Exploring the home environment of adults living with autism spectrum disorder: a qualitative study.

Introduction: The challenges experienced by adults living with autism spectrum disorder (ASD) regarding their interaction with their home environment are thinly documented, although these issues persist with age. Based on the Model of Competence, this study aims to explore the human and nonhuman elements of the home environment influencing the functioning of autistic adults. Methods: An exploratory-descriptive qualitative study was conducted in Quebec City, Canada, with autistic adults (n = 6). Individual semi-structured interviews were undertaken by a single interviewer until data saturation was reached. A content analysis was conducted using NVivo software with a list of codes adjusted according to new emerging themes. Results: Eight themes emerged and were grouped into three categories: 1) Person - Adult living with ASD: coping skills, anxiety; 2) Microsystem - Home environment: entourage, sensory elements, spatial arrangement; 3) Person-environment interaction: routines, socialization, control. The experiences of autistic adults highlight the varied interactions experienced with the nonhuman and human elements of their homes, sometimes resulting in a situation of handicap related to their activities and roles. Conclusion: This qualitative exploration of the environmental challenges experienced at home by autistic adults introduces a better understanding of the person-environment interaction, allowing for easier functional assessment and improved home support.

Factors influencing older adults' participation in telehealth interventions for primary prevention and health promotion: A rapid review.

OBJECTIVE: To identify facilitators and barriers to older adults' participation in telehealth interventions for primary prevention and health promotion. METHODS: Relevant articles were searched using keywords in Embase and MEDLINE. Study characteristics, type of telehealth interventions and technology involved, as well as facilitators and barriers to their use, were extracted from selected articles. The Unified Theory of Acceptance and Use of Technology 2 (UTAUT2) model was used to organise data. RESULTS: A total of 24 articles (pertaining to 20 studies) were included. Nine facilitators and 11 barriers influencing the participation in telehealth interventions for primary prevention and health promotion among older adults were identified. The most recurrent facilitators were related to the individual's performance expectancy and effort expectancy, as well as the presence of a social dimension associated with the intervention (i.e. having a good relationship with the other participants in the program). The two most prevalent barriers were also related to effort expectancy and performance expectancy, followed by barriers related to the inherent characteristics of the technology and older adults' health condition. Experience, age and gender were also found to moderate technology use and acceptance. CONCLUSIONS: This rapid review highlights the importance of adopting a holistic perspective when designing telehealth interventions aimed at preventive and health promotion purposes among older adults.

Understanding the home environment of older adults living with dementia: A scoping review of assessment tools.

Rigorous assessments to better understand the person-environment interaction are essential to comprehend how neurocognitive disorders influence in-home functioning of older people living with dementia. No recent synthesis identifies validated instruments targeting the human (e.g. caregivers) and nonhuman (e.g. objects) elements of the home environment interacting with this population and used with the perspective of aging in place. Consequently, following Arksey and O'Malley's (2005) scoping review method, 2,182 articles were identified in six databases and in gray literature. Two reviewers independently selected 23 relevant articles describing 19 validated assessment tools targeting elements of the home interacting with older people with dementia, namely: nonhuman environment (n = 13), human environment (n = 3), and person-environment interaction (n = 3). This overview highlights the scarcity of tools addressing the human environment and the person-environment interaction to foster sustainable at-home living for older people with neurocognitive disorders, demonstrating the need to incorporate new evidence-based, holistic methods into dementia home care.

Social Isolation of Older Adults Living in a Neighbourhood of Montreal: A Qualitative Descriptive Study of the Perspectives of Older Adults and Community Stakeholders.

