Meanings of Aging in the Right Place for Older Clients of a Temporary Housing Program.

BACKGROUND AND OBJECTIVES: The concept of aging in place is acknowledged as the preference of older adults, yet without consideration of the intersections of diversity in later life, it is critiqued as unattainable, unrealistic, or even undesirable. This gave rise to the exploration of what is needed to age in the right place (AIRP). Building on existing research, we examined the meaning of AIRP to older adults (aged 55+ years) who have experienced homelessness. RESEARCH DESIGN AND METHODS: We conducted photovoice interviews with 11 residents of a temporary housing program in Metro Vancouver (Canada). RESULTS: Using thematic analysis, we organized meanings of AIRP according to (1) Where one lives-the physical and social environment, (2) Where one goes and what one does, and (3) How one feels in "the right place." DISCUSSION AND IMPLICATIONS: Participants meanings' of AIRP are applied to Maslow's hierarchy of needs. That is, when basic needs of shelter are met, participants' considerations of "the right place to age" extend beyond affordable housing to include feeling safe and comfortable in one's home and neighborhood and having access to meaningful engagement and activities-both in vibrant urban districts and naturescapes-enabled by affordable transportation. Our examination of what AIRP means to this group of older adults broadens current conceptualizations. Given the increase in homelessness among older adults, it is imperative that policymakers and practitioners are cognizant of meanings of AIRP so diverse older adults can not only age in place, but can thrive in the right place.

Everyday Pain in Middle and Later Life: Associations with Daily and Momentary Present-Moment Awareness as One Key Facet of Mindfulness.

This study investigated everyday associations between one key facet of mindfulness (allocating attention to the present moment) and pain. In Study 1, 89 community-dwelling adults (33-88 years; Mage = 68.6) who had experienced a stroke provided 14 daily end-of-day present-moment awareness and pain ratings. In Study 2, 100 adults (50-85 years; Mage = 67.0 years) provided momentary present-moment awareness and pain ratings three times daily for 10 days. Multi-level models showed that higher trait present-moment awareness was linked with lower overall pain (both studies). In Study 1, participants reported less pain on days on which they indicated higher present-moment awareness. In Study 2, only individuals with no post-secondary education reported less pain in moments when they indicated higher present-moment awareness. Findings add to previous research using global retrospective pain measures by showing that present-moment awareness might correlate with reduced pain experiences, assessed close in time to when they occur.

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 [...].

Exploring areas of improvement in postnatal care services in a tertiary care hospital in Lahore.

Background and Objective: Poor postnatal care can increase morbidity and mortality. This study assessed the current deficiencies in quality of postnatal care provided to mothers in Lady Aitchison hospital, Lahore when compared to WHO standards and identifies the areas for quality improvement. Methods: It is a descriptive cross-sectional study which employs quantitative method to collect and analyze the data. It was conducted to include ninety-six maternities attending the wards of Lady Aitchison Hospital, Lahore during January 2022 to February 2022. Consenting post-partum mothers were selected by random sampling and interviewed by using a structured proforma. Results: Among 96 mothers, 56% were below 25 years of age, 39% had secondary education, with more than one child (71%) and 57% visited for the first time. Majority of mothers, were given medicine timely (82%) and found the attitude (85%) and information (83%) provided by the healthcare workers helpful. Their subjective satisfaction rate with staff was 90%. The main areas of concern were lack of proper examination guidelines and facilities, limited information to mothers regarding neonatal care and substandard interior of hospitals. The statistics on the detailed maternal and neonatal examination showed that it was left out in 30% to 50% patients. Information regarding the danger signs of mothers and neonates was not given in 69% and information on family planning was provided to only 28%. Contentment with the infrastructure of the hospital was subpar and it was suggested that the sanitary conditions of washrooms and the paraphernalia of the wards i.e., ACs and beds needed improvement. Conclusions: This study suggests that in developing countries like Pakistan, majority of the patients were satisfied by the services of healthcare workers. The prime improvement area is the infra-structure of the hospital which can be upgraded to provide better quality facilities in terms of air-conditioning, washrooms and well-designed areas for extensive examination of breast, pelvis, abdomen and neonates. There is also need for introduction of standard guidelines for postnatal care.

