"My Biggest Fear Is She'll Die Alone": Care Partner Perspectives of Institutional COVID-19 Visitor Restrictions in Ontario, Canada.

In March 2020, the Government of Ontario, Canada implemented public health measures, including visitor restrictions in institutional care settings, to protect vulnerable populations, including older adults (> 65 years), against COVID-19 infection. Prior research has shown that visitor restrictions can negatively influence older adults' physical and mental health and can cause increased stress and anxiety for care partners. This study explores the experiences of care partners separated from the person they care for because of institutional visitor restrictions during the COVID-19 pandemic. We interviewed 14 care partners between the ages of 50 and 89; 11 were female. The main themes that emerged were changing public health and infection prevention and control policies, shifting care partner roles as a result of visitor restrictions, resident isolation and deterioration from the care partner perspective, communication challenges, and reflections on the impacts of visitor restrictions. Findings may be used to inform future health policy and system reforms.

Examining the Needs of Family Caregivers of People Living with Dementia in the Community during the COVID-19 Pandemic.

The COVID-19 pandemic has had a disproportionate effect on older adults and their family caregivers (FCGs). For FCGs, the pandemic has impacted almost every dimension of their lives and caregiving routines, from their own risk of becoming ill to their access to resources that support caregiving. The purpose of this mixed-methods study was to examine the impact of COVID-19 on FCGs' ability to provide care for their family member with dementia. A total of 115 FCGs who identified as having their family member living with dementia residing in the community completed the survey. Ten family caregivers participated in the follow-up focus groups. Recommendations to address the needs of FCGs now and in the future include: (1) making resources for care provision consistently available and tailored, (2) providing support for navigating the health care system, and (3) supplying concise information on how to provide care during public health emergencies.

Educational trajectories, health and longevity

The working group of the Academies of Medicine of France and Mexico initiated its work after the first wave of the COVID 19 pandemic, during which the severity of the disease in certain countries was attributed to a lack of basic education of the population. The study continued and expanded to better understand the roles of basic education and health education on overall health and longevity. This work has demonstrated that, alongside genetics, the affective and educational family environment but also the general one greatly interferes from the very first days of life. Thus, epigenetics plays a major role in the determination of health and disease (DOHAD) as well as in the characterization of gender. Other factors such as socio-economic level, parental education, school in urban or rural areas play a major role in the differential acquisition of health literacy. This determines adherence or not to healthy lifestyles, risky behaviors, substance abuse, but also compliance with hygiene rules and adherence to vaccines and treatments. The combination of all these elements and lifestyle choices facilitates the emergence of metabolic disorders (obesity, diabetes) which promote cardiovascular and kidney damages and neurodegenerative diseases, explaining that the less educated have a shorter survival while they spend more years of life in disability. After having demonstrated the impact of the educational level on health and longevity, the members of the inter-academic group propose specific educational actions at three levels: 1) Children, their parents, and teachers, 2) health professionals and 3) aging people, after emphasizing that these crucial actions can only be carried out with the unfailing support of state and academic authorities. © 2023 l'Académie nationale de médecine Le groupe de travail des Académies de Médecine de France et du Mexique a initié son travail après que la sévérité de la première vague de la pandémie Covid 19 de certains pays ait été corrélée à un manque d'éducation de base de leur population. La réflexion s'est poursuivie et étendue pour mieux comprendre les rôles de l'éducation de base et de l'éducation en santé sur la santé globale et la longévité. Ce travail montre qu'à côté de la génétique, l'épigénétique interfère de façon majeure dès les tous premiers jours de la vie dans la détermination de la santé et des maladies (DOHAD) ainsi que dans la caractérisation du genre. D'autres facteurs environnementaux et/ou éducatifs, comme le niveau socioéconomique ou les modalités de scolarisation (urbain ou rural) interviennent également dans l'acquisition différentielle d'une littératie en santé. Celle-ci détermine l'adhésion ou non à des styles de vie saine, à des comportements à risque, à l'abus de substances, mais aussi au respect des règles d'hygiène et à l'adhésion aux vaccins. Tous ces éléments et choix de vie se conjuguent entre eux pour faciliter la survenue ou la gravité de pathologies. Ainsi, les troubles métaboliques (obésité, diabète) surviennent plus souvent chez les moins éduqués, favorisant les atteintes cardiovasculaires, rénales et les maladies neurodégénératives. Globalement, les personnes moins éduquées vivent moins longtemps après avoir passé plus d'années de vie en incapacité fonctionnelle et dépendance. Après avoir démontré l'impact du niveau éducatif sur la santé et la longévité, les membres du groupe interacadémique déclarent l'urgence des actions à entreprendre et proposent des actions éducatives spécifiques à trois niveaux : 1) les enfants, leurs parents et les enseignants, 2) les professionnels de santé et 3) les personnes vieillissantes, tout en soulignant que ces actions cruciales ne pourront être menées qu'avec le soutien indispensable des autorités étatiques et académiques. © 2023 l'Académie nationale de médecine

