A dearth of research has focused on the diverse experiences of aging sexual minority populations and, in particular, older sexual minority women. Studies that have disaggregated the population of lesbian, gay, bisexual, transgender, questioning, queer, intersex and two-spirit (LGBTQIS+) older adults reveal that due to minority stress and a lifetime of disadvantage. Lesbians experience higher rates of chronic health conditions and mental health problems (including loneliness) than heterosexual women and greater financial inequalities compared to gay men or heterosexual women. Despite this, limited inquiry has explored the everyday lives of older queer women and fewer still draws upon women's commentary on their own lived experiences or centers older women as authoritative agents and experts on their own lives. In response to this knowledge deficit, this research traverses the aging experiences of female-identified members of a gay square dance (GSD) club in Toronto, Canada. We apply queer theory to explicate the unique ways in which a GSD club queers the aging process for 14 older women dancers. Findings of the inquiry highlight the ways in which these dancers confront and reject heteronormativity, while illuminating pathways to successful aging for older sexual diverse women. The older women dancers in this study perform gender in ways that challenged heteronormativity and gender binaries, enhanced belongingness and acceptance, embodied joy, and fostered wellness. These concepts have been identified as critical factors in successful aging and highlight what queering aging might look like for this resilient population who have overcome a lifetime of disadvantage.
This exploratory qualitative study seeks to understand the barriers and facilitators of disclosure and reporting of abuse against older adults by conducting interviews with older adults with lived experience of abuse and service providers working directly with this population in Alberta, Canada. Thematic analysis revealed three key themes: (1) Barriers to disclosure and reporting of abuse; (2) Facilitators to disclosure and reporting; and (3) Key tensions between service providers' and older adults' perceptions of the disclosure and reporting process. Based on these findings, we offer recommendations to increase awareness, promote disclosure, and improve services for older adults experiencing abuse.
Disclosure , Elder Abuse , Qualitative Research , Humans , Alberta , Elder Abuse/psychology , Aged , Male , Female , Aged, 80 and over , Middle Aged , Interviews as Topic
With the increasing aging population there is a need for more gerontological social work practitioners; however, such training for social workers in Canada is limited. To help address this gap, one faculty of social work developed a graduate level clinical social work practice certificate with a specialization in gerontology. In this paper we explore students' and instructors' perspectives about the curriculum, delivery, and impact of this certificate, and provide recommendations for improvement, particularly with respect to the clinical nature of the courses. Eight students and four instructors participated in the study. Strengths and opportunities for enhancement were identified for curriculum and delivery. Study findings also indicated that further curriculum development should focus on enhancing clinical skill development and providing more practice experience. Implications arising from these findings included developing clinical skills through experiential learning, interprofessional education, and service learning.
LGBTQI2S+ (lesbian, gay, bisexual, transgender, questioning, intersex, and two-spirit, etc.) individuals face unique challenges to physical activity participation, such as discrimination and exclusion. Square dance is a form of collaborative group dancing and while traditionally a heteronormative form of dance, gay square dance is typically open to everyone, regardless of sexual orientation. Square dancing offers opportunities to belong to a community of others engaged in the same activity, which older adults often find satisfying. The aim of this research was to understand how older adults who identify as women experience social support in the context of participating in gay square dance and the role previous experiences of social exclusion play in influencing these experiences. Fourteen self-identified women (age range 55-79 years; n = 11 White, n = 1 Black, n = 2 Jewish) belonging to a gay square dance club participated. Participants self-identified as heterosexual (n = 7), lesbian (n = 3), pansexual (n = 1), bisexual (n = 1), or did not identify with existing terminology (n = 2). Interviews were conducted during a gay square-dancing festival and thematically analyzed. Findings highlighted that participants experienced acceptance which affirmed their sense of self and enabled their authentic selves. To foster a sense of belonging and close relationships, specific actions (e.g., demonstrative welcoming of newcomers, mutual support) were taken by other participants in the group. Physical touch is an inherent part of square dancing, which took on different meanings for participants and was overall perceived as safe. Inclusive groups like gay square dance clubs are an important and consistent means where older adult women can experience meaningful social relationships and interactions.
