's neighborhood fosters independence, promotes social connectedness, improves quality of life, and increases life expectancy in older adults. There is a lack of evidence synthesis on immigrant older adults' neighborhood perceptions and experiences, essential for addressing neighborhood-level influences on aging in place. This study systematically synthesizes qualitative evidence on immigrant older adults' perceptions and experiences of their neighborhoods. A comprehensive search was conducted from inception to 5 April 2023, in multiple databases. This review considered studies including immigrant older adults aged ≥60 years, included studies from any country where the neighborhood was the focus, and only considered qualitative data while excluding review studies, theoretical publications, and protocols. Eligible studies were appraised using the JBI critical appraisal checklist for qualitative research. The Joanna Briggs Institute meta-aggregation approach was used to synthesize findings, and the ConQual approach established confidence in the synthesis. A total of 30 studies were included. Most studies were conducted in North America and explored phenomena such as aging in place, social capital, social cohesion, sense of community, and life satisfaction. Key contextual factors were walkable safe access to social spaces, accessible transportation to amenities, social cohesion with neighbors, and pre-migration neighborhood experiences. Immigrant older adults have varied experiences related to their sense of belonging and social cohesion. Factors such as racial discrimination, feeling unsafe, and social isolation contributed to negative perceptions. This review highlights the need for inclusive neighborhoods that align with the needs and values of immigrant older adults aging in place.

Social identity and stroke: 'they don't make me feel like, there's something wrong with me'.

Over 85% of the people survive stroke; and of those, over 80% are discharged to the community. However, the majority do not recover completely. Loss of identity is a commonly reported experience after stroke. Studies focus on the individual survivors' use of their own cognitive resources to adapt to change, rather than examining the effects of social interactions on stroke survivors' identities. Social relationships are the foundation upon which survivors rebuild skills to engage with the world, yet little is known about the ways in which families, friends and neighbours provide a context for the recreation of a sense of self and activities after stroke. This article draws on situational analysis grounded theory analysis of in-depth individual interviews with nine middle-aged survivors of stroke. In situational analysis, the original grounded theory methods proposed by Glaser and Strauss are used; however, the situational context, and how environments and relationships influence actions, is explicitly analysed. Our objective was to understand the ways in which family, social, and community resources might enhance stroke survivors' participation in personally meaningful activities over the long term. The qualitative accounts of these survivors reveal how social support helped them maintain or more importantly regain a position in society. Following any life-changing event, people's sense of self is fluid. A relevant social position entitles stroke survivors to become actively involved in setting their own goals and maintaining a positive identity. However, as these participants attested, stroke impaired their social position and resources to reject an imposed social position. It was difficult for these survivors to construct a valued social identity without the support of other people. Future studies should explore the consequences of social interactions with others and how social attitudes about stroke disability affects individual's activity options, professional practice, and ultimately development of a positive poststroke identity.

Climate change impacts on the health of South Asian children and women subpopulations - A scoping review.

Background and objectives: Climate change impacts are felt unequally worldwide; populations that experience geographical vulnerability, those living in small island states and densely populated coastal areas, and children and women are affected disproportionately. This scoping review aims to synthesize evidence from relevant studies centred on South Asia, identify research gaps specifically focused on children and women's health, and contribute to knowledge about South Asia's existing mitigation and adaptation strategies. Methods: A research librarian executed the search on six databases using controlled vocabulary (e.g., MeSH, Emtree, etc.) and keywords representing the concepts "vulnerable populations" and "climate change" and "health impacts" and "South Asia." Databases were searched from January 2010 to May 2020. Papers were screened independently by two researchers. Results: Forty-two studies were included, of which 23 were based in India, 14 in Bangladesh, and five in other South Asian countries. Nineteen studies focused on meteorological factors as the primary exposure. In contrast, thirteen focused on extreme weather events, nine on air pollution, and one on salinity in coastal areas. Thirty-four studies focused on the health impacts on children related to extreme weather events, meteorological factors, and air pollution, while only eight studies looked at health impacts on women. Undernutrition, ARI (acute respiratory infection), diarrheal diseases, low birth weight, and premature mortality were the major health impacts attributed to extreme weather events, meteorological factors, and air pollution exposure in children and women in the region. Conclusion: Extreme weather events, meteorological factors and air pollution have affected the health of children and women in South Asia. However, the gap in the literature across the South Asian countries concerning relationships between exposure to extreme weather events, meteorological factors, air pollution and health effects, including mental health problems in children and women, are opportunities for future work.

