Volunteering among Older Adults and Effects of Ethnic Minority Status before and during the COVID-19 Pandemic: Longitudinal Analyses of the CLSA.

The COVID-19 pandemic has presented numerous challenges to older adults in Canada, including the ability to volunteer. The purpose of this study is to improve the understanding of the social context surrounding volunteering in Canada, by (a) determining changes in associations between human, social, and cultural capital and volunteering among older adults; and (b) examining the relationship between ethnic minority status and volunteering, using data from the Canadian Longitudinal Study on Aging (CLSA), collected prior to and during the pandemic. This study utilized data from 24,306 CLSA Baseline, Follow-up 1 (FUP1), and COVID-19 Baseline Survey participants (aged 55+). Results confirm a decrease in volunteering during the early stages of the pandemic. Compared to pre-pandemic associations, volunteers during the early stages of the pandemic were more likely to be young-old, male, employed, and not involved in religious activities. Findings provide evidence of pandemic effects on volunteering among older adults in Canada.

Student Preferences for Virtual or In-Person Interprofessional Education Simulations.

The COVID-19 pandemic created a shift in interprofessional education (IPE) courses, causing programs to change pedagogical approaches. We sought to examine student preferences for taking IPE simulations. On post-simulation surveys from two courses (n=844 students, 2020-2022 academic years), we asked students if they preferred to take the simulation through a synchronous in-person or virtual format. More students preferred a virtual platform in academic year 2021-2022 than the previous year (p<0.001). Students who chose the virtual format believed it was more convenient, reduced COVID-19 transmission, and eased interprofessional collaboration. The downsides to in-person simulations included travel logistics and technical challenges in the simulation lab. Students suggested that in-person simulations more closely resembled 'real life' and that communication and body language are easier to convey in person.

Intersections of Ageism and Homelessness Among Older Adults: Implications for Policy, Practice, and Research.

Ageism remains a key issue in gerontological literature and has long been recognized as a deeply harmful form of discrimination. Despite advances in ageism scholarship related to education, advocacy, and prevention, there are calls for ongoing intersectional examinations of ageism among minority groups and across older people facing multiple exclusions. In particular, very little ageism research has considered the experiences of age-based discrimination and prejudice among older people experiencing homelessness. We problematize this gap in knowledge and provide recommendations for policy, practice, and research to address ageist discrimination toward older people experiencing homelessness. Intersections of ageism and homelessness are summarized at four levels: intrapersonal, interpersonal, institutional/community, and societal/structural. Building upon the limited research, we recommend key strategies for supporting and protecting older people experiencing homelessness through the reduction of ageism at each level. We present these insights and recommendations as a call to action for those working in both the aging and housing/homelessness spheres.

From Sheltered in Place to Thriving in Place: Pandemic Places of Aging.

BACKGROUND AND OBJECTIVES: Response to the coronavirus disease 2019 pandemic required rapid changes to physical, social, and technological environments. There is a need to understand how independent-living older adults are adapting to pandemic-borne transformations of place and how environmental factors may shape experiences of aging well in the context of a public health emergency response. RESEARCH DESIGN AND METHODS: We conducted a photovoice study to examine the characteristics associated with aging in place. Our study investigated how independent-living older adults characterized aging in a "right" place approximately 1 year after the onset of the pandemic. RESULTS: Six themes categorized into 2 groups capture how older adults describe a "right" place to age. The first category, "places as enactors of identity and belonging," describes the significance of places contributing to intimate relationships, social connections, and a sense of personal continuity. The second category, "places as facilitators of activities and values," recognizes environments that promote health, hobbies, goals, and belief systems. Participants reported modifying their daily living environments with increased use of technology and more time outdoors. DISCUSSION AND IMPLICATIONS: Our findings emphasize older adults' active engagement with place and strategies used to maintain healthy aging despite public health restrictions. The results also identify place-based characteristics that may help overcome stressful circumstances from older adults' perspectives. These findings inform pathways to pursue to facilitate resiliency for aging in place.