Dancing , Homosexuality, Female , Sexual and Gender Minorities , Humans , Female , Male , Aged , Middle Aged , Social Support , Interpersonal Relations
Background: This study aimed to explore the association between health status (physical, mental, and self-rated health) and multidimensional poverty (subjective and objective poverty) in older adults. Method: A panel binary logit regression approach was applied to four waves of CLHLS data (2008, 2011, 2014, and 2018). In total,1,445 individuals were included after data cleaning. Results: The mean values and proportion of physical, mental, and self-rated health were 5.73 (87.42%), 0.93 (93.06%), and 3.46 (86.7%), respectively, and mean values and proportion of subjective and objective poverty were 0.19 (18.51%) and 0.21(21.4%). In addition, physical, mental, and self-rated health were all found to be associated with subjective poverty among older adults (r = -0.181, r = -0.630, r = -0.321, p < 0.05), that is, the better the physical, mental, and self-rated health, the lower the probability of subjective poverty. A comparable connection between self-rated health and objective poverty also exists (r = -0.157, p < 0.05). Furthermore, medical expenditure played a mediation role in the association between the health status and poverty of older adults. Conclusion: In order to effectively alleviate the poverty of older adults, strategies should be taken to improve the health level of older adults, especially the physical and mental health of high-aged older adults, and the self-rated health of middle-aged older adults. Furthermore, social security and pensions should be further developed to adequately reimburse medical expenditures.
East Asian People , Health Status , Middle Aged , Humans , Aged , Longevity , Poverty , Longitudinal Studies
OBJECTIVES: to examine the causal relationship between sleep quality and life satisfaction and explore the mediating role of health status on the relationship between sleep quality and life satisfaction. METHODS: A total of 1856 older Chinese people participating in 2011, 2014, and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) were included. A cross-lagged panel analysis (CLPA) combined with mediator analysis was utilized. RESULTS: The average sleep quality levels for the years 2011, 2014, and 2018 were 3.70, 3.63, and 3.47 out of 5, respectively. The corresponding average levels of health status were 3.47, 3.44, and 3.39 out of 5, and the average levels of life satisfaction were 3.75, 3.86, and 3.87 out of 5, respectively. In addition, sleep quality at prior assessment points was significantly associated with life quality at subsequent assessments, and vice versa. Also, health status partially mediated this prospective reciprocal relationship. CONCLUSIONS: There is a nonlinear decreased trend in sleep quality and health status, while there exists a nonlinear increased trend in life satisfaction for older adults from 2011 to 2018. Reciprocal positive effects between sleep quality and life satisfaction in older adults exist and are mediated by health status.
This study aims to provide useful insights for the Chinese government in dealing with healthcare fraud by creating an evolutionary game model that involves hospitals, third-party entities, and the government based on the government reward and punishment mechanism. This paper analyzes the evolutionary stability of each participant's strategy choice, discusses the influence of each element on the tripartite strategy choice, and further analyzes the stability of the equilibrium point in the tripartite game system. The results show that (1) the government increasing fines on hospitals is conducive to compliant hospital operations, and the incentive mechanism has little effect on such operations; (2) the lack of an incentive mechanism for third parties results in false investigations by third parties; and (3) rewards from higher levels of government promote strict supervision by local governments, but that the high cost of supervision and rewards for hospitals inhibits the probability of strict supervision. Finally, Matlab 2020a is used for simulation analysis to provide a reference for the government to improve the supervision of healthcare fraud.
In Community-Based Participatory Research (CBPR), people with shared lived experiences (co-researchers) identify priority needs and work collaboratively to co-design an action-oriented research advocacy project. For this to occur, academic researchers must build mutually respectful partnerships with co-researchers by establishing trust. In the context of the COVID-19 pandemic, our objective was to virtually assemble a group of co-researchers (people with diverse but relevant experiences of homelessness and diabetes) and academic researchers who engaged in the CBPR process to identify a project that would address the difficulties of diabetes management while experiencing homelessness. Co-researchers were recruited to the committee from community homeless-serving organizations. Six co-researchers, one peer researcher and three academic researchers from Calgary, Alberta met virtually for bi-weekly committee meetings, from June 2021 to May 2022 to explore barriers to diabetes management and to complete a priority-setting exercise to determine the focus of our collective project. After reflecting on our virtual CBPR experience we present lessons learned related to: i) technical challenges and logistical considerations, ii) meeting virtually and building rapport, iii) driving engagement, and iv) challenges of transitioning from virtual to in-person meeting format. Overall, the process of conducting a CBPR project virtually to engage a group of co-researchers during a pandemic presents its challenges. However, a virtual CBPR project is feasible and can lead to meaningful experiences that benefit all group members, both from the community and academia.