Character Strengths and Resilience in Older Adults during the COVID-19 Pandemic.

During the pandemic, older adults were perceived as a vulnerable group without considering their various strengths. This study explored the associations between character strengths and resilience, and verified if some of these could predict resilience during the COVID-19 pandemic. A sample of 92 participants (women = 79.1%), ≥ 70 years of age (mean = 75.6 years), completed an online version of the Values in Action Inventory of Strengths - Positively keyed (VIA-IS-P) to assess 24 character strengths (grouped under six virtues) and the Connor and Davidson Resilience Scale. Results showed that 20 of the 24 strengths correlated positively and significantly with resilience. A multiple regression analysis revealed that the virtues of courage and transcendence, as well as attitudes toward aging, uniquely predicted the level of resilience. Interventions should be developed to improve certain strengths (e.g., creativity, zest, hope, humor, and curiosity), while reducing ageism, in order to promote resilience.

Developing the Patient Falls Risk Report: A Mixed-Methods Study on Sharing Falls-Related Clinical Information from Home Care with Primary Care Providers.

If interRAI home care information were shared with primary care providers, care provision and integration could be enhanced. The objective of this study was to co-develop an interRAI-based clinical information sharing tool (i.e., the Patient Falls Risk Report) with a sample of primary care providers. This mixed-methods study employed semi-structured interviews to inform the development of the Patient Falls Risk Report and online surveys based on the System Usability Scale instrument to test its usability. Most of the interview sample (n = 9) believed that the report could support patient care by sharing relevant and actionable falls-related information. However, criticisms were identified, including insufficient detail, clarity, and support for shared care planning. After incorporating suggestions for improvement, the survey sample (n = 27) determined that the report had excellent usability with an overall usability score of 83.4 (95% CI = 78.7-88.2). By prioritizing the needs of end-users, sustainable interRAI interventions can be developed to support primary care.

Older Adults and Social Isolation and Loneliness During the COVID-19 Pandemic: An Integrated Review of Patterns, Effects, and Interventions.

A scoping review was conducted to identify patterns, effects, and interventions to address social isolation and loneliness among community-dwelling older adult populations during the COVID-19 pandemic. We also integrated (1) data from the Canadian Longitudinal Study on Aging (CLSA) and (2) a scan of Canadian grey literature on pandemic interventions. CLSA data showed estimated relative increases in loneliness ranging between 33 and 67 per cent depending on age/gender group. International studies also reported increases in levels of loneliness, as well as strong associations between loneliness and depression during the pandemic. Literature has primarily emphasized the use of technology-based interventions to reduce social isolation and loneliness. Application of socio-ecological and resilience frameworks suggests that researchers should focus on exploring the wider array of potential pandemic age-friendly interventions (e.g., outdoor activities, intergenerational programs, and other outreach approaches) and strength-based approaches (e.g., building community and system-level capacity) that may be useful for reducing social isolation and loneliness.

Culture Change in Long-Term Care-Post COVID-19: Adapting to a New Reality Using Established Ideas and Systems.