Efficacy of the Stroll Safe Outdoor Fall Prevention Program: A Randomized Controlled Trial.

BACKGROUND AND OBJECTIVES: Outdoor falls can negatively affect the independence and well-being of community-dwelling older adults. Although there is some overlap, there are also differences in risk factors for indoor and outdoor falls. There are no existing community-based fall prevention programs that specifically target outdoor fall prevention. To fill this gap, the Stroll Safe program was developed. RESEARCH DESIGN AND METHODS: A cluster-randomized controlled trial design was used with randomization at the site level. Participants (N = 86) were aged 60 and older, with a history of an outdoor fall or who had a fear of falling outdoors. Eight naturally occurring retirement community program sites were randomly assigned to the treatment or wait list control group. Outcome measures included the Outdoor Falls Questionnaire, the Falls Behavioral Scale for the Older Person, and the Falls Efficacy Scale-International to examine knowledge of risks, safe strategy use, protective behaviors, and fear of falling. An Analysis of Covariance (ANCOVA) was used to compare change scores between groups with covariates included for any initial differences between groups. A linear mixed model was also conducted to account for any clustering effects. RESULTS: Significant differences (ps < .05) were found between groups for knowledge of outdoor fall risks and safe strategy use. Effect sizes were large (Cohen's d = 1.2-1.9). Results were retained at 6-week follow-up. DISCUSSION AND IMPLICATIONS: Stroll Safe is effective in improving knowledge of outdoor fall risks and increasing safe strategy use for community mobility. Stroll Safe fills a gap in outdoor fall prevention programs. Clinical Trials Registration Number: NCT03624777.

Delivering Services to Older Persons Experiencing Homelessness: Providers' Perspectives of What Does and Does Not Work.

Older people with experiences of homelessness (OPEH) tend to experience more complex health, social, and psychological issues than people experiencing homelessness at younger ages. Simultaneously, many housing resources (e.g., shelters, temporary housing) are often ill equipped to meet the needs of OPEH. As such, OPEH are often unable to age in the right place (AIRP) - that is, in a place that supports unique needs and vulnerabilities. However, several promising practices exist that deliver housing and services tailored to OPEH. To investigate the aspects of housing and shelter that both promote and impede AIRP for OPEH, this study examines the delivery of services in three such promising practices from the perspective of service providers. Findings from fifteen qualitative interviews revealed three overarching themes: 1) barriers to providing individualized support (e.g., staff turnover); 2) shifting contexts and structures (e.g., housing market changes); and 3) mechanisms of success (e.g., facilitating smooth transitions into permanent housing). These findings provide evidence to support the refinement of service delivery to promote AIRP for OPEH. In doing so, these insights can help to elevate promising practices to the level of best practice.

Aging in the Right Place for Older Adults Experiencing Housing Insecurity: An Environmental Assessment of Temporary Housing Program.

Research on programs offering senior-specific housing supports and enabling "aging in the right place" (AIRP) for "older persons with experiences of homelessness" (OPEH) is limited. This paper presents an environmental assessment of a "transitional housing program" (THP) in Metro Vancouver, Canada, for OPEH to AIRP. Data were collected using Aging in the Right Place Environmental (AIRP-ENV) and Secondary Observation (AIRP-ENV-SO) audit tools designed to evaluate multi-unit housing for OPEH. The 241-item AIRP-ENV tool was used to assess the built environmental features of four multi-unit buildings of the THP. The AIRP-ENV-SO tool was used to collect contextual data on the function, safety, and land use of the surrounding neighborhood. Findings identified built environment and urban design features that support THP residents' safety, security, accessibility, functionality, social activity, autonomy, and identity. The THP buildings were rated 'Good' for accessibility, functionality, autonomy and identity, while 'Satisfactory' or 'Poor' for safety, security, and social activity. Findings point to the built environmental features (e.g., size and layout of spaces) required in the THP to create opportunities for increased social engagement among residents and enhanced safety and security. The AIRP-ENV and AIRP-ENV-SO audit tools can help inform programs across the housing continuum to develop supportive built environments that promote AIRP for OPEH.