In Community-Based Participatory Research (CBPR), we value peoples' lived experiences as knowledge and believe that it can help in the design of research projects. In these projects, people with similar lived experiences work with researchers to design a research advocacy project that will make meaningful changes in their community. Trust and respect between all team members are essential for working well together. Establishing trust and respect can be difficult, especially when done virtually. We virtually convened a committee and completed a CBPR project. Our group consisted of seven people with lived experience of diabetes and homelessness and three academic researchers in Calgary, Alberta. We met every two weeks between June 2021 and May 2022 to explore possible topics for our CBPR project, which we narrowed down to their top priority. As we reflected on our experience of working together, we came up with four categories of lessons learned: i) technical challenges, ii) building rapport, iii) driving engagement, and iv) challenges of transitioning from virtual to in-person meeting format. While our experience presented its challenges, we found working virtually to create a CBPR project is possible and can be meaningful for all group members.
Spousal bereavement poses considerable challenges to adults in late life. Some populations, such as older immigrants, may experience heightened negative outcomes as a consequence of spousal bereavement, due to migratory stress and social isolation. Spousal bereavement is culturally embedded as it is related to cultural beliefs and attitudes concerning death and family relationships. However, studies on spousal bereavement or widowhood among older immigrants are extremely limited. This study aims to fill the gap by exploring, via a phenomenological approach, the lived experiences of widowed older Chinese immigrants in Calgary and responding to the question: What are the lived experiences of widowed Chinese older immigrants in coping with their spousal bereavement? With the data drawn from 12 in-depth qualitative interviews, findings were categorized into individual, family, community and societal levels. Study participants experienced long-lasting grief that was private and impacted by their culture and immigration status. Although family and ethno-cultural communities provided various types of supports during participants' widowhood, they did not directly assist them in coping with spousal loss. Most participants did not access social services for bereavement support, more often relying on cultural rituals and faith practices. Findings suggest the need for culturally appropriate bereavement supports and family/community involvement for older immigrant adults who have experienced spousal loss.
Bereavement , Emigrants and Immigrants , Widowhood , Humans , Female , East Asian People , Grief , Adaptation, Psychological
Current knowledge creation and mobilization efforts are concentrated in academic institutions. A community-engaged knowledge hub (CEKH) has the potential for transdisciplinary and cross-sectorial collaboration between knowledge producers, mobilizers, and users to develop more relevant and effective research practices as well as to increase community capacity in terms of knowledge production. Objective: To summarize existing original research articles on knowledge hubs or platforms and to identify the benefits, challenges, and ways to address challenges when developing a CEKH. Methods: This study followed a systematic integrative review design. Following a comprehensive search of academic and grey literature databases, we screened 9030 unique articles using predetermined inclusion criteria and identified 20 studies for the final synthesis. We employed thematic analysis to summarize the results. Results: The focus of the majority of these knowledge mobilization hubs was related to health and wellness. Knowledge hubs have a multitude of benefits for the key stakeholders including academics, communities, service providers, and policymakers, including improving dissemination processes, providing more effective community interventions, ensuring informed care, and creating policy assessment tools. Challenges in creating knowledge hubs are generally consistent for all stakeholders, rather than for individual stakeholders, and typically pertain to funding, resources, and conflicting perspectives. As such, strategies to address challenges are also emphasized and should be executed in unison. Conclusions: This study informs the development of a future CEKH through the identification of the benefits, challenges, and strategies to mitigate challenges when developing knowledge hubs. This study addresses a literature gap regarding the comparisons of knowledge hubs and stakeholder experiences.
Knowledge , Policy , Universities , Schools
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.
Ill-Housed Persons , Humans , Aged , Aged, 80 and over , Housing
As the number of refugees continues to increase globally, so does the number of older adults forced to migrate from their home region to Western countries. Many of these older refugees lose their social networks and support to the events leading to forced migration and may be unable to recreate them once resettled. We used Arksey and O'Malley's (2005) framework to explore how forced migration has diminished the social networks and support of older refugees in Western countries and its impact on their emotional well-being. Eight databases were searched for the review; abstracts were reviewed using Rayyan QCRi(c) before the full-text review. A total of 25 studies were included in the final analysis, and findings revealed that forced migration reduced the quantity of social networks and the quality of social support older refugees received. The reduced social network and support led to social isolation, increased migration-related grief, and mental health challenges. Advances in digital technology are not yet capable of filling the support gap. With this, we hope to inform future research on the social support needs of older refugees and raise awareness of the need for humanitarian support intervention to cushion the impact of the migration-induced loss of social networks and support.
