A Longitudinal Study on the Impact of Indoor Temperature on Heat-Related Symptoms in Older Adults Living in Non-Air-Conditioned Households.

BACKGROUND: Both chronic and acute heat result in a substantial health burden globally, causing particular concern for at-risk populations, such as older adults. Outdoor temperatures are often assessed as the exposure and are used for heat warning systems despite individuals spending most of their time indoors. Many studies use ecological designs, with death or hospitalizations rates. Individual-level outcomes that are directly related to heat-symptoms should also be considered to refine prevention efforts. OBJECTIVES: In this longitudinal study, we assessed the association between indoor temperature and proximal symptoms in individuals ≥60 years of age living in non-air-conditioned households in Montérégie, Quebec, during the 2017-2018 summer months. METHODS: We gathered continuously measured indoor temperature and humidity from HOBO sensors and repeated health-related questionnaires about health-related symptoms administered across three periods of increasing outdoor temperatures, where the reference measurement (T1) occurred during a cool period with a target temperature of 18-22°C and two measurements (T2 and T3) occurred during warmer periods with target temperatures of 28-30°C and 30-33°C, respectively. We used generalized estimating equations with Poisson regression models and estimated risk ratios (RRs) between temperature, humidity, and each heat-related symptom. RESULTS: Participants (n=277) had an average age (mean±standard deviation) of 72.8±7.02y. Higher indoor temperatures were associated with increased risk of dry mouth (T3 RR=2.5; 95% CI: 1.8, 3.5), fatigue (RR=2.3; 95% CI: 1.8, 3.0), thirst (RR=3.4; 95% CI: 2.5, 4.5), less frequent urination (RR=3.7; 95% CI: 1.8, 7.3), and trouble sleeping (RR=2.2; 95% CI: 1.6, 3.2) compared with T1. We identified a nonlinear relationship with indoor temperatures across most symptoms of interest. DISCUSSION: This study identified that increasing indoor temperatures were associated with various health symptoms. By considering the prevalence of these early stage outcomes and indoor temperature exposures, adaptation strategies may be improved to minimize the burden of heat among vulnerable communities. https://doi.org/10.1289/EHP10291.

Cognitive Health Promotion Program for Community-Dwelling Seniors: Who Are We Reaching?

This exploratory study examines the reach of Jog Your Mind, a multifactorial community-based program promoting cognitive vitality among seniors with no known cognitive impairment. The aim was to determine whether the program successfully reached its target population and to compare the characteristics of participants (sociodemographic, health, lifestyle, attitudes, and cognitive profile) with the general population of seniors. Twenty-three community organizations recruited 294 community-dwelling seniors willing to participate in the program. Descriptive analyses revealed that the participants were mostly Canadian-born educated women living alone. Participants' health profile and lifestyle behaviors were fairly similar to those of seniors in Québec and Canada. A large proportion of the participants were concerned about their memory. These results suggest that the program did not attract many hard-to-reach members of the population and reached seniors who may have had some cognitive challenges. Cues to action for improving the reach of cognitive health promotion programs are discussed.

Explaining variation of implementation outcomes of centralized waiting lists for unattached patients.

PURPOSE: Centralized waiting lists (CWLs) for patient attachment to a primary care provider have been implemented across Canada, including Quebec. Little is known about the implementation of CWLs and the factors that influence implementation outcomes of such primary care innovations. The purpose of this paper is to explain variations in the outcomes of implementation by analyzing the characteristics of CWLs and contextual factors that influence their implementation. DESIGN/METHODOLOGY/APPROACH: A multiple qualitative case study was conducted. Four contrasting CWLs were purposefully selected: two relatively high-performing and two relatively low-performing cases with regard to process indicators. Data collected between 2015 and 2016 drew on three sources: 26 semi-structured interviews with key stakeholders, 22 documents and field notes. The Consolidated Framework for Implementation Research was used to identify, through a cross-case comparison of ratings, constructs that distinguish high from low-performing cases. FINDINGS: Five constructs distinguished high from low-performing cases: three related to the inner setting: network and communications; leadership engagement; available resources; one from innovation characteristics: adaptability with regard to registration, evaluation of priority and attachment to a family physician; and, one associated with process domain: engaging. Other constructs exerted influence on implementation (e.g. outer setting, individual characteristics), but did not distinguish high and low-performing cases. ORIGINALITY/VALUE: This is the first in-depth analysis of CWL implementation. Results suggest important factors that might be useful in efforts to continuously improve implementation performance of CWLs and similar innovations.