Meanings of Aging in the Right Place for Older Clients of a Temporary Housing Program.

BACKGROUND AND OBJECTIVES: The concept of aging in place is acknowledged as the preference of older adults, yet without consideration of the intersections of diversity in later life, it is critiqued as unattainable, unrealistic, or even undesirable. This gave rise to the exploration of what is needed to age in the right place (AIRP). Building on existing research, we examined the meaning of AIRP to older adults (aged 55+ years) who have experienced homelessness. RESEARCH DESIGN AND METHODS: We conducted photovoice interviews with 11 residents of a temporary housing program in Metro Vancouver (Canada). RESULTS: Using thematic analysis, we organized meanings of AIRP according to (1) Where one lives-the physical and social environment, (2) Where one goes and what one does, and (3) How one feels in "the right place." DISCUSSION AND IMPLICATIONS: Participants meanings' of AIRP are applied to Maslow's hierarchy of needs. That is, when basic needs of shelter are met, participants' considerations of "the right place to age" extend beyond affordable housing to include feeling safe and comfortable in one's home and neighborhood and having access to meaningful engagement and activities-both in vibrant urban districts and naturescapes-enabled by affordable transportation. Our examination of what AIRP means to this group of older adults broadens current conceptualizations. Given the increase in homelessness among older adults, it is imperative that policymakers and practitioners are cognizant of meanings of AIRP so diverse older adults can not only age in place, but can thrive in the right place.

Correction: Mahmood et al. Aging in the Right Place for Older Adults Experiencing Housing Insecurity: An Environmental Assessment of Temporary Housing Program. Int. J. Environ. Res. Public Health 2022, 19, 14857.

Table Correction [...].

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.

Transportation needs and mobility patterns of persons experiencing homelessness following shelter decentralization.

The provision and siting of homeless emergency shelters have community-wide implications for addressing the needs of people experiencing homelessness (PEH). In Utah, Salt Lake County's transition from a large, centralized emergency shelter sited in a free transit zone to a decentralized scattered-site model outside of a no-cost transit zone provided the context to evaluate how transportation access and mobility patterns of PEH were affected as they were displaced from a centralized service network in a downtown core. We conducted 19 in-depth, semi-structured interviews with PEH aged 18 + who were staying in one of three distributed resource centers who had also previously stayed at the former centralized shelter. Thematic analysis of the interviews resulted in three categories, each with distinct sub-categories: 1) Pre-decentralization transportation and mobility, 2) Post-decentralization transportation and mobility, and 3) Recommendations to improve transportation access for PEH, including lowering or eliminating financial barriers to transportation and expanding transit and shuttle van frequency and route radius. Study findings demonstrate that there is a significant need for community planners to collaborate on the siting of homeless shelters to provide more affordable, flexible, and equitable access to transportation networks.

Aging in Place Through the COVID-19 Pandemic: Perspectives from Aging Service Providers.

Formal and informal networks of resources are critical to supporting the growing number of older adults aging in place (AIP). Data are needed from aging-service providers about assets and barriers that impact their abilities to support AIP during the pandemic, as well as emergent needs resulting from response measures. A series of World Café workshops were conducted with aging-service providers in Salt Lake City, Utah, to understand supportive factors, service gaps, and future needs. Novel domains to support AIP in the context of the pandemic were identified: digital access and literacy, social isolation and mental health, and emergency preparedness. Issues related to access, equity, and affordability were identified as overarching themes across domains. Issues reflect concern over how the pandemic exacerbated socioeconomic and cultural disparities impacting older adults who benefit from aging services. Networks of advocacy and support are needed to bolster resources for older adults, caregivers, and aging-service providers.

Age-Friendly Community Interventions for Health and Social Outcomes: A Scoping Review.