Social Networking , Social Support , Humans , Aged
Background: The fast-paced development of digital technologies in the areas of social media, pet robots, smart homes, and artificial intelligence, among others, profoundly influence the daily lives of older adults. Digital technology can improve the well-being and quality of life of older adults, older immigrants and refugees who suffer migration-associated stress, loneliness, health and psychosocial challenges. Aims: The aim of this scoping review is to map out extant empirical literature that has examined the implication of digital technology among older refugees and immigrants. Methods: Using a1 five-stage framework, we conducted a scoping review of peer-reviewed empirical studies published in English with no time restrictions. We searched nine databases for the reviews, and abstracts were reviewed using Rayyan QCRi(c) before the full-text review. The comprehensive database search yielded 4134 articles, of which 15 met the inclusion criteria. Results: The results of the review suggest that digital technology is essential to the well-being, quality of life of older immigrants and refugees, especially for maintaining and building new social support networks, navigating opportunities, coping with migration-induced stress through e-leisure, and staying connected to their culture. The literature also revealed poor utilisation of digital technologies amongst older immigrants and refugees, suggesting barriers to access. Conclusion: The study concluded by highlighting the need for more research and interventions that focus on multiple strategies, including education for increased access to and utilisation of digital technology to ensure that more older migrants can benefit from the advantages of digital technology in a safe way.
Summary: Social work field education has experienced major disruptions due to the COVID-19 pandemic, while also embracing new opportunities to grow. The Transforming the Field Education Landscape research partnership developed a cross-sectional web-based survey with closed- and open-ended questions to understand student perceptions of COVID-19's impacts on social work field education. The survey opened during the first wave of the pandemic from July 8 to 29, 2020 and was completed by 367 Bachelor of Social Work (BSW) and Master of Social Work (MSW) students across Canada. Quantitative and qualitative data were analyzed using descriptive statistics and thematic analysis. Findings: Respondents experienced reduced practicum hours and placements terminating early or moving online. Students were concerned about gaining adequate experience for future job prospects. They were generally positive about academic institutional responses to COVID-19 but described financial challenges with tuition costs and a lack of paid practica. Respondents were mostly satisfied with practicum supervision. They experienced negative impacts of COVID-19 on mental health with isolation and remote learning and described a lack of institutional mental health support. Students were concerned with missing direct practice skills, while some students reported more flexible hours, access to online events beyond their region, and increased research experience. They expressed a need for practicum flexibility and accommodation. Applications: Recommendations include an increase in flexibility and accommodations for practicum students, exchanges of promising and wise field education practices, and accessible postsecondary mental health supports. Professional development opportunities should support graduates who missed learning opportunities in their practicum.
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.
Ill-Housed Persons , Independent Living , Humans , Aged , Independent Living/psychology , Canada , Housing , Aging/psychology
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.
Ill-Housed Persons , Independent Living , Humans , Aged , Aged, 80 and over , Independent Living/psychology , Ill-Housed Persons/psychology , Housing , Social Problems , Aging
Addiction is one of the most stigmatized public health issues, which serves to silence individuals who need help. Despite emerging global interest in workplace mental health and addiction, scholarship examining addiction among university faculty members (FMs) is lacking, particularly in a Canadian context. Using a Communication Privacy Management (CPM) framework and semi-structured interviews with key informants (deans and campus mental health professionals), this qualitative study aimed to answer the following research questions: (1) What is the experience of key informants who encounter FM addiction? (2) How may addiction stigma affect FM disclosure and help-seeking? and (3) What may help reduce addiction stigma for FMs? Thematic analysis was used to identify three main themes: (1) Disclosure was rare, and most often involved alcohol; (2) Addiction stigma and non-disclosure were reported to be affected by university alcohol and productivity cultures, faculty type, and gender; (3) Reducing addiction stigma may involve peer support, vulnerable leadership (e.g., openly sharing addiction-recovery stories), and non-discriminatory protective policies. This study offers novel insights into how addiction stigma may operate for FMs in relation to university-specific norms (e.g., drinking and productivity culture), and outlines some recommendations for creating more recovery-friendly campuses.