The response to the COVID-19 pandemic in long-term care (LTC) has threatened to undo efforts to transform the culture of care from institutionalized to de-institutionalized models characterized by an orientation towards person- and relationship-centred care. Given the pandemic's persistence, the sustainability of culture-change efforts has come under scrutiny. Drawing on seven culture-change models implemented in Canada, we identify organizational prerequisites, facilitatory mechanisms, and frontline changes relevant to culture change that can strengthen the COVID-19 pandemic response in LTC homes. We contend that a reversal to institutionalized care models to achieve public health goals of limiting COVID-19 and other infectious disease outbreaks is detrimental to LTC residents, their families, and staff. Culture change and infection control need not be antithetical. Both strategies share common goals and approaches that can be integrated as LTC practitioners consider ongoing interventions to improve residents' quality of life, while ensuring the well-being of staff and residents' families.

Co-Designing Together through Crisis: Development of a Virtual Care Guidance Document to Support Providers, Older Adults, and Caregivers.

COVID-19 has had a disproportionate and devastating impact on older adults. As health care resources suddenly shifted to emergency response planning, many health and community support services were cancelled, postponed, or shifted to virtual care. This rapid transformation of geriatric care resulted in an immediate need for practical guidance on decision making, planning and delivery of virtual care for older adults and caregivers. This article outlines the rapid co-design process that supported the development of a guidance document intended to support health and community support services providers. Data were collected through consultation sessions, surveys, and a rapid literature review, and analyzed using appropriate qualitative and quantitative methods. Although this work took place within the context of the COVID-19 pandemic, the resulting resources and lessons learned related to collective impact, co-design, population-based planning, and digital technologies can be applied more broadly.

"We've All Lost So Much": The Long-Term Care Home Experiences of Essential Family Caregivers During COVID-19.

BACKGROUND: During the coronavirus (COVID-19) pandemic, long-term care homes (LTCHs) imposed visitor restrictions that prevented essential family caregivers (EFCs) from entering the homes. Under these policies, EFCs had to engage in virtual, window, and outdoor visits, prior to the re-initiation of indoor visits. OBJECTIVE: To understand EFCs' visitation experiences with LTCH residents during COVID-19. METHODS: Seven virtual focus groups with EFCs were conducted and analysed using a thematic approach. FINDINGS: Six themes were identified: (a) inconsistent and poor communication; (b) lack of staffing and resources; (c) increasing discord between EFCs and staff during COVID-19; (d) shock related to reunification; (e) lack of a person-centred or family-centred approach; and, (f) EFC and resident relationships as collateral damage. DISCUSSION: Our findings reflect how EFCs' visitation experiences were affected by factors at the individual, LTCH, and health-system levels. Future sectoral responses and visitation guidelines should recognize EFCs as an integral part of the care team.

Rapport 23-04. Rapport inter-académique. Trajectoires éducatives, santé et longévité

