Community Group-Based Physical Activity Programs for Immigrant Older Adults: A Systematic Realist Review.

Physical activity program interventions often lack sensitivity to the needs of older immigrant adults. The objective of this systematic realist review is to explain how, why, for whom, and under which circumstances community group-based physical activity programs work for immigrant older adults. The initial program theory was developed using prior research, team expertise, social cognitive theory, and knowledge user consultations. The program theory was tested and refined via a systematic review of the literature. Database searches were conducted in MEDLINE, EMBASE, CINAHL, Scopus, Cochrane Library, Sports Medicine and Education Index, and SPORTDiscus. A total of 22 sources of evidence met inclusion criteria and included intervention studies, systematic reviews, and a discussion paper. Intervention studies were appraised using the Mixed Methods Appraisal Tool. The final program theory constituted eight context-mechanism-outcome configurations that highlight the importance of facilitator characteristics, access to safe spaces, group dynamics, and social support. A limitation was the small number and variable quality of included evidence. Physical activity programs that target immigrant older adults must strengthen physical and psychological safety and maximize opportunities for role modeling and socialization. This research was supported by the Alberta Health Services Seniors Health Strategic Clinical Network and is registered in PROSPERO (ID#258179).

The (un)caring experienced by racialized and/or ethnoculturally diverse residents in supportive living: a qualitative study.

BACKGROUND: Racialized and/or ethnocultural minority older adults in supportive living settings may not have access to appropriate services and activities. Most supportive living facilities are mainstream (not specific to one group); however, culturally specific facilities are purpose-built to accommodate older adults from a particular group. Our objective was to describe the perspectives of diverse participants about access to culturally appropriate care, accessible services, and social and recreation activities in culturally specific and mainstream (non-specific) supportive living facilities. METHODS: We conducted semi-structured interviews with 21 people (11 staff, 8 family members, 2 residents) from 7 supportive living homes (2 culturally specific and 5 mainstream) in Alberta, Canada. We used a rapid qualitative inquiry approach to structure the data collection and analysis. RESULTS: Staff and family members described challenges in accessing culturally appropriate care in mainstream facilities. Family members expressed guilt and shame when their relative moved to supportive living, and they specifically described long waitlists for beds in culturally specific homes. Once in the facility, language barriers contributed to quality of care issues (e.g., delayed assessments) and challenges accessing recreation and social activities in both mainstream and culturally specific homes. Mainstream facilities often did not have appropriate food options and had limited supports for religious practices. Residents who had better English language proficiency had an easier transition to supportive living. CONCLUSIONS: Racialized and/or ethnoculturally diverse residents in mainstream supportive living facilities did not receive culturally appropriate care. Creating standalone facilities for every cultural group is not feasible; therefore, we must improve the care in mainstream facilities, including recruiting more diverse staff and integrating a wider range of recreation and religious services and food options.

The Lived Experiences of Spousal Bereavement and Adjustment Among Older Chinese Immigrants in Calgary.

Spousal bereavement poses considerable challenges to adults in late life. Some populations, such as older immigrants, may experience heightened negative outcomes as a consequence of spousal bereavement, due to migratory stress and social isolation. Spousal bereavement is culturally embedded as it is related to cultural beliefs and attitudes concerning death and family relationships. However, studies on spousal bereavement or widowhood among older immigrants are extremely limited. This study aims to fill the gap by exploring, via a phenomenological approach, the lived experiences of widowed older Chinese immigrants in Calgary and responding to the question: What are the lived experiences of widowed Chinese older immigrants in coping with their spousal bereavement? With the data drawn from 12 in-depth qualitative interviews, findings were categorized into individual, family, community and societal levels. Study participants experienced long-lasting grief that was private and impacted by their culture and immigration status. Although family and ethno-cultural communities provided various types of supports during participants' widowhood, they did not directly assist them in coping with spousal loss. Most participants did not access social services for bereavement support, more often relying on cultural rituals and faith practices. Findings suggest the need for culturally appropriate bereavement supports and family/community involvement for older immigrant adults who have experienced spousal loss.