An ecological approach to activity after stroke: it takes a community.

BACKGROUND: Biopsychosocial recovery from stroke is remarkable for some individuals, but the majority of stroke survivors have difficulty resuming activities. Even survivors with mild disability become disengaged. METHODS: Situational analysis grounded theory and ecological models were used to examine the barriers and facilitators to choice of everyday activities of stroke survivors aged 50 to 64 years. RESULTS: Resuming activities was an iterative process of scaffolding small tasks into activities through bargaining for access to practical support and inclusion into social situations. Although participants geared up to manage their condition and access activities, for the most part they were not in charge of the services and supports they required. They had little control over who was accepted to rehabilitation, for which services they qualified or disability policies. CONCLUSIONS: There are layers of interactions between individuals and multiple factors in their environments that influence participation. Low poststroke activity levels may be amenable to intervention. Further research should consider the following: (1) participation in activities through the lens of all levels of the socioecological model; (2) the impact of disability and aging-related stigma; (3) the results of ad hoc community navigation; and (4) the effects of restrictive health and disability policies on meaningful activity.

Risk and Resilience: How Is the Health of Older Adults and Immigrant People Living in Canada Impacted by Climate- and Air Pollution-Related Exposures?

BACKGROUND: In the rapidly shifting Canadian climate, an ageing population, and increased migration, a greater understanding of how local climate and air pollution hazards impact older adults and immigrant populations will be necessary for mitigating and adapting to adverse health impacts. OBJECTIVES: To explore the reported health impacts of climate change and air pollution exposures in older adults and immigrant people living in Canada, identify known factors influencing risk and resilience in these populations and gaps in the literature. METHODS: We searched for research focused on older adults and immigrants living in Canada, published from 2010 onward, where the primary exposures were related to climate or air pollution. We extracted data on setting, exposures, health outcomes, and other relevant contextual factors. RESULTS AND DISCUSSION: We identified 52 eligible studies, most focused in Ontario and Quebec. Older people in Canada experience health risks due to climate and air pollution exposures. The extent of the risk depends on multiple factors. We found little information about the climate- and air pollution-related health impacts experienced by immigrant communities. CONCLUSIONS: Further research about climate- and air pollution-related exposures, health, and which factors promote or reduce resiliency in Canada's older adults and immigrant communities is necessary.

Tracking the evolution of hospice palliative care in Canada: a comparative case study analysis of seven provinces.

BACKGROUND: An aging population, rise in chronic illnesses, increase in life expectancy and shift towards care being provided at the community level are trends that are collectively creating an urgency to advance hospice palliative care (HPC) planning and provision in Canada. The purpose of this study was to analyze the evolution of HPC in seven provinces in Canada so as to inform such planning and provision elsewhere. We have endeavoured to undertake this research out of awareness that good future planning for health and social care, such as HPC, typically requires us to first look backwards before moving forward. METHODS: To identify key policy and practice events in HPC in Canada, as well as describe facilitators of and barriers to progress, a qualitative comparative case study design was used. Specifically, the evolution and development of HCP in 7 strategically selected provinces is compared. After choosing the case study provinces, the grey literature was searched to create a preliminary timeline for each that described the evolution of HPC beginning in 1970. Key informants (n = 42) were then interviewed to verify the content of each provincial timeline and to discuss barriers and facilitators to the development of HPC. Upon completion of the primary data collection, a face-to-face meeting of the research team was then held so as to conduct a comparative study analysis that focused on provincial commonalities and differences. RESULTS: Findings point to the fact that HPC continues to remain at the margins of the health care system. The development of HPC has encountered structural inheritances that have both sped up progress as well as slowed it down. These structural inheritances are: (1) foundational health policies (e.g., the Canada Health Act); (2) service structures and planning (e.g., the dominance of urban-focused initiatives); and (3) health system decisions (e.g., regionalization). As a response to these inheritances, circumventions of the established system of care were taken, often out of necessity. Three kinds of circumventions were identified from the data: (1) interventions to shift the system (e.g., the role of advocacy); (2) service innovations (e.g., educational initiatives); and (3) new alternative structures (e.g., the establishment of independent hospice organizations). Overall, the evolution of HPC across the case study provinces has been markedly slow, but steady and continuous. CONCLUSIONS: HPC in Canada remains at the margins of the health care system. Its integration into the primary health care system may ensure dedicated and ongoing funding, enhanced access, quality and service responsiveness. Though demographics are expected to influence HPC demand in Canada, our study confirms that concerned citizens, advocacy organizations and local champions will continue to be the agents of change that make the necessary and lasting impacts on HPC in Canada.