Population health intervention research: what is the place for pilot studies?

BACKGROUND: An international workshop on population health intervention research (PHIR) was organized to foster exchanges between experts from different disciplines and different fields. AIMS: This paper aims to summarize the discussions around one of the issues addressed: the place or role of pilot studies in PHIR. Pilot studies are well-established in biomedical research, but the situation is more ambiguous for PHIR, in which a pilot study could refer to different purposes. METHODS: The workshop included formal presentations of participants and moderated discussions. An oral synthesis was carried out by a rapporteur to validate by expert consensus the key points of the discussion and the recommendations. All discussions have been recorded and fully transcribed. DISCUSSION: PHIR generally addresses complex interventions. Thus, numerous tasks may be required to inform the intervention and test different aspects of its design and implementation. While in clinical research the pilot study mainly concerns the preparation of the trial, in PHIR the pilot study focuses on the preparation of both the intervention and the trial. In particular, pilot studies in PHIR could be used for viability evaluation and theory development. RECOMMENDATIONS FROM THE WORKSHOP PARTICIPANTS: The following recommendations were generated by consensus from the workshop discussions: i) terms need to be clarified for PHIR; ii) reporting and publication should be standardized and transparency should be promoted; iii) the objectives and research questions should drive the methods used and be clearly stated; iv) a pilot study is generally needed for complex intervention evaluation and for research-designed programs; and v) for field-designed programs, it is important to integrate evaluability assessments as pilot studies . CONCLUSION: Pilot studies play an important role in intervention development and evaluation. In particular, they contribute to a better understanding of the mechanisms of intervention and the conditions of its applicability and transferability. Pilot studies could therefore facilitate evidence-based decisions about design and conduct of main studies aimed to generate evidence to inform public health policy.

[Adaptation and conditions of use of a health equity tool: The Reflex-ISS tool]. / Adaptation et conditions d'utilisation d'un outil d'analyse des interventions au regard des inégalités sociales de santé.

Although actions to reduce social inequalities in health cannot be considered the exclusive responsibility of public health actors, they should at least make sure their interventions account for these inequalities. However, the actors involved in these interventions have few tools to support them in this process. Therefore, building on a study conducted in France, we have adapted, tested, and developed in Quebec a tool intended to help actors take into account social inequalities in health. The article presents the approach that led to the adaptation of the tool to the Quebec context, to describe the tool, and then to discuss some issues for inclusion in professional practices. A participatory and constructive process between researchers, managers and practitioners led to a useful and useable tool. It is composed of five aspects of intervention (planning, implementation, evaluation, sustainability, and empowerment) and 44 items for discussion presented as questions. A user guide, a glossary, and some practical examples accompany the tool. It follows a reflexive and constructive process wherein a third party facilitator can assist actors involved in an intervention to analyze how they take social inequalities in health into account. This assessment can help generate collective recommendations for improvements, which can be monitored over time, to improve consideration of equity in public health interventions. The article concludes on some issues related to its integration into professional practices.

Area deprivation and attachment to a general practitioner through centralized waiting lists: a cross-sectional study in Quebec, Canada.