Impact of the COVID-19 pandemic on Muslim older immigrants in Edmonton, Alberta: A community-based participatory research project with a local mosque.

OBJECTIVE: Older Muslim immigrants experience multiple vulnerabilities living in Canada. This study explores the experiences of Muslim older adults during the COVID-19 pandemic to identify ways to build community resilience as part of a community-based participatory research partnership with a mosque in Edmonton, Alberta. METHODS: Using a mixed-methods approach, check-in surveys (n = 88) followed by semi-structured interviews (n = 16) were conducted to assess the impact of COVID-19 on older adults from the mosque congregation. Quantitative findings were reported through descriptive statistics, and thematic analysis guided the identification of key findings from the interviews using the socio-ecological model. RESULTS: Three major themes were identified in consultation with a Muslim community advisory committee: (a) triple jeopardy leading to loneliness, (b) decreased access to resources for connectivity, and (c) organizational struggles to provide support during the pandemic. The findings from the survey and interviews highlight various supports that were missing during the pandemic for this population. CONCLUSION: The COVID-19 pandemic exacerbated the challenges associated with aging in the Muslim population and contributed to further marginalization, with mosques being sites of support during times of crises. Policymakers and service providers must explore ways of engaging mosque-based support systems in meeting the needs of older Muslim adults during pandemics.

RéSUMé: OBJECTIF: Les immigrants musulmans âgés vivant au Canada sont confrontés à des vulnérabilités multiples. Cette étude explore les expériences des personnes âgées musulmanes durant la pandémie de COVID-19 afin d'identifier des moyens pour renforcer la résilience communautaire dans le cadre d'un partenariat de recherche participative communautaire (CBPR) avec une mosquée à Edmonton, en Alberta. MéTHODES: À l'aide d'une approche à méthodes mixtes, des enquêtes de contrôle (n = 88) suivies d'entretiens semi-dirigés (n = 16) ont été menés pour évaluer l'impact du COVID-19 sur les personnes âgées de la congrégation de la mosquée. Les résultats quantitatifs ont été rapportés au moyen de statistiques descriptives, tandis que l'analyse thématique a guidé l'identification des principaux résultats des entretiens à l'aide du modèle socio-écologique. RéSULTATS: Trois thèmes majeurs ont été identifiés en concertation avec un comité consultatif de la communauté musulmane : a) triple péril menant à la solitude, b) accès réduit aux ressources pour la connectivité, et c) luttes organisationnelles pour fournir un soutien pendant la pandémie. Les résultats de l'enquête et des entretiens mettent en évidence le manque d'aides diverses à cette population durant la pandémie. CONCLUSION: La pandémie de COVID-19 a exacerbé les défis associés au vieillissement de cette population et a contribué à une marginalisation supplémentaire, les mosquées étant des sites de soutien en temps de crise. Les décideurs politiques et les prestataires de services doivent explorer les moyens d'engager les systèmes d'aide basés dans les mosquées pour répondre aux besoins des adultes musulmans âgés pendant les pandémies.

Current and Future Needs of Gerontological Social Work Practice in Alberta: Findings from the World Café at the Gerontological Symposium in Edmonton, Canada.

The growing aging population in Canada has multi-faceted psycho-social needs. Social workers are well-positioned to address these needs, despite many challenges. This paper reports findings from the World Café at the Gerontology Symposium in Alberta, Canada, held in 2018. The goal was to learn from social work practitioners, researchers, and educators (N = 49) about current and future needs of gerontological social work in Alberta. There were two research questions: 1) What strategies do social workers need on the micro, mezzo, and macro levels to help better serve the growing older adult population in Alberta? (R1) 2) How can social workers promote the value and contribution of gerontological social work within the interprofessional community? (R2) The data were analyzed using qualitative content analysis. Ten R1-related themes emerged: personal traits of a social worker; professional skills; bio-psycho-social needs of older adults; community connections; access to benefits; gerontological social work education; integrated healthcare; aging policy; ageism; and advocacy to strengthen the voice of older adults. The three R2-related themes include strengthening the status of the social work profession; building trust through demonstrated skills; and interprofessional education and practice.