Community capacity development to enhance hospice palliative care in Alberta, Canada communities: evidence demonstrating the value of a community engaged model.

Our study explored the value of a community engaged model for good hospice care in three rural communities in Alberta, Canada. When communities are highly engaged in planning and implementing hospice care in their communities, our study discovered that they have key characteristics: that volunteerism needs to be balanced to prevent burnout; that the local knowledge of community members is used in a number of ways to plan and provide good hospice care; that a variety of resources, infrastructure, policies and expertise are used by the community to nurture community-focused palliative care initiatives. The value to the community or social capital, that accrues from these initiatives is not easily appreciated by the community members, and community-based initiatives benefit when this value is identified for them. In all three communities a focus group was conducted separately with the Hospice Society board and with family members and volunteers connected with the Hospice Society. Participants attending this oral presentation will learn how community palliative care is perceived by non-professional community leaders, as well as strategies that may help address barriers that are encountered when communities become engaged in addressing their own hospice and end of life care needs.

Collaborative model used to develop a resource guide for communities to enhance their palliative and end of life care: the case of Alberta, Canada.

In response to the desire of community organizations in Alberta for information and guidance as they seek to improve palliative and end of life care in their communities, a large number of organizations collaborated to develop a resource guide. In order to achieve this goal, it was first necessary to identify the common information needs of Alberta communities as they pursue their vision for improving local Palliative and End-of-Life Care. A committee comprised of representatives from Alberta Health Services, Alberta Health, Alberta Hospice Palliative Care Association, Hospice Societies, University researchers, Indigenous Health and Palliative Care physicians surveyed numerous community groups and stakeholders about their information needs. As a result of their feedback several themes were identified which formed the basis of the Resource Guide for Community-based Palliative and End-of-Life Care. This oral presentation will leave participants with a good understanding of how multiple stakeholders can work together to strengthen community-led palliative and end-of-life care, at a provincial level, when there is a common goal.

The paradoxical reliance on allopathic medicine and positivist science among skeptical audiences.

A number of studies have found an association between what people see, hear and read in the mass media and their corresponding actions and beliefs. This link has been demonstrated both at the micro and at the macro levels of analysis. However, when people are asked directly about the impact of mass media they tend to deny that they are personally affected. In fact, they tend to describe themselves as critical and skeptical media consumers. The purpose of this paper is to explore this contradiction through 12 in-depth focus group discussions undertaken in Ontario, Canada in 2004. Findings from the focus group interviews confirm earlier research in that people claimed that they were not susceptible to media influence. At the same time as they said that they took information from the mass media "with a grain of salt", they articulated sophisticated and nuanced accounts of how and why they evaluated some information as good and some as bad. In general they evaluated media stories on the basis of the values of allopathic medicine and positivistic science. Moreover, in the context of the focus groups and their explicit comments on their skepticism, they discussed health information from the magazine articles that they were given to read (on either HIV/AIDS, Alzheimer's disease, or a heart disease). Possible explanations for these paradoxical findings are discussed.

OA58†Community capacity development for enhanced hospice palliative care: exploring the value of community engagement.

