The Perpetual Pivot: Understanding Care Partner Experiences in Ontario Long-Term Care Homes during the COVID-19 Pandemic.

Long-term care homes (LTCHs) were impacted during the COVID-19 pandemic. With their ever-changing conditions and restrictions, care partners' roles in LTCHs changed drastically. In this cross-sectional study, an electronic survey was used to examine the experiences of care part-ners who were caring for one or more adults in an Ontario LTCH during the pandemic. The survey was circulated through social media (convenience sample) which produced a convenience sample of 81 caregiver participants. Visit characteristics and a comparison in the quality of care in LTCHs was analyzed before the pandemic as well as during the most restrictive times. Visitation lengths and frequencies, other sources of communication such as phone and video calls, and various types of care provided by caregivers such as personal grooming and personal care all decreased significantly during the pandemic. Care partners also reported that the health of their care recipients decreased significantly during restrictive visitation times. Through thematic analysis, we identified three themes: restrictions and changing LTCH conditions created (1) social isolation and an erosion of connection, (2) a communication breakdown, and (3) a lack of person-centered care. Findings from this research can promote the health and wellbeing of residents and care partners within LTCHs.

Are Age-Friendly Communities "Friendly" for All? Perspectives from LGBTQ2S+ Communities.

Age-friendly initiatives have grown in popularity in their efforts to promote active aging among older adults in Canada and other countries worldwide. However, these initiatives often overlook underrepresented populations, such as lesbian, gay, bisexual, trans, queer, and two-spirit (LGBTQ2S+) older adults, who have unique social and historical contexts which impact their aging experiences. The study involved a survey and key-informant interviews with local leaders, volunteers, staff, and/or LGBTQ2S+ older adults involved in initiatives that were both age and LGBTQ2S+ friendly to explore what it means for a community to be age and LGBTQ2S+ friendly and learn what can further be done to promote these communities. Through a qualitative template analysis, our findings suggest that safety within the social environment should be at the forefront of age-friendly policy initiatives. Considerations and avenues to create this safety and an overall culture of acceptance for all older adults include recognizing generational differences among aging cohorts, increasing LGBTQ2S+ visibility and involvement and highlighting the importance of policy and cultural humility. These considerations and the voices of LGBTQ2S+ older adults need to be integrated into age-friendly community planning and policies to ensure they are inclusive and that all older adults feel safe and can thrive within their communities.

The power of story: Bringing 2SLGBTQ+ digital stories into gerontology settings.

Two-spirit, lesbian, gay, bisexual, trans, and queer or questioning (2SLGBTQ+) older adults are underrepresented in gerontology research and education, impacting the preparedness of health and social care students and professionals working with the diverse aging population. To address this lack of representation of 2SLGBTQ+ older adults in gerontology education, this study explored the use of digital stories as tools for knowledge mobilization and social justice. Digital stories are short videos that pair audio recordings with visuals, including videos, photographs, or artwork. To conduct the study, the research team worked alongside 2SLGBTQ+ older adults to create a suite of three digital stories. These stories were presented at various educational and professional settings in gerontology, and survey and open-feedback responses (n = 147) were gathered from the audience on their perceived impact. Viewers included students, researchers, decision-makers, stakeholders, and citizens. Content analysis was used to analyze the data. From the analysis, digital stories showed the potential to increase viewers' awareness and understanding of 2SLGBTQ+ aging experiences. The format was particularly significant in their learning and enhancing the connection to the content and the storytellers. The findings also suggest that digital stories showed the potential to impact policy and practice for 2SLGBTQ+ communities.

LGBTQ+ Aging Research in Canada: A 30-Year Scoping Review of the Literature.

Canada has a unique socio-political history concerning the inclusion of lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people. With aging populations, understanding diverse groups of older adults is paramount. We completed a systematic search and scoping review of research in Canada to quantify and articulate the scale and scope of research on LGBTQ+ aging. Our search identified over 4000 results and, after screening for relevance, our review focused on 70 articles. Five major themes in the literature on LGBTQ+ aging in Canada were identified: (1) risk, (2) HIV, (3) stigma, and discrimination as barriers to care, (4) navigating care and identity, (5) documenting the history and changing policy landscapes. Most of the articles were not focused on the aging, yet the findings are relevant when considering the lived experiences of current older adults within LGBTQ+ communities. Advancing the evidence on LGBTQ+ aging involves improving the quality of life and aging experiences for LGBTQ+ older adults through research.

"We Are Resilient, We Made It to This Point": A Study of the Lived Experiences of Older LGBTQ2S+ Canadians.