The purpose of this study was to describe the social isolation of older adults in the Côte-des-Neiges neighbourhood (Montreal, Canada) from the perspectives of older adults and community stakeholders. To do so, a descriptive qualitative study was conducted, involving community-dwelling older adults and a variety of key stakeholders from the neighbourhood. Seven focus groups were held, with a total of 37 participants. Focus group transcripts were analyzed using the approach of Miles, Huberman, and Saldaña. Participants reported that social isolation of older adults is characterized by gaps in social interactions (scarcity of social interactions, lack of social support, and unsatisfying relationships) as well as by low social participation that can be depicted in three ways: (1) exclusion by society, (2) self-restriction of participation, and (3) low eagerness to socialize. This study highlights that there is a diversity in how social isolation of older adults manifests itself. It can be the result of a deliberate choice (or not), as well as being desired (or not). These aspects of the phenomenon of social isolation of older adults are still not well described. However, they offer relevant avenues for rethinking approaches to intervention development.

How do dentists perceive portable dentistry? A qualitative study conducted in Quebec.

INTRODUCTION: People with impaired mobility face difficulty accessing dental care. One solution is portable dentistry, which includes delivering dental care in homes or residential institutions. Dentists, however, appear reluctant to offer such services. Our objective was to understand how dentists perceived portable dentistry and potential challenges to its implementation. METHODS: We conducted a qualitative descriptive study based on semi-structured interviews with a sample of dentists in Quebec, Canada. We employed a combination of maximum variation and snowball sampling strategies to recruit 14 participants. The interviews were conducted and audio-recorded through Zoom and lasted approximately 40 minutes. After transcribing them, we performed a thematic analysis with a combination of inductive and deductive coding. RESULTS: Despite perceiving portable dentistry as a valuable practice model, participants showed little interest in adopting this approach, arguing it was not every dentist's "job" to provide portable services. They believed portable dentistry must be financially burdensome and difficult to integrate into their daily work due to lack of time and portable equipment. Accordingly, participants considered it was the duty of governments, professional organisations overseeing dentistry education and practice, and dental schools to develop portable dentistry programs and hire dentists to deliver such services. CONCLUSIONS: To promote portable dentistry, it may be necessary to improve the knowledge and competencies of dentists, but also to challenge their professional identity as well as the current model of dental clinics as the standard of care delivery. To achieve this, we need strong leadership from dental schools, professional organisations and government.

[Les effets de l'environnement de soins sur les comportements réactifs des personnes ayant des troubles neurocognitifs vivant en centre d'hébergement : Une revue de la portée].

Les personnes âgées atteintes de troubles neurocognitifs (démences) vivant en centre d'hébergement adoptent fréquemment des comportements réactifs qui limitent leur engagement dans des occupations. La présente étude vise à identifier des moyens d'intervention centrés sur l'engagement des personnes âgées ayant un trouble neurocognitif avec l'environnement humain et non humain en centre d'hébergement afin de diminuer leurs comportements réactifs, en particulier les comportements d'errance, d'apathie et d'agitation. Cette revue de la portée est basée sur la méthode proposée par Levac et ses collaborateurs (2010). Parmi les 21 études retenues, la plupart s'intéressent à des interventions ciblant l'environnement non humain (n=9) ou ciblant simultanément l'environnement humain et non humain (n=9). Plusieurs de ces interventions sont efficaces pour diminuer les comportements réactifs et permettent aux personnes âgées de s'engager avec leur environnement. Le support de l'environnement humain semble toutefois nécessaire à l'utilisation optimale de plusieurs interventions.

Multimodal Interventions Including Rehabilitation Exercise for Older Adults With Chronic Musculoskeletal Pain: A Systematic Review and Meta-analyses of Randomized Controlled Trials.

