Effectiveness of a Grief Intervention for Caregivers of People With Dementia.

In this article, we report on the structure and effectiveness of a grief management coaching intervention with caregivers of individuals with dementia. The intervention was informed by Marwit and Meuser's Caregiver Grief Model and considered levels of grief, sense of empowerment, coping, and resilience using five methods of delivery. Results indicate that the intervention had significant positive effects on caregivers' levels of grief and increased their levels of empowerment, coping, and resilience. The intervention was found to be effective across caregivers' characteristics as well as across five delivery modalities. Through description of this intervention, as well as outcome, this research contributes to the body of knowledge about caregivers' disenfranchised grief and ways to effectively address it.

Together but apart: Caring for a spouse with dementia resident in a care facility.

This longitudinal, exploratory study was designed to better understand the lived experience of spousal caregivers age 60 and older providing care to partners with Alzheimer's disease and related dementias resident in a care facility. Twenty eight spousal caregivers were interviewed up to three times over a period of 2 years, and long-term care facility staff from four locations across British Columbia (BC), Canada participated in four focus groups. Thematic analysis of interview and focus group transcripts revealed a central, unifying theme 'together but apart'. The results identify key targets for policy makers and service providers to support positive health and well-being outcomes for spousal caregivers providing care to their partners diagnosed with Alzheimer's disease and related dementia and living in care facilities.

Marginal competence, risk assessment, and care decisions: a comparison of values of health care professionals and older adults.

Using a case scenario involving a marginally competent elderly woman living alone at risk, we assessed the care decisions made by older adults (n = 82) and health care professionals (HCPs, n = 87), and identified differences in the values underlying the care decisions. Overall, participants did not place a high value on independence when they appraised the risk to the client as high and safety as low. Under these conditions, elderly respondents tended to be more paternalistic in their decisions about care, while HCPs tended to be more beneficient. If the values of HCPs differ from those of elderly people, how likely is it that the care provided to marginally competent elderly people will be congruent with their wishes? The care provided by HCPs might be improved by incorporating knowledge of the values and perspectives of other older adults.

Developing a national consensus on the accessibility needs of older adults with concurrent and chronic, mental and physical health issues: a preliminary framework informing collaborative mental health care planning.

Canada faces a significant challenge in meeting the health care needs of older adults with complex mental and physical health issues. Studies have shown collaborative mental health services to effectively address the diverse health needs of this group. However, an often overlooked yet important aspect of service delivery planning for this population is to ensure that older adults are sufficiently able to access available best-practice services. The article reports on a national consensus-building exercise conducted by the Collaborative Mental Health Initiative-Seniors Working Group to develop a nationally informed framework on the accessibility needs of older adults as they relate to collaborative mental health care. The framework is intended to provide planners, administrators, and providers with an understanding of the unique accessibility needs of older adults across three priority pillars (personal, caregiver, systemic) and to enable them to embed strategies to address these issues within field-based collaborative mental health initiatives.

Promoting a cultural shift and a system change to respond to agitated and excessive behaviours (REAB).

The Responding to Excessive & Agitated Behaviour (REAB) Program was designedas a system change model to create a healthy work culture and to promote quality, client-centered care. It is a unique program that has integrated best clinical practices with workplace safety policy and criteria promoting continuous assessment ofa facility's ability to meet the requirements of the REAB model. Funding was received from the BC Nursing Directorate. Key clinical and work health leaders in a large BC health authority were supportive of this initiative. Phase I began in 2004 with a review of the literature and environmental scans leading to the development of the REAB model. The model contains ten elements which if addressed promotes the best in clinical practice and working conditions. In Phase II benchmarking data were collected and the REAB process was trialed in fifteen facilities. The findings and the model were validated by a variety of representatives from practice and industry in a one day forum. Phase III was the development of a resource toolkit to guide the implementation process and contained supportive resources. Phase IV, now in progress, consists ofan orientation to the toolkit and access to a facilitator who assists agencies in identifying their own gaps in relation to the model, as wellas guides the implementation of a viable and sustainable plan for improvement. This paper reviews the evolution and the development of this project so that others may incorporate its methodology and resources into their own facility.

Development of a Seniors' Mental Health Policy Lens: an analytical tool to assess policies and programs from a seniors' mental health perspective.

The Seniors Mental Health Policy Lens (SMHPL) is an analytical tool developed to identify unintended negative effects of current and planned policies, programs, and practices on seniors' mental health. It is designed (a) to promote social environments, including health services, supportive of older adults' mental health, and (b) to help ensure that the way mental health services are defined, delivered, and funded will result in increased emphasis on mental health promotion and on the prevention of mental health problems. The SMHPL incorporates Canadian seniors' perspectives on the factors influencing their mental health, and reflects the values of older adults.

Factors affecting the mental health of older adults in rural and urban communities: an exploration.

Stakeholders in rural and mid-size urban communities were asked to share their views concerning factors that affect the mental health of older adults, and indicate how, and how well, these factors were addressed in their community. The identified factors clustered into six categories: clinical, physical, organizational, educational, psychosocial, and spiritual. Additional factors impacting care providers and caregivers and their ability to support the mental health of older adults also emerged. Similarities and distinct differences between rural and urban communities were reported and call for innovative strategies to meet the needs of seniors, particularly those living in rural areas.