Mentally healthy living after pandemic social distancing: a study of older Canadians reveals helpful anxiety reduction strategies.

BACKGROUND: Throughout the COVID-19 pandemic, older Canadians were the most at risk of severe physical harm, including death, and their return to post-COVID life was expected to be especially anxiety-provoking. A study was conducted to obtain nationally representative evidence of older Canadians' self-perceived anxiety levels and their strategies to manage or mitigate it as public health restrictions were lifting. MATERIALS AND METHODS: This study had a cross-sectional descriptive design. An e-survey was used to collect data from 1327 Canadians aged 60+ stratified by age, sex, and education to resemble the larger general population. Participants completed the Geriatric Anxiety Scale (GAS-10) and indicated which of the 16 Centre for Addictions and Mental Health's (2022) Coping with Stress and Anxiety strategies they were using to manage or mitigate their anxiety when social distancing was lifting. Descriptive statistics, Pearson correlation, and multiple regression analysis were used to explore the data. RESULTS: While, on average, older Canadians were mildly anxious, nearly one-quarter of responders rated their anxiety as severe. Age, sex, perceived health, were statistically significant correlates of anxiety. Six coping strategies were associated with significantly lower anxiety scores. Moreover, accepting some fear and anxiety as normal, challenging worries and anxious thoughts, and practising relaxation/meditation appeared to increase anxiety. CONCLUSION: Older Canadians used multiple strategies to manage or mitigate their anxiety, and seemingly, with more successful than detrimental tries. Practitioners have much to learn and understand about older people's mental health promotion efforts after social distancing, now and for future pandemics.

ACP Conversations with Chinese and South Asian Patients: Physicians' Perspectives of Barriers and Facilitating Factors.

Introduction/Objective: Advance Care Planning (ACP) discussions are infrequently conducted with physicians, even fewer among minorities. We explored physicians' experiences in engaging Chinese (CH) and South Asian (SA) patients in ACP conversations to understand initiation and participation patterns, topics covered, and barriers and facilitating factors. Method: Twenty-two physicians with 15%+ SA patients aged 55+ and 19 with 15%+ CH patients aged 55+ were interviewed. Results: SA- and CH-serving physicians described similar initiation patterns, cultural context, and need for standardized ACP routines. However, the SA-serving physicians described greater involvement of family members, while CH-serving physicians described more communication barriers and family members' desire to hide the diagnosis from patients. Conclusion: Cultural taboos surrounding discussion around death and dying appear to influence CH older adults and families strongly. Lack of familiarity with ACP amongst the SA population accounts more for their limited engagement in ACP discussions.

Primary Care Physicians' and Hospitalists' Experience with Advance Care Planning with South Asian Canadian Older Adults before and during COVID-19.

Few older adults discuss their end-of-life care wishes with their physician, and even fewer minorities do this. We explored physicians' experience with advance care planning (ACP) including the barriers/facilitating factors encountered when initiating/conducting ACP discussions with South Asians (SA), one of Canada's largest minorities. Eleven primary care physicians (PC) and 11 hospitalists with ≥ 15 per cent SA patients ≥ 55 years of age were interviewed: 10 in 2020, 12 in 2021. Thematic analysis of transcripts indicated that cultural and communication barriers, physician's specialization, SA older adults' lack of ACP awareness, and decision-making deference to family and physicians were barriers to ACP discussions. Although the COVID-19 pandemic impacted physicians' practices, contrary to our hypothesis most reported no change in frequency of ACP discussions. Although ACP discussions were viewed as best conducted by PC physicians, only 55 per cent had ACP training and only 64 per cent had used ACP tools. Training in ACP facilitation, concerning ACP tool usage, and training in patient-physician communication are recommended.

Suitability of the Attitudes to Aging Questionnaire Short Form for Use among Adults in Their 50s: A Cross-Sectional e-Survey Study.