Disclosure , Universities , Canada , Faculty , Humans , Qualitative Research , Social Stigma
BACKGROUND: Although abuse experienced by older adults is common and expected to increase, disclosure, reporting and interventions to prevent or mitigate abuse remain sub-optimal. Incorporating principles of harm reduction into service provision has been advocated as a strategy that may improve outcomes for this population. This paper explores whether and how these principles of harm reduction were employed by professionals who provide services to older adults experiencing abuse. METHODS: Thematic analysis of qualitative interviews with 23 professionals providing services to older adults experiencing abuse across three Western provinces of Canada was conducted. Key principles of harm reduction (humanism, incrementalism, individualism, pragmatism, autonomy, and accountability without termination) were used as a framework for organizing the themes. RESULTS: Our analysis illustrated a clear congruence between each of the six harm reduction principles and the approaches reflected in the narratives of professionals who provided services to this population, although these were not explicitly articulated as harm reduction by participants. Each of the harm reduction principles was evident in service providers' description of their professional practice with abused older adults, although some principles were emphasized differentially at different phases of the disclosure and intervention process. Enactment of a humanistic approach formed the basis of the therapeutic client-provider relationships with abused older adults, with incremental, individual, and pragmatic principles also apparent in the discourse of participants. While respect for the older adult's autonomy figured prominently in the data, concerns about the welfare of the older adults with questionable capacity were expressed when they did not engage with services or chose to return to a high-risk environment. Accountability without termination of the client-provider relationship was reflected in continuation of support regardless of the decisions made by the older adult experiencing abuse. CONCLUSIONS: Harm reduction approaches are evident in service providers' accounts of working with older adults experiencing abuse. While further refinement of the operational definitions of harm reduction principles specific to their application with older adults is still required, this harm reduction framework aligns well with both the ethical imperatives and the practical realities of supporting older adults experiencing abuse.
Harm Reduction , Aged , Canada , Humans , Qualitative Research
Although geriatric depression is a prevalent, serious, and under-recognized mental health condition in residential care facilities, there is a dearth of related research in Canada. This exploratory mixed methods study examines the perspectives and practices of regulated nurse professionals on assessment of geriatric depression in residential care facilities in Alberta. Findings from the quantitative surveys (n = 635) and qualitative interviews (n = 14) suggest that geriatric depression is not systematically assessed in these care settings due to multiple challenges, including confusing assessment protocol, inconsistent use and contested clinical utility of current assessment methods in facilities, limited availability of mental health professionals in facilities, and the varied views of regulated nurse professionals on who is responsible for depression assessment in facilities. Implications and future research directions are discussed.
Assisted Living Facilities , Depression/diagnosis , Homes for the Aged , Nurses/psychology , Nursing Homes , Adult , Aged , Alberta , Attitude of Health Personnel , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Surveys and Questionnaires , Young Adult
Exercise testing is commonly performed in children for evaluation of cardiac disease. Few data exist, however, on the prevalence, types of arrhythmias, predictors for arrhythmias, and safety of exercise testing in children. A retrospective review of all patients ≤21 years undergoing exercise testing at our center from 2008 to 2012 was performed. Patients with clinically relevant arrhythmias were compared to those not experiencing a significant arrhythmia. 1,037 tests were performed in 916 patients. The mean age was 14 ± 4 years, 537 (55 %) were male, 281 (27 %) had congenital heart disease, 178 (17 %) had a history of a prior arrhythmia, and 17 (2 %) had a pacemaker or ICD. 291 (28 %) patients had a rhythm disturbance during the procedure. Clinically important arrhythmias were noted in 34 (3 %) patients and included: 19 (1.8 %) increasing ectopy with exercise, 5 (0.5 %) VT, 5 (0.5 %) second degree AV block, 3 (0.3 %) SVT, and 2 (0.2 %) AFIB. On multivariate logistic regression, variables associated with the development of clinically relevant arrhythmias included severe left ventricular (LV) dysfunction on echo (OR 1.99, CI 1.20-3.30) and prior history of a documented arrhythmia (OR 2.94, CI 1.25-6.88). There were no adverse events related to testing with no patient requiring cardioversion, defibrillation, or acute anti-arrhythmic therapy. A total of 28 % of children developed a rhythm disturbance during exercise testing and 3 % were clinically important. Severe LV dysfunction and a history of documented arrhythmia were associated with the development of a clinically important arrhythmia.
Arrhythmias, Cardiac/physiopathology , Electrocardiography , Exercise Test/adverse effects , Exercise Test/methods , Risk , Adolescent , Arrhythmias, Cardiac/epidemiology , Child , Female , Heart Defects, Congenital/physiopathology , Humans , Male , Multivariate Analysis , Pacemaker, Artificial/adverse effects , Prevalence , Retrospective Studies , Ultrasonography , Ventricular Dysfunction, Left/diagnostic imaging , Ventricular Dysfunction, Left/physiopathology , Young Adult
