Implementing advance care planning in palliative and end of life care: a scoping review of community nursing perspectives.

BACKGROUND: Advance care planninganning (ACP) is a priority within palliative care service provision. Nurses working in the community occupy an opportune role to engage with families and patients in ACP. Carers and family members of palliative patients often find ACP discussions difficult to initiate. However, community nurses caring for palliative patients can encourage these discussions, utilising the rapport and relationships they have already built with patients and families. Despite this potential, implementation barriers and facilitators continue to exist. To date, no research synthesis has captured the challenges community nurses face when implementing ACP, nor the facilitators of community nurse-led ACP. Considering this, the review question of: 'What factors contribute to or hinder ACP discussion for nurses when providing care to palliative patients?' was explored. METHOD: To capture challenges and facilitators, a global qualitative scoping review was undertaken in June 2023. The Arksey and O'Malley framework for scoping reviews guided the review methodology. Six databases were searched identifying 333 records: CINAHL (16), MEDLINE (45), PUBMED (195), EMBASE (30), BJOCN (15), IJOPN (32). After de-duplication and title and abstract screening, 108 records remained. These were downloaded, hand searched (adding 5 articles) and subject to a full read. 98 were rejected, leaving a selected dataset of 15 articles. Data extracted into a data extraction chart were thematically analysed. RESULTS: Three key themes were generated: 'Barriers to ACP', 'Facilitators of ACP' and 'Understanding of professional role and duty'. Key barriers were - lack of confidence, competence, role ambiguity and prognostic uncertainty. Key facilitators concerned the pertinence of the patient-practitioner relationship enabling ACP amongst nurses who had both competence and experience in ACP and/or palliative care (e.g., palliative care training). Lastly, nurses understood ACP to be part of their role, however, met challenges understanding the law surrounding this and its application processes. CONCLUSIONS: This review suggests that community nurses' experience and competence are associated with the effective implementation of ACP with palliative patients. Future research is needed to develop interventions to promote ACP uptake in community settings, enable confidence building for community nurses and support higher standards of palliative care via the implementation of ACP.

Enhancing Community Participation through Age-Friendly Ecosystems: A Rapid Realist Review.

This rapid realist review explored the key components of age-friendly ecosystems that promote community participation among older adults. The study (undertaken in 2021 and updated in 2023) synthesized evidence from 10 peer-reviewed and grey literature databases to identify the underlying mechanisms and contextual factors that shape why, under what circumstances, and for whom an age-friendly ecosystems might be effective as well as the intervention outcomes. A total of 2823 records were initially identified after deduplication. Title and abstract screening produced a potential dataset of 126 articles, reducing to 14 articles after full text screening. Data extraction focused on the contexts, mechanisms, and outcomes of ecosystems for older adults' community participation. Analysis suggested that age-friendly ecosystems that aim to promote community participation are characterized by the provision of accessible and inclusive physical environments, the availability of supportive social networks and services, and the creation of opportunities for meaningful engagement in community life. The review also highlighted the importance of recognizing the diverse needs and preferences of older adults and involving them in the design and implementation of age-friendly ecosystems. Overall, the study has provided valuable insights into the mechanisms and contextual factors that contribute to the success of age-friendly ecosystems. Ecosystem outcomes were not well discussed in the literature. The analysis has important implications for policy and practice, emphasizing the need to develop interventions that are tailored to the specific needs and contexts of older adults, and that promote community participation as a means of enhancing health, wellbeing, and quality of life in later life.

Supporting intersecting cultural needs of gender and age by increasing cultural safety and humility for Housing First initiatives.