BACKGROUND: Access to primary healthcare is an important social determinant of health and having a regular general practitioner (GP) has been shown to improve access. In Canada, socio-economically disadvantaged patients are more likely to be unattached (i.e. not have a regular GP). In the province of Quebec, where over 30% of the population is unattached, centralized waiting lists were implemented to help patients find a GP. Our objectives were to examine the association between social and material deprivation and 1) likelihood of attachment, and 2) wait time for attachment to a GP through centralized waiting lists. METHODS: A cross-sectional study was conducted in five local health networks in Quebec, Canada, using clinical administrative data of patients attached to a GP between June 2013 and May 2015 (n = 24, 958 patients) and patients remaining on the waiting list as of May 2015 (n = 49, 901), using clinical administrative data. Social and material area deprivation indexes were used as proxies for patients' socio-economic status. Multiple regressions were carried out to assess the association between deprivation indexes and 1) likelihood of attachment to a GP and 2) wait time for attachment. Analyses controlled for sex, age, local health network and variables related to health needs. RESULTS: Patients from materially medium, disadvantaged and very disadvantaged areas were underrepresented on the centralized waiting lists, while patients from socially disadvantaged and very disadvantaged areas were overrepresented. Patients from very materially advantaged and advantaged areas were less likely to be attached to a GP than patients from very disadvantaged areas. With the exception of patients from socially disadvantaged areas, all other categories of social deprivation were more likely to be attached to a GP compared to patients from very disadvantaged areas. We found a pro-rich gradient in wait time for attachment to a GP, with patients from more materially advantaged areas waiting less than those from disadvantaged areas. CONCLUSION: Our findings suggest that there are socio-economic inequities in attachment to a GP through centralized waiting lists. Policy makers should take these findings into consideration to adjust centralized waiting list processes to avoid further exacerbation of health inequities.

Family Physicians Attaching New Patients From Centralized Waiting Lists: A Cross-Sectional Study.

PURPOSE: In response to more than 15% of Canadians not having a family physician, 7 provinces have implemented centralized waiting lists for unattached patients. The aim of this study is to analyze the association between family physicians' characteristics and their participation in centralized waiting lists. METHODS: Cross-sectional observational study using administrative data in 5 local health networks in Quebec, between 2013 and 2015. All physicians who had attached at least 1 patient were included (n = 580). Multivariate linear regressions for the number of patients and proportion of vulnerable patients attached per physician were performed. RESULTS: Physicians with more than 20 years of experience represented more than half of those who had participated in the centralized waiting lists and physicians in traditional primary care models represented more than 40%. Physicians' number of years of practice, primary care model, local health network, and the number of physicians participating in the centralized waiting lists per clinic influenced physicians' participation. Physicians with 0 to 4 years of experience and those practicing in network clinics were found to attach more patients. Practicing in a Centre Locaux de Services Communautaires (local community service center) was associated with attaching 19% more vulnerable patients compared with practicing in a Family Medicine Unit (teaching unit). CONCLUSION: Centralized waiting lists seem to be used by early career physicians to build up their patient panels. However, because of the large number of them participating in the centralized waiting lists, physicians with more experience and those practicing in traditional models of primary care might be of interest for future measures to decrease the number of patients waiting for attachment in centralized waiting lists.

[Co-construction of a program to promote community participation among seniors living with psychosocial issues, with or without mental health problems]. / Participe-présent : co-construction d'un programme visant la participation communautaire des aînés qui vivent des difficultés psychosociales.

Objectives A significant proportion of Quebec seniors are living with mental health problems or psychosocial issues such as isolation, bereavement, and psychological distress. These people face many forms of exclusion and are likely to have limited social participation. This paper describes the co-construction steps of a program aimed at promoting community participation among this population.Methods A method for the co-construction of innovative practices in health promotion was used to develop a program that is relevant, rigorous and feasible in diverse settings. The process included several steps, notably: need analysis among seniors and practitioners, development of a logical model for the program, preparation of the leader's manual, validation of the manual by experts, and pilot testing of the program among groups of seniors.Results The goal of the Count me in! program is to promote utilization of the resources of the community that can provide seniors living with mental health conditions or psychosocial issues with activities and positive social contact. The intervention is based on the Strength Model. It includes an individual interview, an eight-meeting workshop, visits to community resources, and collective production of media communication.Conclusion A co-construction process allowed the program to be continuously adjusted in response to stakeholders' feedback. The most important lever for the co-construction was the reconciliation of the partners' practical, conceptual, and experiential expertise. However, contextual factors such as the organization and the availability of mental health services for seniors constituted important barriers to the process.