To address the numerous challenges associated with aging, increased attention has been given to the development of age-friendly cities and communities (AFCC) to promote healthy aging and social participation. However, limited evidence exists for addressing both health and social needs through the AFCC framework. We address this gap by conducting a scoping review of the interventions that target both health and social outcomes within the purview of the AFCC framework. The results showed that many of the successful interventions used a partnership model and behavioral change theories to inform the program design and implementation. The results also indicated that social participation and engagement played a key role in making the interventions successful. However, the results revealed that the literature is dominated by person-focused approaches. Future research should focus more on evaluating environmental-focused interventions and develop a holistic framework that combines both person- and environment-based approaches to healthy aging.

Delivering Services to Older Persons Experiencing Homelessness: Providers' Perspectives of What Does and Does Not Work.

Older people with experiences of homelessness (OPEH) tend to experience more complex health, social, and psychological issues than people experiencing homelessness at younger ages. Simultaneously, many housing resources (e.g., shelters, temporary housing) are often ill equipped to meet the needs of OPEH. As such, OPEH are often unable to age in the right place (AIRP) - that is, in a place that supports unique needs and vulnerabilities. However, several promising practices exist that deliver housing and services tailored to OPEH. To investigate the aspects of housing and shelter that both promote and impede AIRP for OPEH, this study examines the delivery of services in three such promising practices from the perspective of service providers. Findings from fifteen qualitative interviews revealed three overarching themes: 1) barriers to providing individualized support (e.g., staff turnover); 2) shifting contexts and structures (e.g., housing market changes); and 3) mechanisms of success (e.g., facilitating smooth transitions into permanent housing). These findings provide evidence to support the refinement of service delivery to promote AIRP for OPEH. In doing so, these insights can help to elevate promising practices to the level of best practice.

Understanding discrimination towards persons experiencing homelessness: A scoping review protocol.

INTRODUCTION: Given the increasing rates of homelessness in recent years, there is an urgent need to address the ongoing discrimination and societal disinterest in preventing, reducing and ending homelessness. There is no systematic review of experiences of stigma and discrimination among persons experiencing homelessness or interventions to combat this discrimination. The objective for the proposed study is to identify ways in which persons experiencing homelessness have been stigmatised and discriminated against, the results of these experiences, and interventions to reduce stigma and discrimination towards persons experiencing homelessness. METHODS AND ANALYSIS: We are conducting a scoping review with guidance from the JBI Manual for Evidence Synthesis and Arksey and O'Malley's framework. From 15 to 19 July 2022, we searched the following databases from our institutional licensed years of coverage: Medline, Embase, CINAHL Complete, Academic Search Ultimate, APA PsycINFO, Science Citation Index Expanded, Social Sciences Citation Index, Arts & Humanities Citation Index, Emerging Sources Citation Index, Left, PAIS International, PILOTS, Psychology & Behavioral Sciences Collection, Sociological Abstracts, and Dissertations and Theses Global. Two independent reviewers are screening study titles/abstracts and will independently screen the full texts. Study inclusion criteria include any study type reporting primary findings of English-language research on non-refugee persons experiencing homelessness in any type of setting or service worldwide. Three reviewers will then chart data of our included studies. Data will be extracted and organised into categories and subthemes in tabular form. To understand the validity of the scoping review findings in the local context and to gather additional perspectives on the topic, we will conduct an 'expert consultation' workshop. ETHICS AND DISSEMINATION: This study has ethics approval from the University of Utah Institutional Review Board. Review findings will be disseminated through a peer-reviewed journal and at conferences. We plan to preregister this protocol with Open Science Framework.

Aging in the Right Place for Older Adults Experiencing Housing Insecurity: An Environmental Assessment of Temporary Housing Program.