Post-traumatic stress disorder (PTSD) in mid-age and older adults differs by immigrant status and ethnicity, nutrition, and other determinants of health in the Canadian Longitudinal Study on Aging (CLSA).

PURPOSE: This study aimed to address knowledge gaps about post-traumatic stress disorder (PTSD) in mid-age and older adults, with particular attention to the relationship of PTSD with nutrition and with ethnicity and immigrant status. METHODS: Binary logistic regression analysis of weighted comprehensive cohort data from the baseline Canadian Longitudinal Study on Aging (CLSA; n = 27,211) was conducted using the four-item Primary Care-PTSD tool (outcome) and immigrant status by ethnicity (Canadian-born white, Canadian-born minority, immigrant white, immigrant minority). Covariates included various social, economic, nutrition and health-related variables. RESULTS: After controlling for socioeconomic and health variables, immigrants from minority groups had significantly higher odds of PTSD compared to their Canadian-born counterparts, whereas white immigrants had lower odds of PTSD. These relationships were significantly robust across seven cluster-based regression models. After adjusting for ethnicity/immigrant status, the odds of PTSD were higher among those earning lower household incomes, widowed, divorced, or separated respondents, ever smokers, and those who had multi-morbidities, chronic pain, high nutritional risk, or who reported daily consumptions of pastries, pulses and nuts, or chocolate. Conversely, those 55 years and over, who had high waist-to-height ratio, or who consumed 2-3 fiber sources daily had significantly lower odds of PTSD. CONCLUSION: Interventions aimed at managing PTSD in mid-age and older adults should consider ethnicity, immigrant status, as well as socioeconomic, health, and nutrition status.

Refugee status is associated with double the odds of psychological distress in mid-to-late life: Findings from the Canadian Longitudinal Study on Aging.

Psychological distress is associated with a range of negative outcomes including lower quality of life and an increased risk of premature all-cause mortality. The prevalence of, and factors associated with, psychological distress among middle-aged and older Canadians are understudied. Using the Canadian Longitudinal Study on Aging (CLSA) baseline data, this study examined factors associated with psychological distress among adults between 45 and 85 years, including refugee status and a wide range of sociodemographic, health-related and social support characteristics. Psychological distress was measured by Kessler's Psychological Distress Scale-K10 scores. Bivariate and multivariable binary logistic regression analyses were conducted. The prevalence of psychological distress was significantly higher among the 244 refugees (23.8%), compared to 23,149 Canadian-born Canadians (12.8%) and 4,765 non-refugee immigrants (12.6%), despite the fact that the average time the refugees had lived in Canada was more than four decades. The results of the binary logistic regression analysis indicated refugees had twice the age-sex adjusted odds of psychological distress (OR = 2.31, 95% CI: 1.74, 3.07). Even after further adjustment for 16 potential risk factors, a significant relationship remained between refugee status and psychological distress (OR = 1.56; 95% CI = 1.12, 2.17). Other significant factors associated with psychological distress included younger age, female gender, visible minority status, lower household income, not having an undergraduate degree, multimorbidities, chronic pain, and lack of social support. Policies and interventions addressing psychological distress among Canadians in mid- to later life should target refugees and other vulnerable groups.

Nutritional Factors, Physical Health and Immigrant Status Are Associated with Anxiety Disorders among Middle-Aged and Older Adults: Findings from Baseline Data of The Canadian Longitudinal Study on Aging (CLSA).