BACKGROUND: To sufficiently house and support persons experiencing homelessness (PEH), deeper understandings of the cultural appropriateness and responsiveness of community resources and the service delivery system is essential. In the case of Metro Vancouver, Canada, the cultural appropriateness and responsiveness of Housing First as a service model for supporting PEH was explored. METHODS: Local service providers and stakeholders (n = 52) participated in three full day service-mapping workshops to identify Housing First supports for older adults, youth, and women experiencing homelessness, as part of a municipal-wide participatory and action-oriented study. Data were analyzed using a structured framework thematic analysis approach and cultural safety and humility lenses. RESULTS: We generated three key themes: (i) insufficient built environments create challenges across gender and age, (ii) cultural safety and humility concerns at the intersection of gender and age, and (iii) implications for a culturally-responsive Housing First implementation. CONCLUSIONS: Findings informed the development of a Culturally-Responsive Planning resource to support housing, health, and social service providers who are implementing Housing First initiatives.

Clinical characteristics and microbiological tests analysis of 18 patients with Talaromyces marneffei infection / 中国热带医学

@#Abstract:Objective　To investigate the clinical characteristics and early diagnostic methods of patients with Talaromyces marneffei infection, so as to reduce the mortality of patients. Methods The clinical characteristics and microbiological analysis data including fungal culture, smear examination and mass spectrometry were collected from 18 patients with Talaromyces marneffei infection in the Department of Respiratory Medicine, Department of Tuberculosis, and Department of Critical Respiratory Medicine in Fuzhou Pulmonary Hospital from January 2017 to December 2021, and descriptive analysis was conducted. Results　All the 18 patients were confirmed to be infected with Talaromyces marneffei by conventional culture and matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) mass spectrometry (MS). The main infection sites of 18 patients with Talaromyces marneffei infection were lungs and lymph nodes, and the patients were accompanied by clinical manifestations such as cough, sputum and fever. The imaging features such as patchy shadows, mediastinal lymph node shadows and nodular shadows were common. Microbiological testing showed a statistically significant difference between smear and culture with a higher positive culture rate (χ2=13.74, P<0.05). The positive rate of blood culture in microbiological test was 60.0% (9/15), the positive rate of bronchial lavage fluid culture was 26.7% (4/15), the positive rate of sputum culture was 5.6% (1/18), one case each of pus, bone marrow, pleural fluid and cerebrospinal fluid was positive for culture and the other cases were negative, one case of sputum and one case of pus were positive for smear and the rest were negative. Colony characteristics showed that the colony morphology was mycelial phase at 25 ℃, producing red pigment, and the branching pattern of the penicillus was seen microscopically as monoverticillate or biverticillate; At 35 ℃, the yeast phase appeared at the initial stage, and then the mycelium phase changed after 5-6 days; the yeast phase was observed at 37 ℃, and yeast-like cells were seen under the microscope. All 18 patients with Talaromyces marneffei infection got better after using antifungal drugs. Compared with non-HIV patients with Talaromyces marneffei infection, leukopenia and anemia were common in HIV patients with Talaromyces marneffei infection, and the differences were statistically significant (P<0.05). 　Conclusions The infection of Talaromyces marneffei can be divided into localized type and disseminated type, which usually invade the lungs, skin, lymph nodes and other places. The main manifestations of patients are fever, cough, phlegm and other atypical symptoms. At present, the diagnosis of Talaromyces marneffei infection is mostly based on the fungal culture test, and the application of MALDI-TOF MS method can effectively shorten the diagnosis time of Talaromycosis marneffei. Clinical characteristics combined with microbiological analysis provide an objective basis for early diagnosis of patients with Talaromyces marneffei infection, and timely use of antifungal therapy can improve the prognosis of patients.

Equity in AgeTech for Ageing Well in Technology-Driven Places: The Role of Social Determinants in Designing AI-based Assistive Technologies.