Résumé Le groupe de travail des Académies de Médecine de France et du Mexique a initié son travail après que la sévérité de la première vague de la pandémie Covid 19 de certains pays ait été corrélée à un manque d'éducation de base de leur population. La réflexion s'est poursuivie et étendue pour mieux comprendre les rôles de l'éducation de base et de l'éducation en santé sur la santé globale et la longévité. Ce travail montre qu'à côté de la génétique, l'épigénétique interfère de façon majeure dès les tous premiers jours de la vie dans la détermination de la santé et des maladies (DOHAD) ainsi que dans la caractérisation du genre. D'autres facteurs environnementaux et/ou éducatifs, comme le niveau socioéconomique ou les modalités de scolarisation (urbain ou rural) interviennent également dans l'acquisition différentielle d'une littératie33Littératie en santé : capacité pour une personne de comprendre et utiliser des informations médicales dans l'objectif de gérer sa santé et de pouvoir communiquer avec les divers services de soins. en santé. Celle-ci détermine l'adhésion ou non à des styles de vie saine, à des comportements à risque, à l'abus de substances, mais aussi au respect des règles d'hygiène et à l'adhésion aux vaccins. Tous ces éléments et choix de vie se conjuguent entre eux pour faciliter la survenue ou la gravité de pathologies. Ainsi, les troubles métaboliques (obésité, diabète) surviennent plus souvent chez les moins éduqués, favorisant les atteintes cardiovasculaires, rénales et les maladies neurodégénératives. Globalement, les personnes moins éduquées vivent moins longtemps après avoir passé plus d'années de vie en incapacité fonctionnelle et dépendance. Après avoir démontré l'impact du niveau éducatif sur la santé et la longévité, les membres du groupe interacadémique déclarent l'urgence des actions à entreprendre et proposent des actions éducatives spécifiques à trois niveaux : 1) les enfants, leurs parents et les enseignants, 2) les professionnels de santé et 3) les personnes vieillissantes, tout en soulignant que ces actions cruciales ne pourront être menées qu'avec le soutien indispensable des autorités étatiques et académiques. Summary The working group of the Academies of Medicine of France and Mexico initiated its work after the first wave of the COVID 19 pandemic, during which the severity of the disease in certain countries was attributed to a lack of basic education of the population. The study continued and expanded to better understand the roles of basic education and health education on overall health and longevity. This work has demonstrated that, alongside genetics, the affective and educational family environment but also the general one greatly interferes from the very first days of life. Thus, epigenetics plays a major role in the determination of health and disease (DOHAD) as well as in the characterization of gender. Other factors such as socio-economic level, parental education, school in urban or rural areas play a major role in the differential acquisition of health literacy. This determines adherence or not to healthy lifestyles, risky behaviors, substance abuse, but also compliance with hygiene rules and adherence to vaccines and treatments. The combination of all these elements and lifestyle choices facilitates the emergence of metabolic disorders (obesity, diabetes) which promote cardiovascular and kidney damages and neurodegenerative diseases, explaining that the less educated have a shorter survival while they spend more years of life in disability. After having demonstrated the impact of the educational level on health and longevity, the members of the inter-academic group propose specific educational actions at three levels: 1) Children, their parents, and teachers, 2) health professionals and 3) aging people, after emphasizing that these crucial actions can only be carried out with the unfailing support of state and academic authorities.

COVID-19: Pandemic Risk, Resilience and Possibilities for Aging Research

The COVID-19 global crisis is reshaping Canadian society in unexpected and profound ways. The significantly higher morbidity and mortality risks by age suggest that this is largely a "gero-pandemic,” which has thrust the field of aging onto center stage. This editorial emphasizes that vulnerable older adults are also those most affected by COVID-19 in terms of infection risk, negative health effects, and the potential deleterious outcomes on a range of social, psychological, and economic contexts – from ageism to social isolation. We also contend that the pathogenic analysis of this pandemic needs to be balanced with a salutogenic approach that examines the positive adaptation of people, systems and society, termed COVID-19 resilience. This begs the question: how and why do some older adults and communities adapt and thrive better than others? This examination will lead to the identification and response to research and data gaps, challenges, and innovative opportunities as we plan for a future in which COVID-19 has become another endemic infection in the growing list of emerging and re-emerging pathogens.

Digital Immunization Tracking in Long-Term Care and Assisted Living Facilities.

A disproportionate share of the health impacts of COVID-19 has been borne by older adults, particularly those in long-term care facilities (LTCs). Vaccination has been critical to efforts to combat this issue, but as we begin to emerge from this pandemic, questions remain about how to protect the health of residents of LTC and assisted living facilities proactively in order to prevent such a disaster from occurring again. Vaccination, not just against COVID-19, but also against other vaccine-preventable illness, will be a key component of this effort. However, there are currently substantial gaps in the uptake of vaccines recommended for older adults. Technology offers an opportunity to assist in filling these vaccination gaps. Our experiences in Fredericton, New Brunswick suggest that a digital immunization solution would facilitate better uptake of adult vaccines for older adults in assisted and independent living facilities and would help policy and decision makers to identify coverage gaps and develop interventions to protect these individuals.