Providing Accessible ReCreation Outdoors-User-Driven Research on Standards: Protocol for Mobile and Web-Based Interviews for Winter Assessments.

BACKGROUND: Although there have been recent efforts to improve access to Canadian national parks, many remain not fully accessible to people with disabilities. Winter conditions, in particular, present challenges that limit their participation in outdoor activities. OBJECTIVE: This study aimed to develop a novel method to assess park access during winter, which will inform recommendations for national park standards to meet the needs of all park visitors (regardless of ability) during winter conditions. METHODS: A larger participatory mixed methods research project exploring park access was adapted. A 3-phase approach has already been proposed to achieve the study objectives. In the first phase, a scoping review of the existing accessibility standards will be conducted. In the second phase, objective audits of trails and features in 6 parks, 3 in western Canada and 3 in eastern Canada, will be conducted, as well as mobile interviews with 24 various participants in each region regarding their experiences of and recommendations for improving the park's accessibility. In the final phase, a Delphi participatory consensus development process will be used, based on the data gathered in the first 2 phases, to prioritize recommendations for standards. This paper will focus on the second phase of the study, specifically on whether the in-person winter mobile interviews (ie, walking and wheeling interviews) with people who have a wide range of disabilities while visiting 3 parks in 2 provinces were modified. Changes were made to accommodate the extreme winter weather conditions in Quebec while using safe and informative data collection methods. RESULTS: In Quebec, one park, where winter conditions are safer, has been assessed in person (n=4). Web-based interviews were used to facilitate the assessment of other winter and summer conditions in two other parks (n=8). Winter and web-based interviews were completed in April 2022. Data are currently being collected and analyzed, and results will be completed by December 2022. CONCLUSIONS: We expect that adapting the protocol to gather further information on winter conditions and access to parks will provide high-quality and rich data to better inform park access standards. This participatory mixed methods research will inform the development of park standards that consider the accessibility needs of all people. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/38715.

"A right place for everybody": Supporting aging in the right place for older people experiencing homelessness.

While policies and practices that promote aging in place have risen in prominence over the last two decades, marginalised older adults have largely been overlooked. 'Aging in the right place' is a concept that recognises the importance of adequate and appropriate age-related health and psychosocial supports in shelter/housing settings and their impact on the ability of older people to age optimally. To understand the unique shelter/housing challenges and solutions that affect aging in the right place for older people experiencing homelessness (OPEH), we conducted three World Café workshops in three Canadian cities-Montreal, Calgary, and Vancouver. In total, 89 service providers and OPEH engaged in the workshops, which involved guided, small-table discussions with the goal of stimulating creative ideas and fostering a productive atmosphere. Findings revealed two overarching themes 1) Discrepancies, between the need and availability of housing options and community supports for OPEH, such as affordable transportation, case management, access to healthcare, and system navigation; and 2) Desires, for more peer support, participatory planning, service-enriched housing, social programming, and policies that promote agency, independence, and choice for OPEH. These findings provide evidence to inform the development or modification of housing and supports for OPEH that promote aging in the right place.

Providing Accessible Recreation Outdoors-User-Driven Research on Standards (PARCOURS): Protocol for a Multiphase Study.

BACKGROUND: Canada's national parks are world-renowned. However, despite recent attempts to improve access, many are not accessible to people with disabilities. With the advent of provincial and federal legislation, standards are being developed to assist with the design and management of parks. OBJECTIVE: The overarching objective of this study is to inform accessibility standards for federal parks that meet the needs of all park visitors, regardless of ability. The specific objectives of this study are to identify park accessibility standards that exist internationally, identify the accessibility challenges that people with disabilities face in park environments, and prioritize and recommend accessibility standards for national parks. METHODS: A 3-phase approach will be used to achieve the study objectives. In the first phase, a scoping review of the existing accessibility standards will be conducted. The second phase will include objective audits of trails and features in 6 parks, 3 in western Canada and 3 in eastern Canada, as well as mobile interviews with 24 diverse participants in each region regarding their experiences of and recommendations for improving the park's accessibility. In the final phase, a Delphi participatory consensus development process will be used, based on the data gathered in the first 2 phases, to prioritize recommendations for standards. RESULTS: We expect to find gaps in existing standards that do not account for the diverse range of accessibility requirements that people with disabilities have for visiting parks. We also expect to find that existing standards, on their own, may not be enough to ensure equitable access to all the experiences and amenities that parks have to offer. Development of subsequent guidelines and best practices may be necessary to address complex scenarios for which standards may not be the best approach to ensuring accessibility. CONCLUSIONS: The participatory and mixed methods approaches used in this study will provide rich insights for developing accessible park standards that consider the diverse needs of people with disabilities. The findings will also support the development or enhancement of park standards at all levels of government. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/33611.