AgeTech involves the use of emerging technologies to support the health, well-being and independent living of older adults. In this paper we focus on how AgeTech based on artificial intelligence (AI) may better support older adults to remain in their own living environment for longer, provide social connectedness, support wellbeing and mental health, and enable social participation. In order to assess and better understand the positive as well as negative outcomes of AI-based AgeTech, a critical analysis of ethical design, digital equity, and policy pathways is required. A crucial question is how AI-based AgeTech may drive practical, equitable, and inclusive multilevel solutions to support healthy, active ageing.In our paper, we aim to show that a focus on equity is key for AI-based AgeTech if it is to realize its full potential. We propose that equity should not just be an extra benefit or minimum requirement, but the explicit aim of designing AI-based health tech. This means that social determinants that affect the use of or access to these technologies have to be addressed. We will explore how complexity management as a crucial element of AI-based AgeTech may potentially create and exacerbate social inequities by marginalising or ignoring social determinants. We identify bias, standardization, and access as main ethical issues in this context and subsequently, make recommendations as to how inequities that stem form AI-based AgeTech can be addressed.

Future of digital health and community care: Exploring intended positive impacts and unintended negative consequences of COVID-19.

Response to COVID-19 has both intentionally and unintentionally progressed the digitization of health and community care, which can be viewed as a human rights issue considering that access to health and community care is a human right. In this article, we reviewed two cases of digitization of health and community care during the pandemic; one in Scotland, United Kingdom and another in British Columbia, Canada. An integrated analysis revealed that digitization of health and community care has intended positive and unintended negative consequences. Based on the analysis, we suggest five areas of improvement for equity in care: building on the momentum of technology advantages; education and digital literacy; information management and security; development of policy and regulatory frameworks; and the future of digital health and community care. This article sheds light on how health practitioners and leaders can work to enhance equity in care experiences amid the changing digital landscape.

Co-creating inclusive spaces and places: Towards an intergenerational and age-friendly living ecosystem.

Introduction: Evolving aging societies, ongoing digitalisation and circumstances of COVID-19 are changing living conditions for growing older. There is an increased urgency to view public health with a focus on integrating people of all ages into the matrix of opportunities afforded in their communities. This study initiates the conceptualization of an intergenerational, age-friendly living ecosystem (AFLE) to enhance public health planning. Methodology: A participatory study was conducted using a multi-methods approach. Six virtual co-creation sessions (n = 35-50 participants), alongside a mainly open-ended INTERGEN survey designed specifically for this study (n = 130) were conducted to conceptualize multilevel ideas for building intergenerational age-friendly places using Bronfenbrenner's ecological systems model. At the height of COVID-19, virtual applications (Zoom, Moodboard) and case studies, creative methods (drawing, photography, storytelling and spotlight sessions) were applied to engage academic and non-academic participants between ages 5 - 80+ years, across eight countries. Sessions were video-recorded with visual themes captured by a graphic facilitator. The survey covered issues of multigenerational interactions; intergenerational and age-friendly place features; place safety; and necessary stakeholders required for creating intergenerational and age-friendly places. Data were reflexively analyzed using a team approach to thematic analysis. Results: Findings present both the thematic analysis of Virtual Co-creation Camps (VCCs) and the INTERGEN survey results. These findings are addressed in three overarching categories that highlight the necessary characteristics of AFLEs as suggested by the VCC participants and survey respondents: (i) Sensory factors: feeling and emotion as starting points for physical design; (ii) Physical and digital factors in designing AFLE spaces and places; and (iii) Socio-cultural factors: tackling ageism and exclusion as part of the solution. Discussion: The analysis resulted in a pathway toward enhanced understandings on how multi-generations can better interact with fluctuating organizational domains (industry, voluntary, academic and public sectors) in urban and rural settings to facilitate intergenerational connectivity. Through processes of co-creation, an AFLE proof of concept and roadmap for public health planning was developed to support and provide opportunities for people as they age to reap the socioeconomic benefits of their local and virtual communities and help them become well integrated, valued and contributory members of society.

Cross-National Perspectives on Aging and Place: Implications for Age-Friendly Cities and Communities.