This cross-sectional e-survey study examines the suitability (reliability and validity) of the 12-item Attitudes to Aging Questionnaire Short Form (AAQ-SF) for use among adults in their 50s. The AAQ-SF instrument was originally designed to capture subjective perceptions of physical change, psychosocial loss, and psychological growth by asking people aged 60 and beyond how they feel about growing older. Our sample comprised 517 people residing in three Canadian provinces. Respondents completed the Attitudes to Aging Questionnaire Short Form, the Rosenberg Self-Esteem Scale, and a short sociodemographic profile. Our findings replicate the original AAQ-SF structure for physical change, psychosocial loss, and psychological growth, with a promising internal consistency range for the third subscale. In our sample, psychological growth is best represented as 'Self' and 'Generativity', with a particularly greater capacity to explain variations in scores for item 18 and item 21. Physical change and psychosocial loss scores strongly differed based on perceived health and chronic illness presence. Psychosocial loss and psychological growth were moderately correlated with two aspects of self-esteem. We relate these patterns of findings within the context of prevailing growth and development theory and their perceived implications within the context of COVID-19 and post-pandemic life.

An Agentic Familiarity: The Context of HIV/AIDS and Sexual Orientation for Older Canadians during the COVID-19 Pandemic.

This paper examines how experiences with a previous pandemic, particularly HIV/AIDS, may have informed approaches to COVID-19, with a focus on sexual orientation. METHOD: The sample was drawn from an online survey of Canadians 55+ conducted in 2020, comprising 1143 persons (mean age = 67; 88 gay or bisexual (GB) men, 65 lesbian or bisexual (LB) women, 818 heterosexual women, and 172 heterosexual men). Respondents reported if they, or someone close to them, "had been affected by" one or more pandemics and whether COVID-19 led them to "think more about their prior epidemic/pandemic experiences" and/or feel they "couldn't handle it again". Correlated items reflecting feeling "they have been here before"; "prepared for what is happening"; and "like they needed to act or do something" formed a scale named "agentic familiarity". RESULTS: About half of respondents reported thinking about their previous pandemic experience; about 5% reporting feeling like "they couldn't handle it again" with no gender or sexual orientation differences. Higher agentic familiarity scores were found for GB men and for those with experience with HIV/AIDS vs. other pandemics. DISCUSSION: These outcomes speak to resilience and growth experienced by LGBT (and especially GB) persons through shared stigma and trauma-with implications for current pandemic experiences and future actions, like advance care planning.

Beyond Mortality: The Social and Health Impacts of COVID-19 among Older (55+) BIPOC and LGBT Respondents in a Canada-Wide Survey.

This study focused on the effects of the COVID-19 pandemic on the marginalized populations-specifically Black and Indigenous people as well as People of Color (BIPOC) compared to White older adults and LGBT individuals compared to heterosexual older adults. Data were derived from our national online survey of Canadians aged 55+, conducted from 10 August to 10 October 2020. The survey explored the influence of COVID-19 on lifestyle changes, well-being, and planning for the future. Our sample comprised 4292 respondents. We compared sets of dichotomous variables with White vs. BIPOC, LGBT vs. heterosexual, and LGBT White vs. LGBT BIPOC respondents. Significantly more BIPOC than White individuals reported changes in accessing food (44.3% vs. 33.2%) and in family income (53.9% vs. 38.9%) and fewer reported feeling accepted and happy, and more felt isolated and judged. Significantly more LGBT than heterosexual respondents reported changes in routines and in accessing social support, medical and mental health care and more feeling depressed, lonely, anxious, and sad. More LGBT-BIPOC than LGBT-White respondents reported changes in access to food (66.7 vs. 30.6, p < 0.001); in family income (66.7 vs. 41.5, p < 0.005); and in access to mental health care (38.5 vs. 24.0, p < 0.05). The only difference in emotional response to COVID-19 was that more BIPOC-LGBT than White-LGBT respondents reported feeling judged (25.9 vs. 14.5, p < 0.05). These findings reflect a complex mix of the effects of marginalization upon BIPOC and LGBT older adults, revealing both hardship and hardiness and warranting further research.

A systematic review of gerontechnologies to support aging in place among community-dwelling older adults and their family caregivers.