L'analyse de contribution pour évaluer l'impact de la démarche ÉIS sur les processus décisionnels municipaux : un choix méthodologique intéressant ?

La pertinence de l'évaluation d'impact sur la santé (ÉIS) pour promouvoir le développement de politiques publiques favorables à la santé au sein des municipalités est de plus en plus reconnue. L'appréciation des effets d'une démarche d'ÉIS sur les processus décisionnels d'acteurs municipaux peut toutefois être difficile en raison de la multitude d'influences sociales, économiques, géographiques et personnelles auxquels ils sont soumis. Dans un tel contexte, l'approche évaluative de l'analyse de contribution (AC) s'avère particulièrement intéressante puisqu'elle permet de documenter les facteurs menant à l'efficacité d'une intervention en tenant compte des éléments du contexte. Elle aide l'évaluateur à comprendre comment et pourquoi une intervention fonctionne. Le présent article utilise l'étude de cas pour explorer la faisabilité et l'efficacité de l'AC pour apprécier les effets de démarches d'ÉIS sur le processus décisionnel d'acteurs municipaux. Il décrit les stratégies de collecte et d'analyse de données utilisées auprès de trois municipalités de la Montérégie, au Québec. Cette analyse critique montre que l'AC est pertinente dans le contexte décrit. Elle permet d'établir des associations claires et transparentes entre l'intervention, soit la démarche d'ÉIS, et l'importance accordée à la santé par les acteurs municipaux. Elle assure la prise en compte des facteurs d'influence contextuels et offre la flexibilité nécessaire pour adapter la collecte de données à la réalité du terrain. Néanmoins, la lourdeur de l'approche peut en contraindre l'application et certaines limites méthodologiques ont été observées au niveau de l'analyse des données. Les stratégies mises de l'avant pour y remédier sont décrites.

Attitudes and lifestyle changes following Jog your Mind: results from a multi-factorial community-based program promoting cognitive vitality among seniors.

This study examined the effects on attitudes and lifestyle behavior of Jog your Mind, a multi-factorial community-based program promoting cognitive vitality among seniors with no known cognitive impairment. A quasi-experimental study was conducted. Twenty-three community organizations were assigned either to the experimental group (offering the program) or to the control group (creating a waiting list). They recruited 294 community-dwelling seniors. The aims of the study were to verify the effects of the program on attitudes and behaviors related to cognitive vitality and to explore its effects on cognitive vitality. Data was collected at baseline and after the program. Regression analyses revealed that, following their participation in the program, experimental group participants reported: (i) in terms of attitudes, having a greater feeling of control concerning their cognitive capacities, (ii) in terms of behaviors, using significantly more memory strategies and practicing more physical activity and stimulating activities than control group participants. However, the program had no significant effects on measures of cognitive vitality. This study supports the fact that a multi-factorial community-based program can have significant effects on seniors' attitudes and lifestyle behaviors related to cognitive vitality but at short term, no effects on cognitive vitality it-self were found.

Use of concurrent mixed methods combining concept mapping and focus groups to adapt a health equity tool in Canada.