BACKGROUND AND OBJECTIVES: The age-friendly cities and communities (AFCC) agenda has led to a range of policy initiatives aimed at supporting aging in place for older people. While there is case study evidence of how people age across urban contexts, there has been little research exploring cross-national understandings of age-friendly places among older people. The objective of this article is to identify the place experiences of older people living across cities and communities in India, Brazil, and the United Kingdom and to discuss implications for the AFCC agenda. RESEARCH DESIGN AND METHODS: A total of 300 semistructured interviews were undertaken with older people across 9 cities and 27 communities in India, Brazil, and the United Kingdom. The data were analyzed using thematic analysis undertaken by each national team and then discussed and revised at collaborative workshops with researchers from each of the 3 country teams. RESULTS: The data capture the ways in which place is constructed from the perspective of older people drawing upon social, community, and cultural dimensions of aging across diverse urban environments. We explore how older people negotiate place in the context of their everyday life and identify the relational and interconnected ways in which place attachment, belonging, and identity are constructed. DISCUSSION AND IMPLICATIONS: Age-friendly interventions need to attend to the changing physical, social and cultural dimensions of aging and place. Integrated place-making practices are required to support older people to age in the right place across rapidly transforming urban contexts globally.

Rural Older Adults in Disasters: A Study of Recovery From Hurricane Michael.

OBJECTIVE: This study aims for a greater understanding of how older adults (age 65 and older) in Jackson County, Florida, are prepared for and cope with the effects of a natural disaster. METHODS: A multidisciplinary, international research team developed a survey examining: (1) resources available to individuals aged 65+ in rural communities for preparing for a disaster; (2) challenges they face when experiencing a disaster; and (3) their physical, social, emotional, and financial needs when it strikes. The survey was administered with older adults (65+) in Jackson County, Florida, following Hurricane Michael in 2018. The descriptive, multivariate logistic, and linear regression analyses were performed to examine the relationship between respondents' demographic information and needs, concerns, and consequences of disaster. RESULTS: Results indicated (n = 139) rural community-dwelling older adults rely on social support, community organizations, and trusted disaster relief agencies to prepare for and recover from disaster-related events. CONCLUSIONS: Such findings can be used to inform the development of new interventions, programs, policies, practices, and tools for emergency management and social service agencies to improve disaster preparedness and resiliency among older populations in rural communities.

A protocol for co-creating research project lay summaries with stakeholders: guideline development for Canada's AGE-WELL network.

BACKGROUND: Funding bodies increasingly require researchers to write lay summaries to communicate projects' real-world relevance to the public in an accessible way. However, research proposals and findings are generally not easily readable or understandable by non-specialist readers. Many researchers find writing lay summaries difficult because they typically write for fellow subject specialists or academics rather than the general public or a non-specialist audience. The primary objective of our project is to develop guidelines for researchers in Canada's AGE-WELL Network of Centres of Excellence, and ultimately various other disciplines, sectors, and institutions, to co-create lay summaries of research projects with stakeholders. To begin, we produced a protocol for co-creating a lay summary based on workshops we organized and facilitated for an AGE-WELL researcher. This paper presents the lay summary co-creation protocol that AGE-WELL researchers will be invited to use. METHODS: Eligible participants in this project will be 24 AgeTech project researchers who are funded by the AGE-WELL network in its Core Research Program 2020. If they agree to participate in this project, we will invite them to use our protocol to co-produce a lay summary of their respective projects with stakeholders. The protocol comprises six steps: Investigate principles of writing a good lay summary, identify the target readership, identify stakeholders to collaborate with, recruit the identified stakeholders to work on a lay summary, prepare for workshop sessions, and execute the sessions. To help participants through the process, we will provide them with a guide to developing an accessible, readable research lay summary, help them make decisions, and host, and facilitate if needed, their lay summary co-creation workshops. DISCUSSION: Public-facing research outputs, including lay summaries, are increasingly important knowledge translation strategies to promote the impact of research on real-world issues. To produce lay summaries that include information that will interest a non-specialist readership and that are written in accessible language, stakeholder engagement is key. Furthermore, both researchers and stakeholders benefit by participating in the co-creation process. We hope the protocol helps researchers collaborate with stakeholders effectively to co-produce lay summaries that meet the needs of both the public and project funders.