Promoting health and well-being for older adults is a priority among many jurisdictions worldwide. Canada's population is aging and becoming increasingly diverse; one axis of a diverse aging population is aging members of lesbian, gay, bisexual, transgender, queer, and two-spirit (LGBTQ2S+) communities. We sought to examine the lived experiences of older LGBTQ2S+ people in Canada to understand the barriers and facilitators to healthy aging among members of these communities. A total of 10 focus groups were held in 10 cities from across Canada. Sixty-one older LGBTQ2S+ people (Mean age = 67) participated in the study. Data were analyzed using a constructivist grounded theory approach. Through analysis, we identified themes related to the importance of community capacity, resources, resilience, and personal histories in shaping aging experiences. The findings highlight the importance acknowledging diverse sexual and gender identities and the role of the life course in developing and implementing approaches that promote healthy aging.

La nécessité des approches interdisciplinaires et collaboratives pour évaluer l'impact de la COVID-19 sur les personnes âgées et le vieillissement: déclaration conjointe de l'ACG / CAG et de la RCV / CJA.

La pandémie de la COVID-19 et l'état d'urgence publique qui en a découlé ont eu des répercussions significatives sur les personnes âgées au Canada et à travers le monde. Il est impératif que le domaine de la gérontologie réponde efficacement à cette situation. Dans la présente déclaration, les membres du conseil d'administration de l'Association canadienne de gérontologie/Canadian Association on Gerontology (ACG/CAG) et ceux du comité de rédaction de La Revue canadienne du vieillissement/Canadian Journal on Aging (RCV/CJA) reconnaissent la contribution des membres de l'ACG/CAG et des lecteurs de la RCV/CJA. Les auteurs exposent les voies complexes par lesquelles la COVID-19 affecte les personnes âgées, allant du niveau individuel au niveau populationnel. Ils préconisent une approche impliquant des équipes collaboratives pluridisciplinaires, regroupant divers champs de compétences, et différentes perspectives et méthodes d'évaluation de l'impact de la COVID-19.

Differential Effects of Social Support by Sexual Orientation: A Study of Depression Symptoms Among Older Canadians in the CLSA.

This study examined differences in symptoms of mental illness, specifically depression, by sexual orientation and examined the protective role of social support among lesbian, gay, and bisexual (LGB) older Canadians. Data were drawn from the Canadian Longitudinal Study on Aging, a national study of adults aged 45-85 years at baseline (n = 46,157). We examined whether the effect of sexual orientation on depression symptoms was moderated by four types of social support: emotional/informational support, affectionate support, tangible support, and positive social interaction. LGB identification was associated with increased depression symptoms relative to heterosexual participants. After adjustment for covariates, bisexual identity remained a significant predictor of depression symptoms. Low emotional/informational social support was associated with increased depression symptoms, an effect that was most pronounced for lesbian and gay participants. The findings contribute to the growing body of research on the mental health of older LGB people.

Interdisciplinary and Collaborative Approaches Needed to Determine Impact of COVID-19 on Older Adults and Aging: CAG/ACG and CJA/RCV Joint Statement.

The COVID-19 pandemic and subsequent state of public emergency have significantly affected older adults in Canada and worldwide. It is imperative that the gerontological response be efficient and effective. In this statement, the board members of the Canadian Association on Gerontology/L'Association canadienne de gérontologie (CAG/ACG) and the Canadian Journal on Aging/La revue canadienne du vieillissement (CJA/RCV) acknowledge the contributions of CAG/ACG members and CJA/RCV readers. We also profile the complex ways that COVID-19 is affecting older adults, from individual to population levels, and advocate for the adoption of multidisciplinary collaborative teams to bring together different perspectives, areas of expertise, and methods of evaluation in the COVID-19 response.

"We Live in a Wonderful Country, Canada, but ": Perspectives From Older LGBTQ Ontarians on Visibility, Connection, and Power in Care and Community.

This research investigated the health and aging experiences of 21 lesbian, gay, bisexual, trans, and queer (LGBTQ) adults, aged 60 to 79 years, to identify their service and support needs. Participants engaged in focus groups in four locations in Ontario, Canada. Data were analyzed using inductive thematic approach. Participants anticipated age-related losses and expected a greater use of and dependence on health/social care services. Despite greater LGBTQ visibility and inclusive care, participants perceived care services and facilities as unsafe and without competent support. Participants described employing positive strategies to overcome discrimination, contributing to participants' health and aging experiences.

Canadians Who Care: Social Networks and Informal Caregiving Among Lesbian, Gay, and Bisexual Older Adults in the Canadian Longitudinal Study on Aging.