The aim of this project was to identify and prioritize a set of conditions to be considered for incorporating a health equity tool into public health practice. Concept mapping and focus groups were implemented as complementary methods to investigate the conditions of use of a health equity tool by public health organizations in Quebec. Using a hybrid integrated research design is a richer way to address the complexity of questions emerging from intervention and planning settings. This approach provides a deeper, operational, and contextualized understanding of research results involving different professional and organizational cultures, and thereby supports the decision-making process. Concept mapping served to identify and prioritize in a limited timeframe the conditions to be considered for incorporation into a health equity tool into public health practices. Focus groups then provided a more refined understanding of the barriers, issues, and facilitating factors surrounding the tools adoption, helped distinguish among participants' perspectives based on functional roles and organizational contexts, and clarified some apparently contradictory results from the concept map. The combined use of these two techniques brought the strengths of each approach to bear, thereby overcoming some of the respective limitations of concept mapping and focus groups. This design is appropriate for investigating targets with multiple levels of complexity.

Assessing the performance of centralized waiting lists for patients without a regular family physician using clinical-administrative data.

BACKGROUND: With 4.6 million patients who do not have a regular family physician, Canada performs poorly compared to other OECD countries in terms of attachment to a family physician. To address this issue, several provinces have implemented centralized waiting lists to coordinate supply and demand for attachment to a family physician. Although significant resources are invested in these centralized waiting lists, no studies have measured their performance. In this article, we present a performance assessment of centralized waiting lists for unattached patients implemented in Quebec, Canada. METHODS: We based our approach on the Balanced Scorecard method. A committee of decision-makers, managers, healthcare professionals, and researchers selected five indicators for the performance assessment of centralized waiting lists, including both process and outcome indicators. We analyzed and compared clinical-administrative data from 86 centralized waiting lists (GACOs) located in 14 regions in Quebec, from April 1, 2013, to March 31, 2014. RESULTS: During the study period, although over 150,000 patients were attached to a family physician, new requests resulted in a 30% median increase in patients on waiting lists. An inverse correlation of average strength was found between the rates of patients attached to a family physician and the proportion of vulnerable patients attached to a family physician meaning that as more patients became attached to an FP through GACOs, the proportion of vulnerable patients became smaller (r = -0.31, p < 0.005). The results showed very large performance variations both among GACOs of different regions and among those of a same region for all performance indicators. CONCLUSIONS: Centralized waiting lists for unattached patients in Quebec seem to be achieving their twofold objective of attaching patients to a family physician and giving priority to vulnerable patients. However, the demand for attachment seems to exceed the supply and there appears to be a tension between giving priority to vulnerable patients and attaching of a large number of patients. Results also showed heterogeneity in the performance of centralized waiting lists across Quebec. Finally, our findings suggest it is critical that similar mechanisms should use available data to identify the best strategies for reducing variations and improving performance.

Evaluation of the effects of health impact assessment practice at the local level in Monteregie.

BACKGROUND: In Quebec (Canada), the Monteregie Regional Public Health Department has chosen to use health impact assessment (HIA) to support municipalities through a knowledge exchange and collaborative process in order to positively influence decision-making regarding local policies and projects. The value of HIA is becoming increasingly recognized by municipalities interested in planning and managing their cities with an eco-systemic perspective. However, the knowledge and tools which support the use of the HIA at regional and local levels are still missing. METHODS: The general objective is to evaluate the impact the collaborative HIA process used in Monteregie has had on the formulation, adoption and implementation of policies and projects favourable to health. The methodology is based on Mayne's CA design, which allows the identification of factors which contribute to a change process. It is described as one of the best approaches to reduce uncertainty regarding the observed results and the contribution of a program. All of the HIA processes realised between January 2013 and January 2016 in Monteregie will be studied following a case study strategy. Study populations include regional and local public health professionals, municipal officers and community members implicated in these HIAs. Various qualitative and quantitative methods will be used, including examination of documentation, observations on the city grounds, and individual or group interviews. A model of change will be constructed for each HIA process and will present the logical pathway which leads to the observed results, alternative explanations and hypothesises as to why these results were obtained, and contextual factors that could have influenced them. This model will allow the production of a refined contribution story for each HIA. A convergence and divergence analysis will be completed in order to identify differences or similitudes between the different HIAs studied. DISCUSSION: In addition to contributing to the production of knowledge in relation to the collaborative model of HIA, this research project will allow other regional and local public health actors and municipalities of Quebec or other decision-making and political bodies to understand the usefulness of this approach for the improvement of population health and well-being.