Defining organizational contributions to sustaining an ageing workforce: a bibliometric review.

The ageing of populations worldwide has implications for workforces in developed countries, and labour shortages have increasingly become a political concern. Governments in developed countries have responded by increasing the retirement age as a strategy for overcoming the fall in labour supply. Using bibliometric techniques, we reviewed 122 articles published between 1990 and 2018 to examine the effectiveness of the strategy in addressing the labour shortages and, in particular, to identify the factors that contribute positively to maintaining worker participation within an ageing workforce at an organizational level. The results identified five organizational factors that support continued participation: health, institutions, human resource management, human capital and technology tools. Employers will increasingly need to develop "age-friendly" workplaces and practices if they are to recruit and retain older workers.

Association of Early Interventions With Birth Outcomes and Child Linear Growth in Low-Income and Middle-Income Countries: Bayesian Network Meta-analyses of Randomized Clinical Trials.

Importance: The first 1000 days of life represent a critical window for child development. Pregnancy, exclusive breastfeeding (EBF) period (0-6 months), and complementary feeding (CF) period (6-24 months) have different growth requirements, so separate considerations for intervention strategies are needed. No synthesis to date has attempted to quantify the associations of interventions under multiple domains of micronutrient and balanced energy protein and food supplements, deworming, maternal education, water sanitation, and hygiene across these 3 life periods with birth and growth outcomes. Objective: To determine the magnitude of association of interventions with birth and growth outcomes based on randomized clinical trials (RCTs) conducted in low-income and middle-income countries (LMICs) using Bayesian network meta-analyses. Data Sources: MEDLINE, Embase, and Cochrane databases were searched from their inception up to August 14, 2018. Study Selection: Included were LMIC-based RCTs of interventions provided to pregnant women, infants (0-6 months), and children (6-24 months). Data Extraction and Synthesis: Two independent reviewers used a standardized data extraction and quality assessment form. Random-effects network meta-analyses were performed for each life period. Effect sizes are reported as odds ratios (ORs) and mean differences (MeanDiffs) for dichotomous and continuous outcomes, with 95% credible intervals (CrIs). This study calculated probabilities of interventions being superior to standard of care by at least a minimal clinically important difference. Main Outcomes and Measures: The study compared ORs on preterm birth and MeanDiffs on birth weight for pregnancy, length for age (LAZ) for EBF, and height for age (HAZ) for CF. Results: Among 302 061 participants in 169 randomized clinical trials, the network meta-analyses found several nutritional interventions that demonstrated greater association with improved birth and growth outcomes compared with standard of care. For instance, compared with standard of care, maternal supplements of multiple micronutrients showed reduced odds for preterm birth (OR, 0.54; 95% CrI, 0.27-0.97) and improved mean birth weight (MeanDiff, 0.08 kg; 95% CrI, 0.00-0.17 kg) but not LAZ during EBF (MeanDiff, -0.02; 95% CrI, -0.18 to 0.14). Supplementing infants and children with multiple micronutrients showed improved LAZ (MeanDiff, 0.20; 95% CrI, 0.03-0.35) and HAZ (MeanDiff, 0.14; 95% CrI, 0.02-0.25). The study found that pregnancy interventions generally had higher probabilities of a minimal clinically importance difference than the interventions for the EBF or CF in the first 1000 days of life. Conclusions and Relevance: These analyses highlight the importance of intervening early for child development, during pregnancy if possible. Results of this study suggest that there is a need to combine interventions from multiple domains and test for their effectiveness as a package.

Understanding the functionality of housing-related support services through mapping methods and dialogue.