The main purpose of this study was to compare the lifetime prevalence of anxiety disorders among foreign-born and Canadian-born adults in middle and later life. Using baseline data of the Canadian Longitudinal Study on Aging (2010-2015), multivariable binary logistic regression was conducted to investigate anxiety diagnosis and immigrant status, while controlling for socio-economic, health-related, and nutrition covariates. Of 26,991 participants (49.3% men, 82.5% Canadian born, 58.5% aged 45-65 years), the overall prevalence of self-reported physician diagnosis of anxiety disorders was 8.5%, with immigrants being lower than Canadian-born respondents (6.4% vs. 9.3%, p < 0.001). After accounting for all covariates, the adjusted odds ratio (aOR) for anxiety disorders was lower among immigrants (aOR = 0.77, 95% CI: 0.67-0.88) compared to those who were Canadian born. Identified risk factors included: younger age (aORs = 1.79-3.52), being a woman (aOR = 1.25, 95% CI: 1.07-1.46), single status (aOR = 1.27, 95% CI: 1.09-1.48), lower income (aORs = 1.28-2.68), multi-morbidities (aORs = 2.73-5.13), chronic pain (aOR = 1.31, 95% CI: 1.18-1.44), lifetime smoking ≥ 100 cigarettes (aOR = 1.35, 95% CI: 1.23-1.48), BMI < 18.5 (aOR = 1.87, 95% CI: 1.20-2.92), body fat ≥ 26% (aORs = 1.28-1.79), fruit and vegetable intake (< 3/day; aORs = 1.24-1.26), and pastry consumption (> 1/day; aOR = 1.55, 95% CI: 1.12-1.15) (p < 0.05). Targeting socio-economic and nutritional risk factors may reduce the burden of anxiety disorders in middle and late adulthood.

Psychological distress in older adults linked to immigrant status, dietary intake, and physical health conditions in the Canadian Longitudinal Study on Aging (CLSA).

BACKGROUND: Psychological distress increases mortality risk; there is little knowledge about its prevelance and contributory factors in older populations. METHODS: Canadian Longitudinal Study on Aging baseline data (2010-2015) were analyzed to examine the relationship between Kessler's Psychological Distress Scale-K10 and immigrant status (recent/mid-term,<20 years; long-term, ≥20 years; Canadian-born). Covariates included socioeconomic and health-related variables. Stratified by sex, two series of multinomial logistic regression were used to calculate the likelihood of having mild distress (20 < K10 score ≤24) and moderate/severe distress (K10 score >24). RESULTS: Respondents (n = 25,700) were mainly Canadian-born (82.8%), 45-65 years (59.3%), earning cut-off; OR=1.32, 99% CI 1.02-1.70), and higher nutritional risk (ORs = 2.16-3.31, p's <0.001). For men, psychological distress was associated with under-nutrition (grip strength56 years, ORs=0.19-0.79, p's<0.01), lower income (≤C$149,000, ORs = 1.68-7.79, p's<0.01), multi-morbidities (ORs = 1.67-4.70, p's<0.01), chronic pain (ORs = 1.67-3.09, p's<0.001) and higher intake of chocolate (≥ 0.6 bar/week, ORs=1.61-2.23, p's<0.001). LIMITATIONS: Cross-sectional design prohibits causal inferences. CONCLUSIONS: Nutritional factors, immigration status, social, and health-related problems are strongly associated with psychological distress among midlife and older adults.

Close Relations Matter: The Association Between Depression and Refugee Status in the Canadian Longitudinal Study on Aging (CLSA).

This study examined the prevalence and social determinants of depression among refugee and non-refugee adults aged 45-85 in the Canadian Longitudinal Study on Aging. Bivariate analyses and multivariable binary logistic regression analyses were conducted. The prevalence of depression was higher in a sample of 272 refugees (22.1%) and 5059 non-refugee immigrants (16.6%), compared to 24,339 native-born Canadians (15.2%). The adjusted odds ratio (aOR) of depression for refugees were not attenuated when controlling factors such as, (1) socioeconomic status, (2) health conditions and behaviours, (3) social isolation and online social networking (aORs range from 1.61 to 1.70, p's < 0.05). However, when social support representing close personal relationships was included, the odds of depression for refugees were reduced to non-significance (aOR = 1.30, 95% CI 0.97-1.74, p = 0.08). Refugees' excess vulnerability to depression is mainly attributable to lower levels of affectionate social support. Targeted interventions in nurturing supportive interpersonal relationships for refugees are warranted.

Depression in middle and older adulthood: the role of immigration, nutrition, and other determinants of health in the Canadian longitudinal study on aging.