Jog Your Mind: methodology and challenges of conducting evaluative research in partnership with community organizations.

BACKGROUND: Jog Your Mind is a community-based program aiming at empowering elderly people to maintain their cognitive abilities using a multi-strategic approach including cognitively stimulating activities, mnemonic strategies, and strategies to promote healthy behaviors. It is offered to elderly individuals without known or diagnosed cognitive impairment by volunteers or community practitioners over ten weekly sessions. This paper describes the protocol of a quasi-experimental study designed to evaluate Jog Your Mind. METHODS: Community responsible to recruit participants were either assigned to the experimental group (participating in the Jog Your Mind program) or to the control group (one-year waiting list). All participants were interviewed at baseline (T1), after the program (T2), and 12 months after the baseline (T3). Primary outcomes were the use of everyday memory strategies and aids and subjective memory functioning in daily life. Secondary outcomes included attitudes, knowledge, and behaviors related to cognitive vitality and cognitive abilities (memory and executive functions). Program delivery, organizational and environmental variables were recorded to document the implementation process. RESULTS: Twenty-three community organizations recruited 294 community-dwelling elderly individuals in total at T1. Between T1 and T3, an attrition rate of 15.2% was obtained. CONCLUSIONS: Jog Your Mind is one of the only programs targeting cognition among older adults being offered in community settings by community practitioners. The protocol described was designed with a focus on maximizing broad generalizations of the results while achieving scientific rigor. It can serve as an example to guide future research aiming to evaluate health interventions under natural conditions.

Evaluation of the implementation of centralized waiting lists for patients without a family physician and their effects across the province of Quebec.

BACKGROUND: Most national and provincial commissions on healthcare services in Canada over the past decade have recommended that primary care services be strengthened in order to guarantee each citizen access to a family physician. Despite these recommendations, finding a family physician continues to be problematic. The issue of enrollment with a family physician is worrying in Canada, where nearly 21% of the country's population reported not having a family physician in the last Commonwealth Fund survey.To respond to this important need, centralized waiting lists have been implemented in four Canadian provinces to help 'orphan,' or unaffiliated, patients find a family physician. These organizational mechanisms are intended to better coordinate the demand for and supply of family physicians. The objectives of this study are: to assess the effects of centralized waiting lists for orphan patients (GACOs) implemented in the province of Quebec and to explain the variation among their effects by analyzing factors influencing implementation process. METHODS: This study is based on two complementary and sequential research strategies. The first (objective 1) is a quantitative longitudinal design to assess the effects of all the GACOs (n = 93) in Quebec using clinical-administrative data. The second (objective 2) involves using four case studies to explain variations in effects through in-depth analysis of the various factors contributing to the observed effects. The primary source of data will be key actors involved in the GACOs. We expect to conduct around 40 semi-structured interviews. DISCUSSION: This will be the first study in Canada to evaluate the implementation of this innovation. It will provide an exhaustive picture of the effects of GACO implementation in Quebec and to assess their potential for generalization elsewhere in Canada. At the theoretical level, this study will produce new knowledge on the factors having the greatest influence on the implementation of primary care innovations in professional environments.

[Specialized mental health services for the elderly: a pilot study of the evaluation process]. / Services spécialisés en santé mentale pour les personnes de 60 ans et plus. Étude pilote de l'évaluation du processus.