Aging in the Right Place: A Conceptual Framework of Indicators for Older Persons Experiencing Homelessness.

Aging in place may not be a universally optimal goal nor accessible to all. Research has highlighted the significance of aging in the right place (AIRP) by recognizing that secure housing for older adults should support one's unique vulnerabilities and lifestyles. Despite the evolving conceptualization of AIRP for general populations of older adults, considerations of AIRP relevant for older people with previous or current experiences of homelessness are absent from the existing literature. Given this conceptual gap, we developed a framework of indicators relevant for older persons experiencing homelessness. We engaged community partners in the development of our framework and examined what had been described in prior research on aging in place and person-environment fit for older adults. The resulting conceptual framework is comprised of 6 subcategories of indicators: (a) built environment of the housing unit and surrounding neighborhood, (b) offsite and onsite health and social services and resources, (c) social integration, (d) stability and affordability of place, (e) emotional place attachment, and (f) broader political and economic contexts. This framework provides a practical and meaningful contribution to the literature which can be used to promote AIRP for individuals whose experiences are often not reflected in existing models.

Contextualizing Innovative Housing Models and Services Within the Age-Friendly Communities Framework.

This article compares and contrasts the characteristics of 3 models of housing and services for older adults, cohousing, Naturally Occurring Retirement Community Supportive Services Program, and villages, and links them to the domains of the age-friendly communities (AFCs) framework, specifically (a) services, supports, and information; (b) respect, inclusion, and diversity; (c) social and civic participation; and (d) affordability. We discuss key barriers and challenges of these models with respect to the AFC domains, as well as implementation and sustainability. Consideration of these models in age-friendly housing policy and practice could help expand and diversify the choices in the housing and services continuum. This aligns with AFC's emphasis on the need for housing and services responsive to older adults' diverse health and social needs, provides options that balance autonomy, choice, and support, and emphasizes older adults' participation and involvement in tailoring these options.

Predictors of Psychological Distress and Confidence Negotiating Physical and Social Environments Among Mobility Device Users.

OBJECTIVE: We conducted an intersectional analysis to explore how demographic characteristics and mobility device use were associated with psychological distress (depression and anxiety) and confidence negotiating physical and social environments. DESIGN: Cross-sectional data were collected using the Hospital Anxiety and Depression Scale, modified Wheelchair Use Confidence Scale, and self-reported functional independence scale. PARTICIPANTS: The sample included 105 participants. Primary mobility devices used included mobility scooters (27%), power wheelchairs (26%), manual wheelchairs (25%), walkers (11%), and cane or crutch (12%). The mean age of participants was 58 yrs, 53% were female, and 52% lived alone and were functionally independent with the use of assistive technology. RESULTS: We were able to explain between 39% and 65% of the variance (adjusted R2) in the dependent variables with parsimonious regression models. Age was an independent predictor of all outcomes. Women were less confident negotiating the physical environment, and walker use was associated with depression and lower confidence negotiating physical environments, but increased confidence negotiating social environments. CONCLUSIONS: Age is associated with psychosocial outcomes for assistive device users, and those who use walkers may experience increased challenges with depression and negotiating the physical environment. Pending confirmatory research, the findings may have important implications for targeted interventions related to device provision.

Walk/Wheelability: An Inclusive Instrument Pair for Participatory Age-Friendly Research and Practice.