BACKGROUND AND PURPOSE: Musculoskeletal disorders (MSKDs) are the most common causes of disabilities for older adults. The aim of this systematic review and meta-analysis is to assess the effectiveness of multimodal interventions including exercise rehabilitation for older adults with chronic MSKDs. METHODS: A literature search was conducted up to February 2019 in 5 bibliographical databases to identify randomized controlled trials (RCTs) that compared multimodal interventions including exercise rehabilitation with usual medical care or no intervention. Randomized controlled trials were assessed with the Cochrane risk-of-bias tool. Meta-analyses were performed and pooled mean differences (MDs) or standardized mean differences (SMDs) were calculated. RESULTS: Sixteen RCTs (n = 2322 participants) were included. One RCT was considered at low risk of bias, 8 had some concerns of bias, and 7 had a high risk of bias. Participants suffered from hip or knee osteoarthritis (OA) (n = 12 RCTs), low back pain (LBP) (n = 2 RCTs) and generalized chronic pain (GCP) (n = 2 RCTs). Multimodal interventions were significantly more effective than usual care to decrease pain (visual analog scale, out of 10 points) in the short term, MD: -0.71 (95% confidence interval [CI] -1.08 to -0.34, n = 900), and in the long term: MD: -0.52 (95% CI -0.98 to -0.05, n = 575), but these differences are not considered clinically important. In terms of disabilities, multimodal interventions were also significantly more effective than usual care. The SMDs were -0.47 (95% CI -0.61 to -0.34, n = 903) and -0.29 (95% CI -0.46 to -0.13, n = 568) for OA trials in the short and long terms, respectively, and -0.47 (95% CI -0.81 to -0.12, n = 211) for LBP and GCP trials in the short term. The magnitude of these effects may be considered as small to moderate. CONCLUSION: Multimodal intervention including exercise rehabilitation combined with usual medical care is an efficacious therapeutic option to reduce disabilities in older adults with chronic MSKDs. A significant but not clinically important effect was observed for pain. The most beneficial component of the multimodal interventions in terms of education, exercises, or medication remains to be determined.

A scoping review on dental clinic accessibility for people using wheelchairs.

AIMS: We aimed to explore the scientific literature on accessible dental clinics for wheelchair users. More specifically, we sought out literature addressing how the human environment and physical space shape the dental services of accessible dental clinics. METHODS: We conducted a scoping review (May 2019) in Embase, PubMed, Web of Science, and the Avery index of architectural Periodicals (3994 articles). We followed Arksey and O'Malley's recommended procedures; after screening, we retained 17 articles. We performed a critical appraisal, followed by thematic content analyses of extracted data. RESULTS: The articles originated mainly from the United States and United Kingdom. Only three reported original research. We illustrated the results within a three-step dental care pathway cycle. In each step, the interaction between accessibility of the physical and human environments (ie, the layout/design of the clinic and the attitudes and skills of the dental professional, respectively) contributed to the overall accessibility. We also found that empirical evidence on clinics' accessibility was lacking: many articles resorted to broad "one size fits all" recommendations and fragmented information on accessibility. Finally, the voice of wheelchair users was missing. CONCLUSION: There are knowledge gaps in terms of dental clinics' accessibility. We thus invite researchers to conduct original studies with dental professionals, wheelchair users, and their caregivers.

What do we know about portable dental services? A scoping review.

BACKGROUND: Delivering dental care to patients in their home or residential institutions is known as "portable dentistry". The demand for portable dental services is on the rise, but dentists remain reluctant to adopt portable practices. OBJECTIVES: To explore the literature on portable dental services and understand (a) the process of planning and delivering portable dental services and (b) the benefits and challenges of portable dentistry for service providers and patients. METHODS: A systematic scoping search was conducted. We retrieved 3994 documents, 28 of which were included in the final synthesis. Three authors read the papers and conducted thematic content analyses independently. RESULTS: We present a synthesis of the literature and proposed a model of portable dentistry containing three levels with the patient is at the centre surrounded by concentric rings representing the dentist (dental team) and society. At each of these levels, our model is further subdivided into three components: 1) organisation of the service; 2) arrival and set-up of the service; and 3) delivery of the service. In addition, each level includes 1) human factors, which are related either to the dental professional or the patient; 2) non-human factors, which refer to either the equipment or the physical environment; and 3) financial factors, which are related to cost and remuneration. CONCLUSIONS: We propose a model for portable dentistry that dentists and dental educators interested in this practice should find useful.

Perceptions and needs regarding technologies in nursing homes: An exploratory study.

