Association between intergenerational solidarity involving elders and mental health of Indigenous people living off reserve.

BACKGROUND: Indigenous elders play an important role in transmitting knowledge, values and practices, hence fostering identity-building through intergenerational solidarity. We aimed to verify the association between intergenerational solidarity involving Indigenous elders and mental health of Indigenous people living off reserve. METHODS: We carried secondary analyses of data for a subsample from the cross-sectional 2012 Aboriginal Peoples Survey (total sample: n = 28,410 Indigenous persons aged ≥6 years old living off reserve; subsample: n = 13,020 aged 18-44 years old). Controlling for age as well as material and social deprivation, we used logistic regressions to verify the association between intergenerational solidarity (proxied as time spent with an elder and potential of turning to an elder or grandparent for support in times of need) and mental health (perceived mental health, mood disorders, anxiety, suicidal thoughts and attempts). RESULTS: About 39 and 9% of the respondents respectively reported having spent time with an elder and would have turned to an elder or grandparent for support in times of need. Women who would not turn to an elder or grandparent for support in times of need were more likely to report fair or poor perceived mental health (OR = 1.69, p = 0.03). Men not spending time with an elder were more likely to experience mood disorders (OR = 1.66, p = 0.004). Women who would not turn to an elder or grandparent for support in times of need were more likely to experience anxiety disorders (OR = 1.57, p = 0.04). Women not spending time with an elder or who would not turn to an elder or grandparent for support in times of need were respectively more likely to have suicidal thoughts (OR = 1.62, p = 0.04) or to have attempted suicide (OR = 3.38, p = 0.04). CONCLUSION: Intergenerational solidarity is associated with better mental health outcomes of Indigenous people living off reserve. These results could guide policies and practices that aim to enhance mental health and wellness in Indigenous populations.

Understanding the positive outcomes of discharge planning interventions for older adults hospitalized following a fall: a realist synthesis.

BACKGROUND: Older adults hospitalized following a fall often encounter preventable adverse events when transitioning from hospital to home. Discharge planning interventions developed to prevent these events do not all produce the expected effects to the same extent. This realist synthesis aimed to better understand when, where, for whom, why and how the components of these interventions produce positive outcomes. METHODS: Nine indexed databases were searched to identify scientific papers and grey literature on discharge planning interventions for older adults (65+) hospitalized following a fall. Manual searches were also conducted. Documents were selected based on relevance and rigor. Two reviewers extracted and compiled data regarding intervention components, contextual factors, underlying mechanisms and positive outcomes. Preliminary theories were then formulated based on an iterative synthesis process. RESULTS: Twenty-one documents were included in the synthesis. Four Intervention-Context-Mechanism-Outcome configurations were developed as preliminary theories, based on the following intervention components: 1) Increase two-way communication between healthcare providers and patients/caregivers using a family-centered approach; 2) Foster interprofessional communication within and across healthcare settings through both standardized and unofficial information exchange; 3) Provide patients/caregivers with individually tailored fall prevention education; and 4) Designate a coordinator to manage discharge planning. These components should be implemented from patient admission to return home and be supported at the organizational level (contexts) to trigger knowledge, understanding and trust of patients/caregivers, adjusted expectations, reduced family stress, and sustained engagement of families and professionals (mechanisms). These optimal conditions improve patient satisfaction, recovery, functional status and continuity of care, and reduce hospital readmissions and fall risk (outcomes). CONCLUSIONS: Since transitions are critical points with potential communication gaps, coordinated interventions are vital to support a safe return home for older adults hospitalized following a fall. Considering the organizational challenges, simple tools such as pictograms and drawings, combined with computer-based communication channels, may optimize discharge interventions based on frail patients' needs, habits and values. Empirically testing our preliminary theories will help to develop effective interventions throughout the continuum of transitional care to enhance patients' health and reduce the economic burden of avoidable care.

Financial Exploitation of Older Women: A Case Analysis Using the Struggle for Recognition Theory.

This article aims to make a theoretical contribution to the field of mistreatment of older adults by introducing Honneth's Struggle for Recognition theory in order to document financial mistreatment of older women. Through a case analysis of an older woman financially exploited by her son, considering self-agency and structure, it shows how financial mistreatment disrespects the three components of Honneth's theory, primary relationships, legal relations, and community of value. Personal integrity, social integrity, and honor and dignity are threatened by mistreatment. This case analysis opens for further theoretical exploration of the Struggle for Recognition theory in the understanding of mistreatment of older adults.

When bathing leads to drowning in older adults.