Research on programs offering senior-specific housing supports and enabling "aging in the right place" (AIRP) for "older persons with experiences of homelessness" (OPEH) is limited. This paper presents an environmental assessment of a "transitional housing program" (THP) in Metro Vancouver, Canada, for OPEH to AIRP. Data were collected using Aging in the Right Place Environmental (AIRP-ENV) and Secondary Observation (AIRP-ENV-SO) audit tools designed to evaluate multi-unit housing for OPEH. The 241-item AIRP-ENV tool was used to assess the built environmental features of four multi-unit buildings of the THP. The AIRP-ENV-SO tool was used to collect contextual data on the function, safety, and land use of the surrounding neighborhood. Findings identified built environment and urban design features that support THP residents' safety, security, accessibility, functionality, social activity, autonomy, and identity. The THP buildings were rated 'Good' for accessibility, functionality, autonomy and identity, while 'Satisfactory' or 'Poor' for safety, security, and social activity. Findings point to the built environmental features (e.g., size and layout of spaces) required in the THP to create opportunities for increased social engagement among residents and enhanced safety and security. The AIRP-ENV and AIRP-ENV-SO audit tools can help inform programs across the housing continuum to develop supportive built environments that promote AIRP for OPEH.

Community perspectives on how decentralising an emergency shelter influences transportation needs and use for persons experiencing homelessness.

Despite steady increases in homelessness in the U.S., only recently has research on transportation needs and use for persons experiencing homelessness (PEH) been the focus of research endeavours. Moreover, limited research has identified how the geographic relocation of homeless community services and resources impacts the transportation needs of PEH and how this process affects access to health and social services. To fill this gap in the literature, using a community-engaged research approach, we conducted a qualitative research study in which 24 professionals working in planning, transportation, local government, and the homelessness services sector were engaged in in-depth, semi-structured interviews. We examined participant perspectives on how PEH transportation needs and use changed after three new emergency shelters replaced a centralised one, and how access to health and social services was impacted. Data were organised into three overarching categories: (1) Changes in transportation need and use following decentralisation; (2) Impact of transportation changes on PEH access to services; and (3) Recommendations for improving transportation access. Findings suggest the need to offer PEH transportation on demand, provide education on transportation and system navigation, and increase transportation-related funding for homeless service providers and PEH to ensure transportation costs are not a barrier to healthcare and social services.

"A right place for everybody": Supporting aging in the right place for older people experiencing homelessness.

While policies and practices that promote aging in place have risen in prominence over the last two decades, marginalised older adults have largely been overlooked. 'Aging in the right place' is a concept that recognises the importance of adequate and appropriate age-related health and psychosocial supports in shelter/housing settings and their impact on the ability of older people to age optimally. To understand the unique shelter/housing challenges and solutions that affect aging in the right place for older people experiencing homelessness (OPEH), we conducted three World Café workshops in three Canadian cities-Montreal, Calgary, and Vancouver. In total, 89 service providers and OPEH engaged in the workshops, which involved guided, small-table discussions with the goal of stimulating creative ideas and fostering a productive atmosphere. Findings revealed two overarching themes 1) Discrepancies, between the need and availability of housing options and community supports for OPEH, such as affordable transportation, case management, access to healthcare, and system navigation; and 2) Desires, for more peer support, participatory planning, service-enriched housing, social programming, and policies that promote agency, independence, and choice for OPEH. These findings provide evidence to inform the development or modification of housing and supports for OPEH that promote aging in the right place.

Aging in the Right Place: A Conceptual Framework of Indicators for Older Persons Experiencing Homelessness.

Aging in place may not be a universally optimal goal nor accessible to all. Research has highlighted the significance of aging in the right place (AIRP) by recognizing that secure housing for older adults should support one's unique vulnerabilities and lifestyles. Despite the evolving conceptualization of AIRP for general populations of older adults, considerations of AIRP relevant for older people with previous or current experiences of homelessness are absent from the existing literature. Given this conceptual gap, we developed a framework of indicators relevant for older persons experiencing homelessness. We engaged community partners in the development of our framework and examined what had been described in prior research on aging in place and person-environment fit for older adults. The resulting conceptual framework is comprised of 6 subcategories of indicators: (a) built environment of the housing unit and surrounding neighborhood, (b) offsite and onsite health and social services and resources, (c) social integration, (d) stability and affordability of place, (e) emotional place attachment, and (f) broader political and economic contexts. This framework provides a practical and meaningful contribution to the literature which can be used to promote AIRP for individuals whose experiences are often not reflected in existing models.