In Quebec, the Centre de santé et services sociaux (CSSS) Cavendish offers specialized services for the elderly with mental health problems (SSSM 60+) (Nour et al., 2011a). This article describes a targeted segment of the population reached (considering the exclusion criteria, only 50% of the elderly receiving services from the SSSM 60+ were followed). The article presents the model of individual changes relating to services, and explores the psychosocial mediators that influence the efficiency of services. This population experiences various psychosocial problems, the most important being mild to moderate symptoms of depression. Services and interventions by the SSSM 60+ team appear to increase significantly the therapeutic alliance and the feeling of empowerment in this clientele. Prioritizing these two concepts during service delivery appears to be an avenue to consider.

[An ecological perspective on the determinants of the cognitive vitality of seniors]. / Perspective écologique sur les déterminants de la vitalité cognitive des aînés.

Cognitive aging is a heterogeneous reality among the senior population. Studies have recently identified certain factors that may contribute to maintaining the cognitive health of seniors. To date, these research studies have primarily focused on individual determinants, namely: health conditions and lifestyle habits. A review of the literature was conducted in order to explore the socio-environmental factors that may influence the cognitive vitality of seniors. This review demonstrates that studies that have examined this potential link are very rare. Only the type and socioeconomic level of the neighbourhood of the residence, as well as the size of the social network, were identified as influential factors. However, studies have shown that the environment could modulate certain lifestyle habits which, in turn, can influence cognition. This article uses an ecological approach to illustrate individual and socio-environmental targets for the promotion of the cognitive health of seniors.

The role of social reinforcement in the maintenance of short-term effects after a self-management intervention for frail housebound seniors with arthritis.

Following the program I'm Taking Charge of My Arthritis!, study participants reported fewer functional limitations, less helplessness, and better coping effectiveness than did controls. This study examined the maintenance of these effects and the role of social reinforcement in maintaining benefits eight months post-intervention. The study collected information (1) at baseline (n=125); (2) two months later, before randomization (pre-intervention); (3) two months post-randomization (post-intervention 1); and (4) ten months post-randomization (post-intervention 2) (n=80). We conducted a randomized controlled trial comparing three groups: a control group, intervention group without social reinforcement, and intervention group with social reinforcement after the program. A multilevel analysis revealed that intervention participants with social reinforcement following the program continued to report significantly fewer functional limitations and greater coping effectiveness compared to intervention group participants without social reinforcement. This research provides preliminary evidence for the value of additional contact with frail housebound seniors post-intervention for maintaining the intervention benefits.

[Palliative care practices at home: instead of social exclusion of older people in later life?]. / Les pratiques de soins palliatifs à domicile: lieu d'exclusion sociale des personnes âgées en fin de vie?

The understanding of palliative care practices at home (PCH) is limited by the lack of available scientific knowledge. This is explained by the fact that its practices are relatively recent and they question our relationship with death and dying individuals. This study aims to contribute to the advancement of knowledge about PCH with the elderly. More specifically, with a perspective of social exclusion, it aims to understand how practices either do or do not produce social exclusion with seniors receiving palliative care. Nineteen participants from two local community services centers were interviewed and six multidisciplinary meetings were attended for observation. This study suggests that positive representations concerning the elderly in palliative care and recognition of their autonomy can avoid social exclusion, including its symbolic and identificatory dimensions. However, standardization of practices seems to contribute to institutional exclusion and foster nonrecognition.

[The Projet PIE: a promising strategy to reach elders with a mental health problem]. / Le Projet PIE : une stratégie prometteuse de dépistage des aînés qui présentent des problèmes de santé mentale.

Approximately fifty percent of older adults with a mental health problem do not receive services. A proactive outreach strategy, Project PIE (Prevention-Intervention-Education) relies upon the assistance of non-traditional referral sources, namely community liaisons, to identify and refer to the CSSS vulnerable or isolated elders with a mental health problem. An evaluation of this project reveals encouraging results. The project appears useful, relevant and efficient to detect elders with a mental health problem and offer the required assistance. This project also appears to be a means to foster social solidarity.