Pandemic Stories: The Voices of Older Adults.

To document the reactions and experiences of older persons during the COVID-19 pandemic, we have conducted a qualitative study of 25 older adults (50 years of age and older) throughout the pandemic, using serial interviewing methods. This analysis reports on the data collected from the first two rounds of interviews - one conducted in the summer of 2020 and one conducted in the fall of 2020. Our thematic analysis found eight major themes: thoughts on the dangers of the pandemic, how the virus has changed daily life (including social life), health care during COVID (being a caregiver, losing a loved one, seeking health care), missing spontaneity and dealing with existential dread, the growing frustration, seeking connection through civic participation, adaptation and resilience, and the social ills that the pandemic has revealed. These stories describe both loneliness and connection, hope coupled with disappointment, but overwhelmingly, an insight into what the pandemic has shown us about the social ills that it has revealed.

Multimorbidity Treatment Burden Questionnaire (MTBQ): Translation, Cultural Adaptation, and Validation in French-Canadian.

Reliable treatment burden measures are needed given the aging population and the associated increase in multimorbidity and polypharmacy. Treatment burden is defined as the effort to care for one's health and the resulting impact on one's daily life. This study aimed to translate the Multimorbidity Treatment Burden Questionnaire (MTBQ) for French-Canadians and assess its reliability and validity. The MTBQ was translated and tested with cognitive debriefing interviews, and the French version (MTBQ-F) was then administered 2 times among 105 participants. Reliability and validity were examined using the intra-class correlation coefficient (ICC), Cronbach's alpha, and Spearman's correlations. The median global MTBQ-F scores were 32.69 (interquartile range [IQR]: 21.15-48.08) and 30.77 (IQR: 21.15-46.15) for the first and second administrations, respectively. Test-retest (ICC: 0.73; 95% CI: 0.63-0.81) and internal consistency reliability (Cronbach's alpha: 0.80) were good. There was a moderate positive correlation between the MTBQ-F score and the number of self-reported conditions (rho: 0.28). This valid instrument could identify patients experiencing a high treatment burden and assess the impact of interventions among them.