INTRODUCTION: Bathing is the most problematic activity of daily living for aging adults, and the ability to perform it is influenced by physical capabilities that decrease with age. Drowning is an under-documented event related to bathing for older adults. This study investigates the circumstances of these tragedies, to prevent them. METHODS: Census of 2005-2014 bathtub drownings in the province of Quebec (Canada) involving victims aged 65+. Coroner's reports were analyzed using a grid based on factors previously associated with bath-related drownings in literature, iteratively modified. RESULTS: Among the 92 bathtub drowning victims inventoried, 42% were aged 65+. The average age of older victims is 79 (65-97, ±9 years). Main probable cause of drowning is a cardiac problem, although only 19% of victims had a medical history of heart disease. Most victims were alone in their apartment or residence when drowning occurred. Risky periods appear to be springtime, Sundays, and evenings. Despite expectations, relevant information about the physical environment is very scarce. CONCLUSIONS: At least 39 Quebecers, aged 65+, drowned in their bathtubs over a 10-year period. More older adults than children are victims of bathtub drownings in community-dwellings. It seems that bathing may induce heart distress, leading to an appreciable number of drownings. PRACTICAL IMPLICATIONS: Since cardiac health problems are present in these deplorable events, promoting access to safety devices in the environment (emergency button, grab bars) and modified personal hygiene habits (bathing chair, showering) might be potential ways to prevent drowning and improve safety in older adults while they perform their personal hygiene, an essential activity for health and human dignity.

Risks Perceived by Frail Male Patients, Family Caregivers and Clinicians in Hospital: Do they Change after Discharge? A Multiple Case Study.

INTRODUCTION: Up to 40% of hospitalised seniors are frail and most want to return home after discharge. Inaccurate estimation of risks in the hospital may lead to inadequate support at home. This study aimed to document convergences and divergences between risks and support needs identified before hospital discharge and perceived at home post-discharge. METHODS: This research used a multiple case study design. Three cases were recruited, each involving a hospitalised frail patient aged 70+, the main family caregiver and most of the clinicians who assessed the patient before and after hospital discharge. Thirty-two semi-structured interviews were conducted and their transcripts analysed using a qualitative thematic analysis approach. RESULTS: Among risks raised by participants, falls were the only one with total inter-participant/inter-time/inter-case convergence. In all cases, all participants mentioned, before and after discharge, home adaptations and use of technical aids to mitigate this risk. However, clinicians recommended professional services while patients and family caregivers preferred to rely on family members and their own coping strategies. CONCLUSION: The divergences identified for most risks and support needs between users and clinicians, before and after discharge, provide new insights into a comprehensive and patient-centred risk assessment process to plan hospital discharge for frail elderly.

Awareness tool for safe and responsible driving (OSCAR): a potential educational intervention for increasing interest, openness and knowledge about the abilities required and compensatory strategies among older drivers.

OBJECTIVE: This pilot study aimed to verify the impact of the awareness tool for safe and responsible driving (OSCAR) on older adults' (1) interest, openness, and knowledge about the abilities and compensatory strategies required for safe driving; (2) awareness of changes that have occurred in their own driving abilities; and (3) actual utilization of compensatory strategies. METHODS: A preexperimental design, including a pretest (T0) and posttest (T1) 8 to 10 weeks after exposure to the intervention, was used with 48 drivers aged between 67 and 84. The participants had a valid driving license and drove at least once a week. RESULTS: Overall, the results demonstrate that OSCAR increased interest, openness, and knowledge about the abilities and compensatory strategies of older drivers (P <.01). After exposure to OSCAR, the majority of the participants confirmed that changes had occurred in at least one of their abilities. Moreover, half of the older drivers reported having started using 6 or more compensatory strategies. CONCLUSION: In summary, in addition to increasing older adults' interest, openness, and knowledge to discussion about driving, OSCAR also improved awareness of the changes that could negatively impact safe driving and enhanced utilization of compensatory strategies. While promoting safe driving and the prevention of crashes and injuries, this intervention could ultimately help older adults maintain or increase their transportation mobility. More studies are needed to further evaluate OSCAR and identify ways to improve its effectiveness.

Comparison between younger and older drivers of the effect of obstacle direction on the minimum obstacle distance to brake and avoid a motor vehicle accident.

Our objectives were to determine the effects of age and direction of appearance of an obstacle on the minimum obstacle distance to brake and avoid a motor vehicle accident. Ten younger and 10 older drivers were tested in a custom-made driving simulator using an animation of a straight suburban road. Driving at 50 km/h, participants suddenly encountered pedestrians appearing at increasingly closer distances in front, from the left or from the right. They then had to brake as fast as possible and come to a complete stop before running over the pedestrian. Results showed that older drivers had 1.8m greater minimum obstacle distance than younger drivers. This decreased ability with age appeared to be due to a decline in response initiation. Pedestrians appearing from the periphery also resulted in 2.1m (left) and 2.8m (right) greater minimum obstacle distance than those appearing directly in front. This decreased ability with obstacle direction appeared to be mostly due to declines in response initiation and response geometry. Finally, the difference with age was greater when pedestrians appeared from the right compared to the left or front. Therefore, it is important to include both temporal and geometrical performance measures in studies on motor vehicle accidents.