This article describes the experience and process of using community mapping as a tool for collecting data on the functioning of housing-related support services in Metro Vancouver. We outline our mapping methods and discuss strengths and challenges encountered during workshops aimed at understandings how the system of housing-related supports function. Strengths were that workshops provided a forum for social participation and engagement. In addition, mapping is a research tool that enables local knowledge of service functioning and service gaps to be accessed and exchanged. Challenges include ensuring diverse representation; reducing power imbalances; and having adequate space to accommodate interested participants.

Exploring Privilege in the Digital Divide: Implications for Theory, Policy, and Practice.

Background and Objectives: The digital revolution has resulted in innovative solutions and technologies that can support the well-being, independence, and health of seniors. Yet, the notion of the "digital divide" presents significant inequities in terms of who accesses and benefits from the digital landscape. To better understand the social and structural inequities of the digital divide, a realist synthesis was conducted to inform theoretical understandings of information and communication technologies (ICTs); to understand the practicalities of access and use inequities; to uncover practices that facilitate digital literacy and participation; and to recommend policies to mitigate the digital divide. Research Design and Methods: A systematic search yielded 55 articles published between 2006 and 2016. Synthesis of existing knowledge, combined with user-experience elicited through a deliberative dialogue session with community stakeholders (n = 35), made visible a pattern of privilege that determined individual agency in ICT access and use. Results: Though age is consistently centralized as the key determinant of the digital divide, our analyses, which encompassed both van Dijk's resources and appropriation theory and intersectionality, appraised this notion and revealed that age is not the sole determinant. Findings highlight the role of other factors that contribute to digital inequity among community-dwelling middle-aged (45-64) and older (65+) adults, including education, income, gender, and generational status. Discussion and Implications: Informed by results of a realist synthesis that was guided by intersectional perspectives, a conceptual framework was developed outlining implications for theory, policy, and practice to address the wicked problem that is the digital divide.

Senior Services that Support Housing First in Metro Vancouver.

Housing First is a model and philosophy for housing homeless people in immediate and permanent housing. In order to implement and deliver Housing First, research is essential to understand the system of support services as they currently exist. Guided by principles of community-based participatory research, this paper presents the findings from a senior-focused deliberative dialogue workshop in Metro Vancouver, Canada. Participants (16 service providers and 1 service recipient) identified services and resources available to support seniors in maintaining housing and barriers and facilitators for accessing services. Broadly, data were organized into seven themes: (1) Housing; (2) Home support; (3) Transportation; (4) Information availability, accessibility, and navigation; (5) Cultural diversity; (6) Discrimination; and (7) Funding and financial support. Results found that affordable housing that adapts to changing health conditions, income supports, health services, homecare, transportation, and culturally appropriate and nondiscriminatory informational resources are among the supports most needed for persons as young as 50 years old to succeed under the Housing First model in Metro Vancouver. Barriers to Housing First service provision, including rigid eligibility criteria for chronically and episodically homeless, should be revised to better support the growing number of older adults who are newly entering homelessness in Metro Vancouver.

Contextual Factors for Aging Well: Creating Socially Engaging Spaces Through the Use of Deliberative Dialogues.

Purpose of the Study: Home and community engagement are key contextual factors for aging well, particularly for older adults in vulnerable social positions. A community-based participatory action research project conducted in Western Canada examined how to best use the shared amenity spaces in a low-income seniors' apartment complex in order to connect services and programs with tenants and to provide opportunities for service providers and local stakeholders to build upon and create new relationships toward collaboration and service delivery. Design and Methods: Pre-move deliberative dialogue workshops (n = 4) were conducted with stakeholders (e.g., service providers, developers, and municipal government employees). Workshop participants (n = 24) generated ideas and plans on how physical and social environments can contribute to the social engagement of senior tenants. Results: Shared dialogue led to community investment and asset sharing by integrating the knowledge and experiences of multiple stakeholder groups into the planning process. This article highlights how collaborative planning approaches for the effective use of the social environment (e.g., social programming), within the physical environment (e.g., amenity and community spaces), can generate rich and illuminating data for informing enhancements in the social environment of apartment dwelling low-income seniors. Contextual challenges to service provision are discussed, including the need for communication about and coordination of on-site programming, culturally diverse and responsive programming, and long-term funding. Implications: Prolonging independent community living with the assistance of support services should be a goal to both delay premature relocation into institutional care and meet the preferences of older adults.