Design Considerations for the Development and Implementation of a Medical Respite for Older Adults Experiencing Homelessness in Metro Vancouver.

BACKGROUND: Older persons with lived or living experience of homelessness (PWLEs) often live with complex physical and/or mental health conditions which are challenged by poor access to health services, especially primary care. To fill the gap in the continuum of care following hospital discharge for PWLEs, medical respite provides health and shelter support for PWLEs who do not have acute care needs that qualify for a stay in a hospital bed, yet are too sick or frail to recover on the streets or in a traditional shelter. OBJECTIVE: This study examines how a medical respite could be designed for older PWLEs in Metro Vancouver, BC. RESEARCH DESIGN: Using a community-based participatory research approach, in-depth interviews and focus groups were conducted with PWLE (n=15) and service provider (n=11) participants. RESULTS: Participants offered rich suggestions about (a) the culture of the medical respite, (b) the physical design of a medical respite, (c) individuals who should be involved in medical respite delivery, (d) services a medical respite should provide, and (e) who the medical respite should serve. CONCLUSIONS: When designing a medical respite for older PWLEs, considerations include providing an environment where patients can rest, but also feel safe and be surrounded by persons who they trust and who care for them. Developing a medical respite that adheres to the tenets of trauma-informed and patient-centered care acknowledges the mistrust and traumatization that often accompanies homeless patients presenting to health care.

Updated Understanding of the Experiences and Perceptions of Alcohol Use in Later Life.

The purpose of this study was to update our understandings of older adults' experiences and perceptions of alcohol use. Taking a community-based research approach, three Knowledge Café workshops hosted 66 older adults and service providers in Vancouver, BC. Thematic analysis identified three overarching categories: (a) reasons older adults use alcohol, including out of habit, social expectations, or to self-medicate; (b) personal experiences of alcohol use, including reduced consumption over time as a result of the cost of alcohol, the physical effects, and increased knowledge about the effects of alcohol; and (c) older adults' perceptions of alcohol use outcomes, including positive outcomes from drinking in moderation and negative outcomes that can worsen one's health, lead to tolerance, and harm others. Developing and promoting healthy drinking behaviours in later life is needed as the general population continues to age.

Canadian Guidelines on Alcohol Use Disorder Among Older Adults.

BACKGROUND: Alcohol use disorder (AUD) is an increasingly common, under-recognized, and under-treated health concern in older adults. Its prevalence is expected to reach unprecedented levels as the Canadian population ages. In response, Health Canada commissioned the Canadian Coalition of Seniors' Mental Health to create guidelines for the prevention, screening, assessment, and treatment of AUD in older adults. METHODS: A systematic review of English language literature from 2008-2018 regarding AUD in adults was conducted. Previously published guidelines were evaluated using AGREE II, and key guidelines updated using ADAPTE method by drawing on current literature. Recommendations were created and assessed using the GRADE method. RESULTS: Twenty-two recommendations were created. Prevention recommendations: Best advice for older adults who choose to drink is to limit intake to well below the national Low-Risk Alcohol Drinking Guidelines. Screening recommendations: Alcohol consumption should be reviewed and discussed on an annual basis by primary care providers. This type of discussion needs to be normalized and approached in a simple, neutral, straight-forward manner. Assessment recommendations: Positive screens for AUD should be followed by a comprehensive assessment. Once more details are obtained an individualized treatment plan can be recommended, negotiated, and implemented. Treatment recommendations: AUD falls on a spectrum of mild, moderate, and severe. It can also be complicated by concurrent mental health, physical, or social issues, especially in older adults. Naltrexone and Acamprosate pharmacotherapies can be used for the treatment of AUD in older adults, as individually indicated. Psychosocial treatment and support should be offered as part of a comprehensive treatment plan. CONCLUSION: These guidelines provide practical and timely clinical recommendations on the prevention, assessment, and treatment of AUD in older adults within the Canadian context.