BACKGROUND AND OBJECTIVES: Recent critical evaluations of age-friendly efforts have highlighted the need to prioritize the disenfranchised, including people with mobility limitations. This article examines the validity of a 13-item Stakeholders Walkability/Wheelability Audit in Neighborhoods (SWAN13) scale to measure the "walk/wheelability" of street segments from the perspectives of people with mobility limitations. RESEARCH DESIGN AND METHODS: Data were drawn from preliminary studies of the SWANaudit which was conducted in 2 Canadian metropolitan areas. Sixty-one participants who use mobility devices (e.g., walkers, power wheelchairs) and older adults from community organizations audited 195 street segments. We factor analyzed the data from their audits. RESULTS: SWAN13 has a 1-factor structure. 13 items were retained from 85 SWANaudit items. SWAN13 encompassed both physical and social aspects of walk/wheelability. The alpha for the scale was .79. Convergent validity was found with the University of Alabama Life-Space Assessment (ρ = .22, p = .003), especially at the neighborhood level (ρ = .23, p = .002). Significant correlation was also found with subjective assessments of a priori walk/wheelability domains (ρ = .63, p < .001). DISCUSSION AND IMPLICATIONS: Walk/wheelability affects the life space of older adults and people with mobility limitations. It is an important latent variable that should be addressed to promote well-being and social participation. SWAN13 may be used in city-wide surveys to identify neighborhoods that may require age-friendly interventions from mobility perspectives. Detailed audits and interventions may be carried out in tandem using the paired SWANaudit instrument. Walk/wheelability is an inclusive and measurable concept that accounts for the needs of people with various mobility needs.

Using photovoice to increase social inclusion of people with disabilities: Reflections on the benefits and challenges.

The aim of this study was to understand the mobility experiences of mobility device users regarding the environmental and social barriers and facilitators in their community and to discuss the benefits and challenges of using photovoice, as a participatory methodology, to increase social participation for people with disabilities. Photovoice was used with mobility device users (n = 70) in two different locations in Canada. The participants took pictures for two weeks and then participated in individual interviews and focus group sessions to discuss their photographs. The participants took over 1,000 pictures that were grouped into five themes around social participation and accessibility. They chose the most illustrative pictures to share in an exhibit to create a dialogue with different stakeholders. Using photovoice offered many benefits such as allowing the participants to be equal partners of the research and made their voices heard, but also presented disability and study-related challenges.

Perceptions of the Neighborhood Built Environment for Walking Behavior in Older Adults Living in Close Proximity.

Past research documents a discordance between perceived and objectively assessed neighborhood environmental features on walking behavior. Therefore, we examined differences in the perception of the same neighborhood built environment. Participants were grouped if they lived 400 m or closer to each other. The perception of the pedestrian infrastructure, neighborhood aesthetics, safety from crime, and safety from traffic was derived from a telephone survey from two North American metropolitan areas; 173 individuals were clustered into 42 groups. Older adults who walked for transport in their neighborhood experienced the same neighborhood as more walkable (ß = .19; p = .011) with better pedestrian infrastructure (ß = .16; p = .037). Older adults with physical limitations experienced the same neighborhood as less safe from crime (ß = -.17; p = .030) and traffic (ß = -.20; p = .009). The study supports the notion that individual behavior and physical restrictions alter the environment's perception and explains part of the discordance between objective and subjective assessment of the neighborhood environment.

Examining the Impact of Knowledge Mobilization Strategies to Inform Urban Stakeholders on Accessibility: A Mixed-Methods study.

Urban areas offer many opportunities for people with disabilities, but limited accessibility may prevent their full engagement in society. It has been recommended that the experience-based perspective of people with disabilities should be an integral part of the discussion on urban accessibility, complementing other stakeholder expertise to facilitate the design of more inclusive environments. The goals of this mixed-method study were to develop knowledge mobilization (KM) strategies to share experience-based findings on accessibility and evaluate their impact for various urban stakeholders. Using a participatory approach, various KM strategies were developed including videos, a photo exhibit and an interactive game. These strategies were evaluated based on various impact indicators such as reach, usefulness, partnerships and practice changes, using quantitative and qualitative methods. The findings suggested that the KM strategies were effective in raising the awareness of various urban stakeholders and providing information and guidance to urban planning practices related to accessibility.