BACKGROUND: Over time, palliative care has become "professionalised", placing a burden on health care systems to manage the suffering of individuals and families with advancing, life-limiting illness. The need to develop resources, infrastructure and policy to enhance the capacity for communities to facilitate and support individuals and families can add value to communities, enrich hospice-palliative care and reduce health care system burden. AIM: Few examples of communities developing such capacity exist, however, this oral presentation will describe the results of one study that examined, in one rural community in western Canada, key factors that influenced their ability to address their own hospice palliative care needs. We will report on factors that helped and factors that hindered them in their initial stages of planning for better care. A follow up study that is just at its initial stages (i.e. to start in Jan./Feb., 2015) will examine the value and outcomes of a model where communities collaborate with health care providers to strengthen their hospice palliative care community level capacities. In two rural communities in western Canada, such questions asked will be: What expertise and infrastructure is required to nurture community-based palliative care initiatives? What criteria constitute community engagement and leadership in hospice palliative care development? When using a model where communities collaborate with health care providers to strengthen their hospice palliative care, what are the direct outcomes? And are these of value, and if so, in what way, and if not why not? METHODS: The two studies use multiple research methods. Both use a case study approach and framework. Results are also generated from a systematic literature review; semi-structured key informant interviews and focus group interviews. RESULTS: Results from the first study reveal significant barriers to a community planning their hospice palliative care needs, such as: a lack of provincial guidelines or funds; unforeseen workload; community expectations for a hospice building versus improved care; and an overall fear of failure. Key factors supporting their planning were: improved community awareness; putting hospice palliative 'on the map' at a provincial level; substantial donations for new services etc. Although our second, follow study to determine more concrete outcomes to community leadership and collaboration with health care providers are unknown, we imagine results will speak to the need for specific and tangible resources, infrastructure and specific policy direction.

Assumptions, ambiguities, and possibilities in interdisciplinary population health research.

The rhetoric of "interdisciplinary," "multi-disciplinary," and "transdisciplinary" permeates many population health research projects, funding proposals, and strategic initiatives. Working across, with, and between disciplines is touted as a way to advance knowledge, answer more complex questions, and work more meaningfully with users of research. From our own experiences and involvement in the 2003 CIHR Institute for Public and Population Health's Summer Institute, interdisciplinary population health research (IPHR) remains ambiguously defined and poorly understood. In this commentary, we critically explore some characteristics and ongoing assumptions associated with IPHR and propose questions to ensure a more deliberate research process. It is our hope that population health researchers and the CIHR will consider these questions to help strengthen IPHR.

Older adults with hoarding behaviour aging in place: looking to a collaborative community-based planning approach for solutions.

This paper reports on and synthesizes new research that examines how a collaborative community response can promote successful aging in place for older adults with hoarding behaviour. Through interviews with older adults with hoarding behaviour, who used a particular community support and a focus group interview with members of the community collaborative that directed supports for this population, our findings suggest that there were valuable outcomes for both groups. These older adults with hoarding behaviour were able to remain in their own homes, their safety was enhanced, their sense of isolation was minimized, empowerment was fostered, and they gained valuable insight into their behaviour. The members of the community collaborative were able to access the expertise of other professionals, maximize their own expertise, and they generated an enhanced understanding of the experience of older adults living with hoarding behaviour in Edmonton. This study is a significant addition to the much too sparse literature about the community planning needs of older adults with hoarding behaviour. It offers knowledge that is integral to theories and principles of better aging in place but attempts to translate this into practice.

Inclusivity and dementia: health services planning with individuals with dementia: effective inclusion requires action at multiple levels by individuals with dementia, care partners, service providers and funding organizations.

Historically, Alzheimer societies have identified the care partners of persons with dementia as their central clients. This focus is broadening to include the person with the disease, as well. This paper presents the results of a Canadian research study addressing organizational considerations related to effective inclusion of persons with dementia in planning and decision-making about health services and programs. Our findings suggest that effective inclusion requires action at multiple levels by individuals with dementia, care partners and friends; service organizations and providers; and funding organizations. Additional research is needed to explore the applicability of these findings to other organizations in different localities and to examine emergent themes further. Of these, one that has received little attention to date concerns the potential risks associated with effective inclusion.

Understanding the experience of moving a loved one to a long-term care facility:family members' perspectives.

This project was designed to develop an understanding of family members' experiences of moving a loved one to a long-term care facility and to identify ways in which facilities might help ease this process. Twenty-one semi-structured interviews were conducted with family members who had recently moved a relative into one of three long-term care facilities in Southern Ontario, Canada. Several factors appeared to contribute to the overall experience of the move to long-term care and either served to impede or facilitate a positive transition for families. These factors included: the experience during the waiting process, preparation for the move, ease of the actual move, control over decisions, communication throughout the process, support from others, and family and resident perceptions and attitudes towards the move. Easing the difficult aspects of moving a loved one to a long-term care setting can be facilitated with better preparation and support from facilities and community services.