Two of the most salient problems in nursing homes are the responsive behaviours and falls of older people living with Alzheimer's disease and related disorders. Intelligent videomonitoring and mobile applications are potential technologies that may help prevent and manage these problems. However, evidence for the needs for technologies in nursing homes is scarce. This study aimed to explore the perceptions and needs of care managers, and of formal and family caregivers in nursing homes regarding these potential technologies. With an exploratory qualitative design based on Rogers' diffusion of innovation theory, individual interviews and a content analysis were conducted. Results show that the potential users of these technologies consider them relevant in nursing homes. The characteristics that would make these technologies useful in nursing homes are described. These results could be used to develop useful technologies to improve the quality of clinical practice in nursing homes.

The effects of a strong desire to void on gait for incontinent and continent older community-dwelling women at risk of falls.

AIMS: The fall rate in urgency urinary incontinence (UUI) and mixed UI (MUI) older women is higher when compared with that of continent women. One hypothesis is that a strong desire to void (SDV) could alter gait parameters and therefore increase the risk of falls. The aim of this study was to investigate and compare the effect of SDV on gait parameters in UUI/MUI and continent older women who experienced falls. The secondary aim was to determine the relationship between UI severity and gait parameters in incontinent women. METHODS: A quasi-experimental pilot study was conducted with two groups of healthy community-dwelling women who experienced at least one fall in the last year: continent (n = 17; age: 74.1 ± 4.3) and UUI/MUI (n = 15; age: 73.5 ± 5.9). We recorded, analyzed, and compared spatiotemporal gait parameters for participants in each group with both SDV and no desire to void condition. RESULTS: A pattern of reduced velocity (P = 0.05) and stride width (P = 0.02) was observed in both groups with SDV. Incontinence severity was correlated with reduced velocity (rs = -0.63, P = 0.01), increased stance time (rs = 0.65, P = .01) and stance time variability (rs = 0.65, P = .01) in no desire to void condition and with reduced velocity (rs = -0.56, P = .03) and increased stride length variability (rs = 0.54, P = .04) in SDV condition. CONCLUSIONS: SDV reduced gait velocity and stride width regardless of continence status in older women at risk of falls. Further, UI severity in the UUI/MUI women was correlated to reduced gait velocity and increased variability. Our findings could explain the higher fall rate in this population.

Age-Related Eye Disease and Cognitive Function: The Search for Mediators.

PURPOSE: Age-related eye disease may be associated with cognitive decline, but the scientific literature has not been consistent. Furthermore, no studies have been able to explain the relationship. Our objective was to assess whether older adults with age-related macular degeneration (AMD) or glaucoma performed worse on 6 cognitive tests compared with older adults with normal vision and, if so, to understand why. DESIGN: Cross-sectional analysis of hospital-based study (Maisonneuve-Rosemont Hospital Ophthalmology Clinics, Montréal, Canada). PARTICIPANTS: Three hundred thirty-six adults 65 years of age or older with either AMD, glaucoma, or normal vision. METHODS: Cognition was measured with 6 cognitive tests administered orally. Activity levels were measured using the Victoria Longitudinal Study Activity Lifestyle Questionnaire. Visual acuity and visual field were measured. Multiple linear regression was used. Mediation was assessed using structural equation modeling. MAIN OUTCOME MEASURES: Results of the verbal fluency test (animal and letter versions), the digit span test (forward and backward versions), and the logical memory test (immediate and delayed recall). RESULTS: People with glaucoma showed lower scores on 3 cognitive tests than the group with normal vision: the digit span forward and backward tests (ß = -0.8 [95% confidence interval (CI), -1.5 to -0.2] and ß = -0.7 [95% CI, -1.3 to -0.1], respectively) and the logical memory test with immediate recall (ß = -1.3 [95% CI, -2.4 to -0.2]). Activity levels statistically significantly mediated the relationship between glaucoma and the digit span forward test (P = 0.043; percentage of the total effect mediated, 17%). CONCLUSIONS: People with glaucoma showed lower scores on cognitive tests that may depend on verbal working memory and encoding. If confirmed in longitudinal studies, interventions should be developed that are appropriate for a visually impaired population to slow this cognitive decline.