Informing Understandings of Mild Cognitive Impairment for Older Adults: Implications From a Scoping Review.

The development of effective interventions for mild cognitive impairment (MCI) in older adults has been limited by extensive variability in the conceptualization and definition of MCI, its subtypes, and relevant diagnostic criteria within the neurocultural, pharmaceutical, and gerontological communities. A scoping review was conducted to explore the conceptual development of MCI and identify the resulting ethical, political, and technological implications for the care of older adults with MCI. A comprehensive search was conducted between January and April 2013 to identify English-language peer-reviewed articles published between 1999 and 2013. Our analysis revealed that the MCI conceptual debate remains unresolved, the response to ethical issues is contentious, the policy response is limited, and one-dimensional and technological interventions are scarce. Reflections on the conceptual, ethical, and policy responses in conjunction with the identification of the needs of older adults diagnosed with MCI highlight significant opportunities for technological interventions to effectively reposition MCI in the aging care discourse.

From Familiar Faces to Family: Staff and Resident Relationships in Long-Term Care.

OBJECTIVE: Long-term care (LTC) facilities are increasingly intent on creating a "homelike" atmosphere for residents. Although residential staff are integral to the construction of a home within LTC settings, their perceptions have been relatively absent from the literature. METHOD: Thirty-two LTC staff participants were interviewed about their experiences and perceptions of the physical environment and conceptualizations of home, and thematic analyses were conducted. RESULTS: An overarching category-interpersonal relationships-emerged from our analyses emphasizing the importance of relationships in creating a homelike environment within institutional settings. Sub-themes that inform our understanding include the following: (a) Staff members' perceptions of home; (b) "Their second home": Adjustment to and familiarity in LTC; and (c) "We become family": Relationality makes a home. DISCUSSION: The study provides evidence to inform current policies and practices in LTC. Specifically, enough time and space should be given to residents and staff to create and maintain personal relationships to make residential care homelike.

Place-making with older persons: Establishing sense-of-place through participatory community mapping workshops.

Principles of aging-in-place emphasize the importance of creating sustainable environments that enable older people to maintain a sense of belonging, autonomy, independence, safety and security. Simply altering the built environment is insufficient for creating more inclusive environments for older persons, as creating 'meaningful' places for aging involves consideration of psychosocial and cultural issues that go beyond issues of physical space. This paper illustrates how applications of community-based participatory research methods, in particular, participatory community mapping workshops (PCMWs), can be used to access experiences of place, identify facilitators and barriers to accessing the built environment and co-create place-based solutions among older people and service providers in a new affordable housing development in Western Canada. Founded on tenets of empowerment and relationship building, four PCMWs were undertaken with 54 participants (N = 38 older people; N = 16 local service providers). PCMWs comprised (i) experiential group walks around the community to access understandings of place and community and (ii) mapping exercises, whereby participants articulated their place-based needs within the context of the new affordable housing development and surrounding neighbourhood. Dialogues were digitally recorded, transcribed and thematically analysed. Visual data, including photographs taken during experiential group walks were categorized and integrated into the narrative to illustrate place meanings. PCMWs enabled senior housing and social care professionals and decision-makers to co-construct knowledge with older tenants that facilitated place action and change. Key themes identified by participants included: identifying services and needs for health and wellbeing, having opportunities for social participation and overcoming cross-cultural challenges. PCMWs were found to be a nuanced method of identifying needs and resources and generating knowledge.