Canada is experiencing population aging and evidence on the provision of care is based on data collected from majority populations. This analysis compared social networks and patterns of care provision between heterosexual and lesbian, gay, and bisexual (LGB) Canadians between the age of 45 and 85 years. Data were drawn from the Canadian Longitudinal Study on Aging (CLSA), a large national study of health and aging. The results from analysis of baseline data showed that LGB participants were less likely to have children and reported seeing their friends more recently than heterosexual participants. Gay and bisexual men were more likely to provide care support in comparison to heterosexual men. LGB participants were more likely to provide care to friends. The results highlight the importance of considering distinct social networks in the development of policy and practice approaches to support a diverse aging population.

Meaning-Centered Men's Groups: Initial Findings of an Intervention to Enhance Resiliency and Reduce Suicide Risk in Men Facing Retirement.

Objectives: To assess the preliminary effectiveness of Meaning-Centered Men's Groups (MCMG), a 12-session existentially-oriented, community-based, psychological group intervention designed to enhance psychological resiliency and prevent the onset or exacerbation of suicide ideation among men who are concerned about or struggling with the transition to retirement.Methods: We recruited 30 men (n= 10 per group), 55 years and older (M= 63.7, SD= 4.1) from community settings to participate in a course of MCMG to be delivered in a community center. Participants completed eligibility, pre-, mid-, and post-group assessments of suicide ideation and psychological risk and resiliency factors.Results: Participants experienced significant increases in attitudinal sources of meaning in life, psychological well-being, life satisfaction, retirement satisfaction, and general health, and decreases in depression, hopelessness, loneliness, and suicide ideation.Conclusions: Preliminary findings suggest that MCMG is a novel men's mental health intervention that may help to enhance psychological well-being and potentially reduce the severity or prevent the onset of symptoms of depression, hopelessness, and suicide ideation.Clinical Implications: Upstream psychological interventions may serve an important role in mental health promotion and suicide prevention with potentially vulnerable individuals facing challenging life transitions.

Care and LGBT Aging in Canada: A Focus Group Study on the Educational Gaps among Care Workers.

OBJECTIVES: Educational interventions have the potential to equip healthcare providers to support diverse aging populations. The purpose of this research was to identify educational gaps hindering the provision of person-centered care to older adults who identify as LGBT. METHODS: Three focus groups were conducted in urban centers in northern, southern, and eastern Ontario with healthcare professionals and frontline staff. Semi-structured focus group discussion guides were developed based on the literature identifying some of the knowledge gaps, attitudes, challenges, and barriers around providing care for older LGBT adults. RESULTS: The focus group data revealed several key findings related to 1) lack of curricula within formal education; 2) the need to create safer physical and social environments; and 3) the need to build relationships with LGBT-focused groups/organizations. CONCLUSIONS: Care providers want to provide open space for sexual and gender diverse older adults but lack the knowledge to do so. CLINICAL IMPLICATIONS: There is an ongoing gap within formal education systems such that historically marginalized populations who are now aging may be systemically neglected within formal curricula.

Dying in Long-Term Care: Perspectives from Sexual and Gender Minority Older Adults about Their Fears and Hopes for End of Life.

As lesbian, gay, bisexual, transgender, and queer (LGBTQ+) communities age, many individuals expect a need to enter the long-term care system toward the end of life. Not unlike most aging Canadians, this anticipation is met with concern and fear. However, previous research suggests that older LGBTQ + individuals have unique fears often related to personal safety and discrimination. This qualitative study examined the hopes and fears of older LGBTQ + adults considering long-term care as they face end of life. Data were collected from three focus groups in Ontario, Canada, and analyzed using inductive thematic analysis. Specific and frequent reference to fear of entering long-term care homes was common across all focus groups, as participants anticipated: social isolation, decreased independence and capacity for decision-making, increased vulnerability to LGBTQ+-related stigma as well as exposure to unsafe social and physical environments. The results from this study, therefore, emphasize the need for palliative care specialists and long-term care home staff to address the unique health needs of older LGBTQ + adults nearing the end of life in order to work toward allaying fears and creating supportive and inclusive long-term care environments.

Physical and mental health inequalities among aging lesbian, gay, and bisexual Canadians: cross-sectional results from the Canadian Longitudinal Study on Aging (CLSA).