Objective: Paucity of information concerning the efficacy of gerontechnologies to support aging in place among community-dwelling older adults prevents potential users, healthcare professionals, and policymakers from making informed decisions on their use. The goal of this study was to identify gerontechnologies tested for home support in dyads of community-dwelling older adults with unimpaired cognition and their family caregivers, including their benefits and challenges. We also provide the level of evidence of the studies and recommendations to address the specific challenges preventing their use, dissemination, and implementation. Methods: We conducted a systematic review of the literature published between 2016 and 2021 on gerontechnologies tested for home support in dyads. Two independent reviewers screened the abstracts according to the inclusion/exclusion criteria. A third reviewer resolved eligibility discrepancies. Data extraction was conducted by two independent reviewers. Results: Of 1,441 articles screened, only 13 studies met the inclusion criteria with studies of moderate quality. Mostly, these gerontechnologies were used to monitor the older adult or the environment, to increase communication with family caregivers, to assist in daily living activities, and to provide health information. Benefits included facilitating communication, increasing safety, and reducing stress. Common challenges included difficulties using the technologies, technical problems, privacy issues, increased stress and dissatisfaction, and a mismatch between values and needs. Conclusion: Only a few gerontechnologies have proven efficacy in supporting community-dwelling older adults and their family caregivers. The inclusion of values and preferences, co-creation with end users, designing easy-to-use technologies, and assuring training are strongly recommended to increase acceptability and dissemination. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=310803, identifier CRD42022310803.

Advance Care Planning among Older Gay Men Living with HIV in Montreal, Canada: Challenges to Thinking and Talking about Future Care.

This qualitative study employed a cross sectional focus group design to explore how older gay men living with HIV, experience, perceive, and engage with advance care planning (ACP). Seven gay men 50+, residing in Montreal, Canada, participated in a focus group that was audio-recorded, transcribed, and thematically analyzed. Findings suggested that social isolation, preoccupations with day-to-day living, and managing disclosures related to sexual orientation and HIV status created barriers to these men's capacities to think about let alone talk about future care. These findings challenge current conceptualizations of ACP, which position reflection as an individual process that precedes allocating a decision-maker and communicating care preferences. Analyses further revealed that relational connections helped create a space where ACP could occur for participants. Hence, improving the uptake of ACP amongst older gay men with HIV may require interventions that embed such discussions into broader programs aimed at building support and community.

Pilot Study of a Digital Screen-Based Calming Device for Managing Resistance During Morning and Evening Care of Persons With Dementia.

Resistance to care is among the most common behaviors exhibited by persons with dementia (PwD). Resistance to care is a barrier to safety and comfort of PwD and caregivers. Nonpharmacological interventions are recommended as first-line management. In the current study, 13 long-term care (LTC) residents aged 74 to 100 years with a history of behavioral and psychological symptoms of dementia (BPSD) were randomized to intervention (n = 7) and control (n = 6) groups. On Days 1 to 3, the intervention group received usual care plus exposure to MindfulGarden (MG), a novel digital calming device during morning and evening care, activities widely recognized as problematic for PwD and staff; the control group received usual care only. On Day 4, both groups were exposed to MG with verbal prompting. Trends in the data suggest that MG reduced BPSD and duration of care in the morning and may be a useful tool in management of resistance to routine care in PwD in LTC settings. [Journal of Gerontological Nursing, 47(11), 15-21.].

Advance care planning among older Canadians amid the COVID-19 pandemic: a focus on sexual orientation.

OBJECTIVES: The COVID-19 pandemic has led to death and hardship around the world, and increased popular discourse about end-of-life circumstances and conditions. The extent to which this discourse and related pandemic experiences have precipitated advance care planning (ACP) activities was the focus of this study with a particular emphasis on sexual orientation. METHODS: A large, national online survey was conducted between 10 August and 10 October 2020 in Canada. The final sample of 3923 persons aged 55 and older was recruited using social media, direct email, and Facebook advertising and in conjunction with community groups. Women comprised almost 78% of the sample; just more than 7% of the sample identified as lesbian, gay, and bisexual (LGB). Measures included demographic variables and a series of questions on ACP, including documents and discussions undertaken prior to the pandemic and since its onset. RESULTS: Descriptive analyses revealed few gender or sexual orientation differences on documents and discussions prior to the pandemic; since its onset, LGB persons have completed or initiated wills, powers of attorney, advance directives, representation agreements, and have engaged in ACP discussions in greater proportion than heterosexuals. Logistic regressions reveal the increased likelihood of pre-pandemic ACP engagement by age, gender (women), and education; since the pandemic onset, gender, education, and sexual orientation were predictive of greater ACP engagement. Care discussions were more likely undertaken by women and LGB persons since the pandemic most often with spouses, family, and friends, especially among LGB persons. DISCUSSION: Gender roles and previous pandemic experiences (HIV/AIDS, in particular) are implicated in this pattern of results; opportunities for educational interventions are considered.