Conditions and ethical challenges that could influence the implementation of technologies in nursing homes: A qualitative study.

AIM: To explore the conditions that may influence the implementation of an interactive mobile application (app) and an intelligent videomonitoring system (IVS) in nursing homes (NHs) and the ethical challenges of their use. BACKGROUND: There is a lack of knowledge about implementing technologies in NHs and the ethical challenges that might arise. In past studies, nursing care teams expressed the need for technologies offering clinical support. Technologies like an IVS and an app could prove useful in NHs to prevent and manage falls and responsive behaviours. DESIGN: An exploratory qualitative study was conducted with care managers, family caregivers and formal caregivers in five NHs. METHODS: Each participant was shown a presentation of a potential app and a short video on an IVS. It was followed by an individual semi-structured interview. A conventional content analysis was performed. FINDINGS: Potential users found it would be possible to implement these technologies in NHs even if resistance could be expected. To facilitate adoption and achieve clinical benefits, the implementation of technologies should be pilot-tested, and coaching activities should be planned. Ethical risks were considered already present in NHs even without technologies, for example, risks to privacy. Strategies were proposed, for instance, to adapt the code of ethics and procedures. Some potential prejudices about the interest and abilities of older staff, nurses' aides, and family caregivers to use technology were identified. CONCLUSIONS: Through rigorous and ethical implementation, technologies supporting clinical care processes could benefit older people living in NHs, as well as their relatives and the staff. IMPLICATIONS FOR PRACTICE: Various strategies are proposed to successfully implement technologies. Effort should be made to avoid prejudices during implementation, and procedures should be adapted to mitigate possible ethical challenges.

Feasibility of Implementing an Exercise Program in a Geriatric Assessment Unit: the SPRINT Program.

BACKGROUND: An exercise program involving patients, caregivers, and professionals, entitled SPecific Retraining in INTerdisciplinarity (SPRINT), has been developed to prevent functional decline during hospitalization of older patients. GOAL: Assess the feasibility of implementing SPRINT in the context of a Geriatric Assessment Unit (GAU). METHODS: GAU's health-care professionals were instructed with the SPRINT. All new patients were evaluated by a physiotherapist shortly after admission to validate the eligibility criteria and allocation category of exercises. Questionnaires on physical activities were filled out by professionals, patients, and caregivers at baseline and after intervention. Quantitative and qualitative information was collected on adherence to the program. RESULTS: SPRINT was applied to 19 of the 50 patients admitted during the three-month pilot study. A daily average of one exercise session per patient was performed, most frequently with a nurse (37%), physician (20%), care attendant (13%) or by the patient alone (22%). The caregivers participated only 4% of the time. Barriers and facilitators in applying SPRINT have been identified. CONCLUSIONS: SPRINT appears relevant and applicable within GAUs. Future studies should be conducted to assess its safety and effectiveness in preventing hospital-related functional decline.

What do we know about technologies for dementia-related wandering? A scoping review: Examen de la portée : Que savons-nous à propos des technologies de gestion de l'errance liée à la démence?

BACKGROUND: Occupational therapists use technologies to manage wandering-related risks to promote safety and independence among individuals with dementia living in the community. PURPOSE: The purpose of this review was to examine types of technologies used to manage wandering behaviour. METHOD: Using a modification of Arksey and O'Malley's methodology, we systematically searched peer-reviewed and grey literature on technologies used in home or supportive care environments for persons with dementia at risk for wandering. Data from the studies were analyzed descriptively. FINDINGS: The literature described 83 technologies. Nineteen devices were clinically tested. Interventions ranged from alarm products to mobile locator devices. Benefits included reductions in risk and caregiver burden. IMPLICATIONS: Occupational therapy strategies include technologies to enhance function in persons with dementia. Technologies can also reduce risks of wandering and should be affordable. Ethical issues of the use of technology must be addressed. More research is needed to increase levels of evidence.

Age-Related Eye Disease and Participation in Cognitive Activities.