Providing long‐term care: Options for a better workforce

Older people and their care workers have been disproportionately affected by the COVID‐19 pandemic. Many OECD Member countries have taken measures to contain the spread of the infection and improve the care workforce. Yet the health crisis is highlighting and exacerbating pre‐existing structural problems in the long‐term care (LTC) sector. In many OECD Member countries, recruiting enough workers in LTC remains a challenge and care workers experience difficult working conditions. Skills mismatch and poor integration with the rest of health care lie at the root of preventable hospital admissions even in normal times. Such challenges are likely to become ever more acute if no further action is taken given the speed of population ageing. Policies to improve recruitment and which also address retention through training, improvements in coordination and productivity, leveraging the effect of digital technologies, are needed.Alternate :Les personnes âgées et leurs soignants ont été touchés de manière disproportionnée par la pandémie de COVID‑19. De nombreux pays de l’OCDE ont pris des mesures pour empêcher la propagation de l’infection et augmenter le nombre de soignants. Néanmoins la crise sanitaire met en lumière et exacerbe les problèmes structuraux existants dans le secteur des soins de longue durée. Dans de nombreux pays membres de l’OCDE, le recrutement d’un nombre de travailleurs suffisants dans le domaine des soins de longue durée demeure un défi et les soignants ont des conditions de travail difficiles. L’inadéquation des compétences et une mauvaise intégration avec le reste des soins de santé donnent lieu à des hospitalisations évitables, même en temps normal. Compte tenu de la vitesse à laquelle la population vieillit, ces défis sont susceptibles de s’accentuer encore plus si aucune autre action n’est entreprise. Il est nécessaire de mettre en œuvre des politiques visant à améliorer le recrutement et permettant de maintenir les effectifs via la formation, des améliorations dans la coordination et la productivité, tout en tirant parti de l’effet des technologies numériques.Alternate :La pandemia de COVID‐19 ha afectado de forma desproporcionada a las personas de la tercera edad y sus proveedores de cuidados. Muchos países miembros de la Organización de Cooperación y Desarrollo Económicos (OCDE) han adoptado medidas encaminadas a evitar que la infección se propague y aumentar el número de proveedores de cuidados. A pesar de ello, la crisis sanitaria está poniendo de relieve y agravando los problemas estructurales existentes en el sector de los cuidados de larga duración. En muchos países miembros de la OCDE, la contratación de un número suficiente de proveedores de cuidados de larga duración sigue constituyendo un desafío y las condiciones de trabajo de dichos proveedores son complejas. Incluso en circunstancias normales, se registran hospitalizaciones evitables debido a competencias inadecuadas y a la escasa integración con el resto del sistema de atención de salud. Habida cuenta de la velocidad a la que envejece la población, es probable que estos problemas se agraven si no se adoptan medidas al respecto. Se precisan políticas que tengan por objetivo mejorar la contratación y abordar la retención mediante programas de formación, mejoras en materia de coordinación y de productividad, e iniciativas de aprovechamiento de las tecnologías digitales.Alternate :Ältere Menschen und ihre Pflegekräfte sind von der COVID‐19‐Pandemie unverhältnismäßig stark betroffen worden. Viele OECD‐Mitgliedstaaten haben Maßnahmen ergriffen, um die Ausbreitung der Infektion einzudämmen und das Pflegepersonal zu fördern. Die Gesundheitskrise verdeutlicht und verschärft jedoch bereits bestehende strukturelle Probleme im Langzeitpflegebereich. In vielen OECD‐Mitgliedstaaten ist es nach wie vor eine Herausforderung, genügend Arbeitskräfte für die Langzeitpflege zu finden, und die