Implementing Advance Care Planning Tools in Practice: A Modified World Café to Elicit Barriers and Recommendations from Potential Adopters.

This paper reports findings from a modified World Café conducted at a palliative care professional conference in 2019, where input on tools to support advance care planning (ACP) was solicited from healthcare practitioners, managers and family members of patients. Barriers to ACP tool use included insufficient structures and resources in healthcare, death-avoidance culture and inadequate patient and family member engagement. Recommendations for tool use included clarification of roles and processes, training, mandates and monitoring, leadership support, greater reflection of diversity in tools and methods for public engagement. This paper illuminates factors to consider when implementing ACP tools in healthcare.

A Novel Intervention for Management of Behavioral and Psychological Symptoms of Dementia in Nursing Home Communal Areas: Results of a Small-Scale Pilot Trial.

BACKGROUND: Behavioral and psychological symptoms of dementia (BPSD) exhibited by persons with dementia (PwD) in nursing home communal areas are generally managed by segregation and/or pharmacological interventions. OBJECTIVE: This study trialed MindfulGarden (MG), a novel digital calming device, in a Canadian nursing home. METHODS: Participants were 15 PwD (mean age = 87.67; 5m,10f; mean MMSE = 11.64±7.85). Each was observed by a research assistant (RA) for an average of 8-10 hours on two separate days. The RA followed them during time spent in communal areas of the nursing home including their unit's dining space, lounges, and corridors and spaces shared with other units (e.g., gym and gift shop) and documented any BPSD exhibited. Day-1 provided baseline data; on Day-2, residents were exposed to MG if nursing staff considered their BPSD were sufficiently intense or sustained to warrant intervention. Staff rated the impact as positive, neutral, or negative. RESULTS: On Day-1, 9 participants exhibited both aggressive and non-aggressive behaviors, 4 non-aggressive behaviors only, and 2 no BPSD. On Day-2, 7 exhibiting aggressive behaviors were exposed to MG. Staff reported MG as having distracting/calming effects and gave positive impact ratings to 6/13 exposures; there were no negative ratings. The most common aggressive BPSD on days of observation were pushing/shoving and screaming. CONCLUSION: MG may have value as a "psychiatric crash cart" in de-escalating agitation and aggression in care home settings.

The Role of Information and Communication Technology in End-of-Life Planning Among a Sample of Canadian LGBT Older Adults.

To better understand the role of technology in later-life planning among older lesbian, gay, bisexual, and trans (LGBT) adults, we conducted focus groups to explore factors linked to diverse sexual orientations and gender identities. Twenty focus groups were facilitated across Canada with 93 participants aged 55 to 89. Constant comparative analysis yielded four categories: (a) fear, (b) individual benefits, (d) social elements, and (d) contextual elements. Fear related to technology and fear of end-of-life planning. Individual benefits referred to technology as a platform for developing LGBT identities and as a source of information for later-life planning. Social elements were establishment and maintenance of personal relationships and social support networks. Contextual elements referred to physical and situational barriers to technology use that limited access and usability. These findings can inform technological practice and services to enhance later-life planning.

End-of-Life Preparations Among LGBT Older Canadian Adults: The Missing Conversations.

LGBT (lesbian, gay, bisexual, and transgender) older adults are more likely than their heterosexual peers to age with limited support in stigmatizing environments often poorly served by traditional social services challenging their preparedness for end of life. Fourteen focus groups and three individual interviews were conducted in five Canadian cities with gay/bisexual men (5 groups; 40 participants), lesbian/bisexual women (5 groups; 29 participants), and transgender persons (3 interviews, 4 groups; 24 participants). Four superordinate themes were identified: (a) motivators and obstacles, (b) relationship concerns, (c) dynamics of LGBT culture and lives, and (d) institutional concerns. Several pressing issues emerged including depression and isolation (more common among gay and bisexual men), financial/class issues (lesbian and bisexual women), and uncomfortable interactions with health-care providers (transgender participants). These findings highlight the challenges and complexities in end-of-life preparation within LGBT communities.