Studies have found a benefit to living a cognitively active life in older age. Our goal was to quantify participation in cognitively stimulating activities in adults with and without age-related eye disease. We conducted a cross-sectional hospital-based study in Montreal, Canada of older adults (n = 303) having either age-related macular degeneration (AMD) (n = 96), glaucoma (n = 93), or normal vision (n = 114). To be eligible, the AMD group had to have bilateral late stage AMD with a better eye visual acuity of 20/30 or worse. The glaucoma group had to have a diagnosis of bilateral primary open-angle glaucoma with visual field mean deviation < = -4 dB in their better eye. Further inclusion criteria included age ≥ 65 and a Mini-Mental State Exam Blind score ≥ 10. Cognitive activities were measured using the Victoria Longitudinal Study Activity Questionnaire. Linear regression was used. Patients with AMD (ß = -4.2, 95% confidence interval (CI) -6.0, -2.4) and glaucoma (ß = -1.8, 95% CI -3.3, -0.3) participated in fewer cognitive activities per month compared to those with normal vision after adjusting for age, sex, education, diabetes, number of comorbidities, cognition, and cataract. People with AMD and glaucoma participated in fewer cognitive activities, which could put them at risk for future cognitive impairment.

[Intelligent videosurveillance and falls detection: Perceptions of professionals and managers]. / Vidéosurveillance intelligente et détection des chutes: perception des professionnels et des gestionnaires.

DESCRIPTION: Gerontechnologies can be used to detect accidental falls. However, existing systems do not entirely meet users' expectations. Our team developed an intelligent video-monitoring systems to fill these gaps. Authors advocate consulting potential users at the early stages of the design of gerontechnologies and integrating their suggestions. PURPOSE: This study aims to explore health care workers' opinion regarding the intelligent video monitoring to detect falls by older adults living at home. METHOD: This qualitative study explored the opinions of 31 participants using focus groups. Transcripts were analyzed using predetermined codes based on the competence model. FINDINGS: Participants reported several advantages for using the intelligent video monitoring and provided suggestions for improving its use. IMPLICATIONS: The participants' suggestions and comments will help to improve the system and match it to users' needs.

Postsecondary academic achievement and first-episode psychosis: A mixed-methods study.

BACKGROUND: Postsecondary academic achievement as an area of functional recovery for young adults living with mental illness has received little research attention. PURPOSE: This study had three purposes: to compare rates of participation, performance, and satisfaction in postsecondary education between young adults with first-episode psychosis and closely matched young adults; to identify characteristics associated with academic participation; and to explore the processes associated with educational experiences. METHOD: One hundred young adults ages 18 to 30 participated in the study. Quantitative data on academic engagement, performance, and satisfaction, and qualitative data (n = 52) on academic experiences were integrated through pattern analyzes. FINDINGS: Young adults with psychosis were significantly less likely to be engaged in postsecondary education. No difference appeared for the extent of engagement, but performance and satisfaction were lower among participants with psychosis. Participants engaged in reflexive decision making to access postsecondary education and to maintain adequate academic performance. Strategies used by successful students with mental illness were identified. IMPLICATIONS: Assessment and intervention focused on educational needs and skills should become landmark practices for psychiatric rehabilitation practitioners, including occupational therapists.

Perception et réceptivité des proches-aidants à l'égard de la vidéosurveillance intelligente pour la détection des chutes des aînés à domicile.

To address the issue of falls, which are increasing as the population ages, an intelligent video-monitoring system is being developed. The aim of the study is to explore caregivers' perceptions of and receptiveness to a prototype of this fall detection system. A cross-sectional mixed-method study was carried out with individual interviews of 18 caregivers. Statistical frequencies and content analysis were conducted (SPSS and N'Vivo). The results show that most participants (n = 15/18) liked the intelligent video-monitoring system and were willing to use it. They would worry less if they could be alerted if a care recipient fell, but they were concerned about privacy and cost. Participants had a positive perception of the system and expressed their wishes regarding the kind of alert and the person to contact in case of a fall.