Arbeitsbedingungen für Pflegekräfte si d schwierig. Ein Qualifikationsdefizit und eine unzureichende Einbindung in die übrige Gesundheitsversorgung sind die Ursache für vermeidbare Krankenhauseinweisungen selbst in normalen Zeiten. Diese Herausforderungen werden wahrscheinlich immer akuter werden, wenn angesichts der raschen Alterung der Bevölkerung keine weiteren Maßnahmen ergriffen werden. Es bedarf Strategien zur Verbesserung der Personalrekrutierung und der Personalbindung durch Fortbildung, Verbesserung der Koordinierung und der Produktivität unter Nutzung der Wirkung digitaler Technologien.Alternate :Пандемия COVID‑19 оказала неравнозначное влияние на пожилых людей и персонал по уходу за ними. Многие страны‐члены ОЭСР принимают меры, чтобы контролировать распространение инфекции и улучшать качество рабочей силы в сфере ухода. Однако кризис в области здравоохранения выдвигает на первый план и усугубляет ранее существовавшие структурные проблемы в области долгосрочного ухода (ДУ). Во многих странах‐членах ОЭСР найм достаточного количества работников для ДУ остаётся проблемой, а сами работники в сфере ухода имеют тяжёлые условия труда. Даже и в обычные времена несоответствие навыков и плохое взаимодействие с остальными службами здравоохранения лежат в основе предотвратимых госпитализаций. Учитывая скорость старения населения, такие проблемы, вероятно, ещё сильнее обострятся, если в дальнейшем не будут приниматься соответствующие меры. Необходимы меры по улучшению ситуации с набором персонала, а также по удержанию работников посредством тренингов, улучшения координации работы и продуктивности, эффективного использования цифровых технологий.Alternate :老年人及其照护工作人员遭受了新冠肺炎大流行病不成比例的影响。许多经合组织成员国已采取措施控制感染传播并改善照护人员队伍。然而, 这场健康危机正凸显并加剧长期照护部门业已存在的结构性问题。在许多经合组织成员国, 招聘足够的长期照护工作人员仍然是一项挑战, 照护人员也面临着艰难的工作条件。即使在正常情况下,可避免入院问题的根源在于技能不匹配以及与其他卫生健康部门的整合不力。鉴于人口老龄化速度, 如不采取进一步行动, 这些挑战可能会变得更加严峻。需要制定政策来改善招聘, 并通过培训、改善协调和生产力以及利用数字技术成果来留住人才。Alternate :تأثر كبار السن والعاملين في مجال رعايتهم بشكل غير متناسب بجائحة كوفيد‐19. واتخذت العديد من البلدان الأعضاء في منظمة التعاون والتنمية في الميدان الاقتصادي ، لا يزال توظيف عدد كافٍ من العاملين في مجال الرعاية طويلة الأمد يمثل تحديًا ويواجه العاملون في المجال ذاته ظروف عمل صعبة. ويكمن عدم تطابق المهارات وضعف التكامل مع بقية جوانب الرعاية الصحية في أساسمنظمة التعاون والتنمية في الميدان الاقتصاديتدابير لاحت٠اء انتشار العدوى وتحسين القوى العاملة في مجال الرعاية. ومع ذلك، فإن الأزمة الصحية تسلط الضوء على المشاكل الهيكلية الموجودة مسبقًا وتؤدي إلى تفاقمها في قطاع الرعاية طويلة الأمد. وفي العديد من البلدان الأعضاء في الإستشفاءات التي يمكن الوقاية منها، حتى في الأوقات العادية. ومن المرجح أن تصبح مثل هذه التحديات أكثر حدة إذا لم يتم اتخاذ مزيد من الإجراءات بالنظر إلى سرعة شيخوخة السكان. وهناك حاجة إلى سياسات لتحسين التوظيف والتي تتناول الاستبقاء من خلال التدريب، وتحسين التنسيق والإنتاجية، والاستفادة من تأثير التكنولوجيات الرقمية.Alternate :Os idosos e seus profissionais de saúde foram desproporcionalmente afetados pela pandemia de Covid‐19. Muitos países membros da OCDE tomaram medidas para conter a propagação da infecção e melhorar a mão de obra assistencial. No entanto, a crise da saúde está destacando e agravando os problemas estruturais preexistentes no setor de cuidados de longa duração (LTC). Em muitos países membros da OCDE, o recrutamento de trabalhadores suficientes para LTC continua sendo um desafio e os profissionais de saúde vivenciam condições de trabalho difíceis. A incompatibilidade de competências e a integração deficiente com o restante dos cuidados de saúde estão na raiz das internações hospitalares evitáveis, até mesmo em tempos normais. Esses desafios provavelmente se tornarão cada vez mais intensos se nenhuma ação adicional for tomada, considerando‐se a velocidade do envelhecimento da população. Há necessidade de políticas para melhorar o recrutamento e que também abordem a retenção por meio de treinamento, melhorias na coordenação e na produtividade, aproveitando o efeito das tecnologias digitais.

