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.

Negotiating access to a diagnosis of dementia: Implications for policies in health and social care.

The 'Pathways to Diagnosis' study captured the experience of the prediagnosis period of Alzheimer's disease and related dementias through indepth interviews with 29 persons with dementia and 34 of their family caregivers across four sites: anglophones in Calgary, francophones in Ottawa, Chinese-Canadians in Greater Vancouver and Indo-Canadians in Toronto. In this cross-site analysis, we use the 'Candidacy' framework to comprehensively explore the challenges to securing a diagnosis of dementia in Canada and to develop relevant health and social policy. Candidacy views eligibility for appropriate medical care as a process of joint negotiation between individuals and health services, which can be understood relative to seven dimensions: identification of need, navigation, appearances at services, adjudication by providers, acceptance of/resistance to offers, permeability of services and local conditions. Interviewees experienced challenges relative to each of the seven dimensions and these varied in form and emphasis across the four ethno-linguistic groups.

The role of physical environment in supporting person-centered dining in long-term care: a review of the literature.

The physical environment of dining rooms in long-term care facilities is increasingly recognized as an important catalyst in implementing a culture based on person-centered care philosophy. Mealtimes are important opportunities to support residents' personhood in care facilities. This article presents a critical review of the literature on evidence-based physical environmental interventions and examines their implications for creating a more person-centered dining environment, specifically for residents with dementia. The review identifies the role of a supportive dining environment to foster: a) functional ability, b) orientation, c) safety and security, d) familiarity and home-likeness, e) optimal sensory stimulation, f) social interaction, and g) privacy and personal control. It is clear from this review that there is a growing body of research to support the importance of certain physical environmental features in the dining context that can foster positive resident outcomes. The evidence indicates that well-designed physical settings play an important role in creating a person-centered dining environment to support best possible mealtime experience of residents. Gaps in the literature and directions for future research are discussed.