OBJECTIVE: International estimates suggest the presence of health inequalities among older sexual minorities (i.e., individuals who identify as lesbian, gay, or bisexual and are 65 years old or above). In this study, we investigated the presence of health inequalities among aging lesbian and bisexual females, as well as aging gay and bisexual males in Canada. METHODS: We used baseline data from the Canadian Longitudinal Study on Aging (CLSA) Tracking and Comprehensive cohorts to cross-sectionally compare self-reported physical and mental health indicators by sex and sexual orientation. Within our analysis sample of 51,208 Canadians 45 years old and over, 2% (n = 1057) of respondents identified as lesbian, gay, or bisexual. RESULTS: Compared to heterosexual female peers, lesbian and bisexual females had greater odds of heavy drinking (AOR = 1.8, 95% CI = 1.3-2.4) and being a former smoker (AOR = 1.5, 95% CI = 1.2-1.9). Gay and bisexual males had greater odds of reporting a diagnosis of cancer (AOR = 1.5, 95% CI = 1.0-1.9) and currently smoking (AOR = 1.5, 95% CI = 1.1-2.0), compared to heterosexual males. Female and male sexual minorities had greater odds of reporting mood disorders (including depression) and anxiety disorders relative to heterosexual peers of the same sex. CONCLUSION: These findings highlight the importance of considering both sex and sexual orientation when developing approaches to support the physical and mental health of a diverse aging population in Canada.

Staying Out of the Closet: LGBT Older Adults' Hopes and Fears in Considering End-of-Life.

Canada is experiencing population aging, and given the heterogeneity of older adults, there is increasing diversity in late life. The purpose of this study was to help fill the research gaps on LGBT aging and end-of-life. Through focus groups, we sought to better understand the lived experience of older LGBT individuals and to examine their concerns associated with end-of-life. Our analysis highlights the idea that identifying as LGBT matters when it comes to aging and end-of-life care. In particular, gender identity and sexual orientation matter when it comes to social connections, in the expectations individuals have for their own care, and in the unique fear related to staying out of the closet and maintaining identity throughout aging and end-of-life. This study underscores the need to consider gender identity and sexual orientation at end-of-life. In particular, recognition of intersectionality and social locations is crucial to facilitating positive aging experiences and end-of-life care.

Family caregiver support groups: spiritual reflections' impact on stress management.

OBJECTIVES: Caregiving for people with neurodegenerative disease (e.g. Alzheimer's disease (AD); frontotemporal dementia (FTD)) is provided primarily by the family care system. Caregiving is taxing and much of the caregiving research is guided by a stress/adaptation theoretical perspective. Within this theoretical model, the role of spirituality in rendering meaning to the caregiver role remains unexplored. We conducted a qualitative analysis of expressions of spirituality and its meaningfulness during the caregiving journey within the context of an online video conferencing support group intervention program. METHODS: Eighteen AD and six FTD caregivers participated in the Caring for Others evidence-based program consisting of 10 weekly virtual online support group sessions facilitated by experienced gerontological social workers. RESULTS: Content analysis of the video-recorded group interactions yielded recurrent themes of caregivers' spiritual reflections and their associations with managing caregiver stress responses. CONCLUSION: The findings inform professional observations of the importance of spiritual beliefs in understanding how caregivers ascribe both positive and negative meanings to critical life events and their management.

Healthcare and End-of-Life Needs of Lesbian, Gay, Bisexual, and Transgender (LGBT) Older Adults: A Scoping Review.

Lesbian, gay, bisexual, and transgender (LGBT) older adults face a number of challenges with respect to access to healthcare especially towards end-of-life. Through a systematic search and scoping review of the literature, we sought to answer two related research questions. In particular, the purpose of this scoping review was to determine the healthcare needs of LGBT older adults nearing end-of-life as well as the factors that contribute to a good death experience among older adults who identify as LGBT. A systematic search of electronic databases for articles published between 2005 and 2016 as well as screening for relevance resulted in 25 results. The data were charted and grouped according to the themes of: social support and chosen family, intimacy, health status, fear of discrimination and lack of trust, lack of knowledge and preparedness, and cultural competence in the healthcare system. The results suggest a role for health and social service workers in contributing to a positive care experience for LGBT older adults by becoming knowledgeable about the unique needs of this population and being unassuming and accepting of individuals' sexuality. Many of the articles reviewed collected data outside of Canada, limiting generalizability and highlighting a need for Canadian data on LGBT aging and end-of-life.

Elevated Hospitalization Risk of Assisted Living Residents With Dementia in Alberta, Canada.