Everyday Walking Among Older Adults and the Neighborhood Built Environment: A Comparison Between Two Cities in North America.

A walkable neighborhood becomes particularly important for older adults for whom physical activity and active transportation are critical for healthy aging-in-place. For many older adults, regular walking takes place in the neighborhood and is the primary mode of mobility. This study took place in eight neighborhoods in Metro Portland (USA) and Metro Vancouver (Canada), examining older adults' walking behavior and neighborhood built environmental features. Older adults reported walking for recreation and transport in a cross-sectional telephone survey. Information on physical activity was combined with audits of 355 street segments using the Senior Walking Environmental Audit Tool-Revised (SWEAT-R). Multi-level regression models examined the relationship between built environmental characteristics and walking for transport or recreation. Older adults [N = 434, mean age: 71.6 (SD = 8.1)] walked more for transport in high-density neighborhoods and in Metro Vancouver compared to Metro Portland (M = 12.8 vs. M = 2.2 min/day; p < 0.001). No relationship was found between population density and walking for recreation. Older adults spent more time walking for transport if pedestrian crossing were present (p = 0.037) and if parks or outdoor fitness amenities were available (p = 0.022). The immediate neighborhood built environment supports walking for transport in older adults. Comparing two similar metropolitan areas highlighted that high population density is necessary, yet not a sufficient condition for walking in the neighborhood.

Solitude in context: On the role of culture, immigration, and acculturation in the experience of time to oneself.

Older adults spend much time in solitude (without social interaction), putting them at risk of loneliness, especially if aging outside their country of origin (e.g., Chinese immigrants to Canada). Yet, cultural contextual factors that may reduce loneliness in moments of solitude are poorly understood. This study sought to disentangle the roles of culture, immigration, and acculturation in solitude-loneliness associations across two countries. Community-dwelling adults aged 51-85 in Vancouver (N = 58 East Asian, N = 37 European/North American) and in Hong Kong (N = 56 East/Southeast Asian) completed approximately 30 ecological momentary assessments over 10 days on their current affect and social situations. Participants in Vancouver spent more time in solitude, desired solitude more, and felt less lonely overall than those in Hong Kong. Multilevel models revealed that moments of solitude felt lonelier than moments spent in social interaction, but only for individuals less acculturated to their host culture or not concurrently desiring solitude. Associations held regardless of host culture, cultural heritage, or immigration status. Findings suggest that solitude need not feel lonely if it happens by choice and if individuals feel connected with their host culture, for both immigrant older adults and those aging in their birth country.

"These Few Blocks, These Are My Village": The Physical Activity and Mobility of Foreign-Born Older Adults.

BACKGROUND AND OBJECTIVES: The self-reported health of foreign-born older adults (FBOAs) is lower than that of nonimmigrant peers. Physical activity (PA) and mobility enhance health in older age, yet we know very little about the PA and mobility of FBOAs. In this analysis we sought to determine: (a) What factors facilitate PA amongst FBOAs? and (b) How do gender, culture, and personal biography affect participants' PA and mobility? RESEARCH DESIGN AND METHODS: We worked closely with community partners to conduct a mixed-method study in Vancouver, Canada. Eighteen visible minority FBOAs completed an in-depth interview in English, Cantonese, Mandarin, Punjabi, or Hindi. RESULTS: Three dominant factors promote participants' PA and mobility: (a) participants walk for well-being and socialization; (b) participants have access to a supportive social environment, which includes culturally familiar and linguistically accessible shops and services; and (c) gender and personal biography, including work history and a desire for independence, affect their PA and mobility behaviors. DISCUSSION AND IMPLICATIONS: We extend the Webber et al. mobility framework, with examples that further articulate the role of gender (e.g., domestic work), culture (cultural familiarity) and personal biography (work history and a desire for familial independence) (Webber, S. C., Porter, M. M., & Menec, V. H. (2010). Mobility in older adults: A comprehensive framework. The Gerontologist, 50, 443-450. doi:10.1093/geront/gnq013). Future programming to support the PA of FBOAs should be culturally familiar and linguistically accessible.