A Scoping Literature Review of Dementia-Friendly Hospital Design.

Purpose: We report the findings of a knowledge synthesis research project on the topic of dementia-friendly acute care (D-FAC) design. This exploratory project systematically mapped what is known about D-FAC physical design in hospitals. We discuss our challenges in locating reportable evidence and the implications of such design for maximizing independent function while ensuring safety and harm reduction in older people living with dementia. Design and Methods: Exploratory iterative design utilizing scoping literature review methodology. Results: A total of 28 primary studies plus expert reviewers' narratives on the impact of design and architectural features on independent function of hospitalized older people with dementia were included and evaluated. Items were mapped to key design elements to describe a D-FAC environment. This scoping review project confirms the limited nature of available acute care design evidence on maximizing function. Implications: Physical design influences the usability and activity undertaken in a health care space and ultimately affects patient outcomes. Achieving safe quality hospital care for older people living with dementia is particularly challenging. Evidence of design principle effectiveness is needed that can be applied to general medical and surgical units where the bulk of older persons with and without dementia are treated.

Developing a Research Agenda on Resident-to-Resident Aggression: Recommendations From a Consensus Conference.

This article provides an overview of the development of a research agenda on resident-to-resident aggression (RRA) in long-term care facilities by an expert panel of researchers and practitioners. A 1-day consensus-building workshop using a modified Delphi approach was held to gain consensus on nomenclature and an operational definition for RRA, to identify RRA research priorities, and to develop a roadmap for future research on these priorities. Among the six identified terms in the literature, RRA was selected. The top five priorities were: (a) developing/assessing RRA environmental interventions; (b) identification of the environmental factors triggering RRA; (c) incidence/prevalence of RRA; (d) developing/assessing staff RRA education interventions; and (e) identification of RRA perpetrator and victim characteristics. Given the significant harm RRA poses for long-term care residents, this meeting is an important milestone, as it is the first organized effort to mobilize knowledge on this under-studied topic at the research, clinical, and policy levels.

Increased health service utilization costs in the year prior to institutionalization: findings from the canadian study of health and aging.

OBJECTIVES: The objective of this study was to characterize patterns of formal health service utilization costs during older adults' transition from community to institutional care. METHODS: Participants were 127 adults (age ≥ 65) from the British Columbia sample (N = 2,057) of the Canadian Study of Health and Aging who transitioned from community to institutional care between 1991 and 2001. Health service utilization costs were measured using Cost-Per-Day-At-Risk at five time points: > 12 months, 6-12 months, and ≤ 6 months preinstitutionalization, and ≤ 6 months and 6-12 months postinstitutionalization. Cost-Per-Day-At-Risk was measured for Continuing Care, Medical Services Plan, and PharmaCare costs by calculating total health service use over time, divided by the number of days the participant was alive. RESULTS: Significant differences in Cost-Per-Day-At-Risk were observed for Continuing Care, Medical Services Plan, and PharmaCare costs over time. All health service utilization costs increased significantly during the 6-12 months and ≤ 6 months prior to institutionalization. Postinstitutionalization Continuing Care costs continued to increase at ≤ 6 months before decreasing at 6-12 months, while decreases occurred for Medical Services Plan and PharmaCare costs relative to preinstitutionalization costs. CONCLUSIONS: The increases in costs observed during the year prior to institutionalization, characterized by a flurry of health service utilization, provide evidence of distinct cost patterns over the transition period.

A national comparison of spousal abuse in mid- and old age.

This exploratory study addresses whether there are similar or different risks and protective factors associated with spousal abuse among mid-age adults (persons aged 45-59) and old-age adults (persons aged 60 and over). The risk and protective factors of abuse are compared across these two age groups and situated within a life course framework. Cross-sectional data from the 1999 and 2004 General Social Surveys are merged to address the research questions. Overall, it was found that there are as many differences as there are similarities in risk/protective factors connected to individual, relationship, and community environments. The findings are discussed in terms of program development and future research.