OBJECTIVES: Assisted living (AL) is an increasingly used residential option for older adults with dementia; however, lower staffing rates and service availability raise concerns that such residents may be at increased risk for adverse outcomes. Our objectives were to determine the incidence of hospitalization over 1 year for dementia residents of designated AL (DAL) facilities, compared with long-term care (LTC) facilities, and identify resident- and facility-level predictors of hospitalization among DAL residents. METHODS: Participants were 609 DAL (mean age 85.7 ± 6.6 years) and 691 LTC (86.4 ± 6.9 years) residents with dementia enrolled in the Alberta Continuing Care Epidemiological Studies. Research nurses completed a standardized comprehensive assessment of residents and interviewed family caregivers at baseline (2006-2008) and 1 year later. Standardized administrator interviews provided facility level data. Hospitalization was determined via linkage with the provincial Inpatient Discharge Abstract Database. Multivariable Cox proportional hazards models were used to identify predictors of hospitalization. RESULTS: The cumulative annual incidence of hospitalization was 38.6% (34.5%-42.7%) for DAL and 10.3% (8.0%-12.6%) for LTC residents with dementia. A significantly increased risk for hospitalization was observed for DAL residents aged 90+ years, with poor social relationships, less severe cognitive impairment, greater health instability, fatigue, high medication use (11+ medications), and 2+ hospitalizations in the preceding year. Residents from DAL facilities with a smaller number of spaces, no chain affiliation, and from specific health regions showed a higher risk of hospitalization. CONCLUSIONS: DAL residents with dementia had a hospitalization rate almost 4-fold higher than LTC residents with dementia. Our findings raise questions about the ability of some AL facilities to adequately address the needs of cognitively impaired residents and highlight potential clinical, social, and policy areas for targeted interventions to reduce hospitalization risk.

Pharmacological treatments for neuropsychiatric symptoms of dementia in long-term care: a systematic review.

BACKGROUND: Medications are frequently prescribed for neuropsychiatric symptoms (NPS) associated with dementia, although information on the efficacy and safety of medications for NPS specifically in long-term care (LTC) settings is limited. The objective of this study was to provide a current review of the efficacy and safety of pharmacological treatments for NPS in LTC. METHODS: We searched MEDLINE, EMBASE, PsychINFO, and the Cochrane Library for randomized controlled trials comparing medications with either placebo or other interventions in LTC. Study quality was described using the Cochrane collaboration risk of bias tool. The efficacy of medications was evaluated using NPS symptom rating scales. Safety was evaluated through rates of trial withdrawals, trial withdrawals due to adverse events, and mortality. RESULTS: A total of 29 studies met inclusion criteria. The most common medications evaluated in studies were atypical antipsychotics (N = 15), typical antipsychotics (N = 7), anticonvulsants (N = 4), and cholinesterase inhibitors (N = 3). Statistically significant improvements in NPS were noted in some studies evaluating risperidone, olanzapine, and single studies of aripiprazole, carbamazepine, estrogen, cyproterone, propranolol, and prazosin. Study quality was difficult to rate in many cases due to incomplete reporting of details. Some studies reported higher rates of trial withdrawals, adverse events, and mortality associated with medications. CONCLUSIONS: We conclude that there is limited evidence to support the use of some atypical antipsychotics and other medications for NPS in LTC populations. However, the generally modest efficacy and risks of adverse events highlight the need for the development of safe and effective pharmacological and non-pharmacological interventions for this population.

Efficacy and feasibility of nonpharmacological interventions for neuropsychiatric symptoms of dementia in long term care: a systematic review.

BACKGROUND: Nonpharmacological therapies are often recommended as a first-line treatment for neuropsychiatric symptoms (NPS) of dementia in long term care (LTC); however, little is known about which nonpharmacological interventions are most effective for NPS in LTC or the feasibility of interventions, given the availability of resources in typical LTC environments. METHODS: We searched the electronic databases MEDLINE, EMBASE, PsychINFO (1980-2010), the Cochrane Library, and Google Scholar using keywords and medical subject headings for randomized, controlled trials evaluating nonpharmacological interventions for NPS conducted in LTC settings. Change in severity of NPS symptoms was evaluated through the NPS outcomes measures reported in studies. We assessed study quality and described the feasibility of interventions based on various aspects of study design. RESULTS: A total of 40 studies met inclusion criteria. Sixteen (40%) of 40 included studies reported statistically significant results in favor of nonpharmacological interventions on at least one measure of NPS. These interventions included staff training in NPS management strategies, mental health consultation and treatment planning, exercise, recreational activities, and music therapy or other forms of sensory stimulation. Many of the studies had methodological limitations that placed them at potential risk of bias. Most interventions (n = 30, 75%) required significant resources from services outside of LTC or significant time commitments from LTC nursing staff for implementation. CONCLUSIONS: There are several nonpharmacological interventions that may be effective for NPS in LTC, although there are a limited number of large-scale, high-quality studies in this area. The feasibility of some interventions will be limited in many LTC settings and further research into practical and sustainable interventions for NPS in LTC is required to improve usage of these important treatments.