BACKGROUND: Little is known about depression in middle-aged and older Canadians and how it is affected by health determinants, particularly immigrant status. This study examined depression and socio-economic, health, immigration and nutrition-related factors in older adults. METHODS: Using weighted comprehensive cohort data from the baseline Canadian Longitudinal Study on Aging (n = 27,162) of adults aged 45-85, gender-specific binary logistic regression was conducted with the cross-sectional data using the following variables: 1) Depression (outcome) measured using the Center for Epidemiologic Studies Short Depression (CESD-10) rating scale; 2) Immigration status: native-born, recent and mid-term (< 20 years), and long-term immigrants (≥20 years); and 3) covariates: socioeconomic status, physical health (e.g., multi-morbidity), health behavior (e.g., substance use), over-nutrition (e.g., anthropometrics), under-nutrition (e.g., nutrition risk), and dietary intake. RESULTS: The sample respondents were mainly Canadian-born (82.6%), women (50.6%), 56-65 years (58.9%), earning between C$50,000-99,999 (33.2%), and in a relationship (69.4%). When compared to Canadian-born residents, recent, mid-term (< 20 years), and longer-term (≥ 20 years) immigrant women were more likely to report depression and this relationship was robust to adjustments for 32 covariates (adjusted ORs = 1.19, 2.54, respectively, p < 0.001). For women, not completing secondary school (OR = 1.23, p < 0.05), stage 1 hypertension (OR = 1.31, p < 0.001), chronic pain (OR = 1.79, p < 0.001), low fruit/vegetable intakes (OR = 1.33, p < 0.05), and fruit juice (OR = 1.80, p < 0.001), chocolate (ORs = 1.15-1.66, p's < 0.05), or salty snack (OR = 1.19, p < 0.05) consumption were associated with depression. For all participants, lower grip strength (OR = 1.25, p < 0.001) and high nutritional risk (OR = 2.24, p < 0.001) were associated with depression. For men, being in a relationship (OR = 0.62, p < 0.001), completing post-secondary education (OR = 0.82, p < 0.05), higher fat (ORs = 0.67-83, p's < 0.05) and omega-3 egg intake (OR = 0.86, p < 0.05) as well as moderate intakes of fruits/vegetables and calcium/high vitamin D sources (ORs = 0.71-0.743, p's < 0.05) predicted a lower likelihood of depression. For men, chronic conditions (ORs = 1.36-3.65, p's < 0.001), chronic pain (OR = 1.86, p < 0.001), smoking (OR = 1.17, p < 0.001), or chocolate consumption (ORs = 1.14-1.72, p's < 0.05) predicted a higher likelihood of depression. CONCLUSIONS: The odds of developing depression were highest among immigrant women. Depression in middle-aged and older adults is also associated with socioeconomic, physical, and nutritional factors and the relationships differ by sex. These results provide insights for mental health interventions specific to adults aged 45-85.

The factor structure of a Chinese Geriatric Depression Scale-SF: use with alone elderly Chinese in Shanghai, China.

OBJECTIVE: This study aimed to examine the factor structure of a Chinese version of the 15-item Geriatric Depression Scale (GDS) with a sample of community dwelling elderly Chinese living alone in Shanghai, China. METHOD: Data were obtained between August and October 2008 through face-to-face interviews, using a structured survey questionnaire, from a random sample of 228 Chinese who were 60 years and older and living alone in one of the aging communities in Shanghai, China. Depressive symptoms were measured by a 15-item Chinese version Geriatric Depression Scale. Both exploratory factor analysis and confirmatory factor analysis were conducted to examine the factor structure of the GDS. RESULTS: Over 30% of the elderly Chinese living alone reported having symptoms that indicated that they had mild or an above mild level of depression. Furthermore, the findings also indicated that the depression symptoms were loaded into a four-factor model: 1) positive and negative mood; 2) energy level; 3) inferiority; and 4) disinterested, explaining over 58% of the total variance of depressive symptoms. CONCLUSIONS: The findings presented evidence of the applicability of the GDS to elderly Chinese living alone in China. This instrument would be useful for identifying potential depression concerns among elderly Chinese living alone.