"It Makes You Feel Good to Help!": An Exploratory Study of the Experience of Peer Mentoring in Long-Term Care.

Social isolation and loneliness in long-term care settings are a growing concern. Drawing on concepts of social citizenship, we developed a peer mentoring program in which resident mentors and volunteers formed a team, met weekly for training, and paired up to visit isolated residents. In this article, we explore the experiences of the resident mentors. As part of a larger mixed-methods study conducted in 10 sites in Canada, we interviewed mentors (n = 48) and analysed data using inductive thematic analysis. We identified three inter-related themes: Helping others, helping ourselves described the personal benefits experienced through adopting a helping role; Building a bigger social world encapsulated new connections with those visited, and; Facing challenges, learning together described how mentors dealt with challenges as a team. Our findings suggest that a structured approach to mentoring benefits residents and helps them feel confident taking on a role supporting their isolated peers.

En temps d’épidémie et de vie ordinaire : le monde de la vieillesse dans l’œuvre d’Albert Camus

Résumé En réponse à l’absurdité du monde, Albert Camus a souhaité que la révolte n’enferme pas les êtres humains dans la passivité mais les porte à agir pour défendre la liberté, la justice et pour soulager les souffrances. Camus a souhaité ainsi illustrer dans ses œuvres une éthique de la compréhension. Le roman La Peste raconte une épidémie s’abattant sur une ville et qui décime toutes les générations. Qu’en fut-il alors de la place des personnes âgées dans ce drame ? L’expérience de la pandémie à SARS-CoV-2 qui, elle, a frappé électivement les personnes âgées incitait à explorer cette question qui, au-delà de la pandémie, questionne sur la vision d’une société sur les personnes âgées et sur les relations intergénérationnelles. Il était alors tentant de parcourir l’ensemble de l’œuvre de Camus pour s’interroger sur le regard qu’il portait sur les vieux, lui, révolté contre un monde absurde mais soucieux de résister, lui qui faisait dire au Docteur Rieux, parcourant la ville pour visiter ses malades, qu’un monde sans amour était comme un monde mort. Le regard que porte Camus sur les vieux et les vieilles mérite d’être médité dans le monde d’aujourd’hui. Summary In reaction to the absurdity of the world, Albert Camus hoped that revolt would not imprison human beings in passivity but would lead them to act in defence of freedom, justice and the relief of suffering. Camus thus aimed in his writings to set out “an ethic of understanding”. His novel The Plague tells of an epidemic that strikes a city and decimates all generations. What was the place of the elderly in this catastrophe? The experience of the SARS-CoV-2 pandemic, which mainly affected the elderly, prompted us to explore this issue, which, beyond the pandemic, raises questions about a society's view of the elderly and about intergenerational relationships. It was then tempting to peruse the whole of Camus's writings and to explore the way he viewed the elderly - he who rose up against an absurd world but was intent on resisting it, he who had Doctor Rieux, visiting his patients across the city, say that a world without love was like a dead world. Camus’ view of old people deserves to be pondered in today's world.

Aligning Virtual Care in Canada with the Needs of Older Adults.

Public health measures associated with coronavirus disease (COVID-19) have accelerated the adoption of virtual health care across Canada. We explore the opportunities that virtual care presents in achieving the Quadruple Aim and challenges to navigate, through the lens of care for older adults. In particular, we recommend virtual care-related policies related to older adults that address (a) limited uptake among the socio-economically disadvantaged, (b) user-centered design of virtual care technologies, and (c) integration of iterative evaluations to ensure equitable and efficient achievement of desired outcomes. As virtual care accelerates forward, we must not leave older Canadians behind.

Imperfect Solutions to the Neoliberal Problem of Public Aging: A Critical Discourse Analysis of Public Narratives of Long-Term Residential Care.

Public representations of long-term residential care (LTRC) facilities have received limited focus in Canada, although literature from other countries indicates that public perceptions of LTRC tend to be negative, particularly in contexts that prioritize aging and dying in place. Using Manitoba as the study context, we investigate a question of broad relevance to the Canadian perspective; specifically, what are current public perceptions of the role and function of long-term care in the context of a changing health care system? Through critical discourse analysis, we identify four overarching discourses dominating public perceptions of LTRC: the problem of public aging, LTRC as an imperfect solution to the problem, LTRC as ambiguous social spaces, and LTRC as a last resort option. Building on prior theoretical work, we suggest that public perceptions of LTRC are informed by neoliberal discourses that privilege individual responsibility and problematize public care.

A Scoping Review of Care Trajectories across Multiple Settings for Persons with Dementia.

Multiple transitions across care settings can be disruptive for older adults with dementia and their care partners, and can lead to fragmented care with adverse outcomes. This scoping review was conducted to identify and classify care trajectories across multiple settings for people with dementia, and to understand the prevalence of multiple transitions and associated factors at the individual and organizational levels. Searches of three databases, limited to peer-reviewed studies published between 2007 and 2017, provided 33 articles for inclusion. We identified 26 distinct care trajectories. Common trajectories involved hospital readmission or discharge from hospital to long-term care. Factors associated with transitions were identified mainly at the level of demographic and medical characteristics. Findings suggest a need for investing in stronger community-based systems of care that may reduce transitions. Further research is recommended to address knowledge gaps about complex and longitudinal care trajectories and trajectories experienced by sub-populations of people living with dementia.