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Development and Validation of a Multi-domain Multimorbidity Resilience Index for an Older Population: Results from the Baseline Canadian Longitudinal Study on Aging

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2018-07-27
Abstract: 

Background  Multimorbidity is recognized as a major public health issue that increases with age and affects approximately two-thirds of older people in Canada, the US, Australia and many European countries. This study develops and tests a three domain (functional, social and psychological) multimorbidity resilience composite index based on a previously developed lifecourse model of multimorbidity resilience, incorporating measures of adversity and positive adaptation. The criterion validity of the measure is demonstrated by means of an analysis of key outcome variables drawn from the literature.

Methods  We used the baseline data from the Comprehensive Cohort of the Canadian Longitudinal Study on Aging. Associations of functional, social, psychological as well as total resilience with two health utilization and three illness context outcome variables were examined using logistic regression analyses, adjusted for age, gender, marital status, income, education, region, and number of chronic conditions.

Results  The sample included all 6771 Canadian adults aged 65 or older (mean age 73.0, 57% women) who reported two or more of 27 possible chronic conditions. Total resilience was associated with: perceived health (OR = 1.68, CI 1.59–1.77); sleep quality (OR = 1.34, CI 1.30–1.38); perceived pain (OR = 0.80, CI 0.77–0.83); hospital overnight stays (OR = 0.87, CI 0.83–0.91); and emergency department visits (OR = 0.90, CI 0.87–0.94)., after adjusting for socio-demographic factors, and number of chronic conditions. These associations were similar for the unadjusted models, as well as for the functional, social and psychological resilience sub-indices.

Conclusions  Combining components of adversity and positive adaptation within functional, social and psychological domains produces a measure of multimorbidity resilience that is associated with more positive health outcomes. Several implications of a composite multimorbidity resilience measure for clinical practice are identified. This measure can be replicated using measures found in other secondary health data sets. Future validation using longitudinal data is warranted.

Document type: 
Article
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Use Of Touch Screen Tablets to Support Social Connections and Reduce Responsive Behaviours among People with Dementia in Care Settings: A Scoping Review Protocol

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2019-11-19
Abstract: 

Introduction The disabilities associated with dementia make the adjustment to staying in a care setting stressful. Separation from family can exacerbate the effects of stress. The use of touch screen tablets such as an iPad may offer potential to support the person with dementia staying in a care setting. Although electronic devices are used among people with dementia for a variety of purposes, a comprehensive review of studies focusing on their impact in care settings for social connection and patient/resident behaviour is lacking. This scoping review will focus on the use of touch screen tablets to support social connections and reducing responsive behaviours of people with dementia while in a care setting, such as a hospital ward.

Methods and analysis This scoping review will follow Joanna Briggs Institute scoping review methodology. The review team consists of two patient partners and three family partners, a nurse researcher, a research assistant and an academic professor. All authors including patient and family partners were involved in preparing this scoping review protocol. In the scoping review, we will search the following databases: MEDLINE, AgeLine, Cochrane, CINAHL, PsycINFO and IEEE. Google and Google Scholar will be used to search for additional literature. A hand search will be conducted using the reference lists of included studies to identify additional relevant articles. Included studies must report on the impact of using a touch screen technology intervention that involves older adults with dementia in care settings, published in English since 2009.

Ethics and dissemination This review study does not require ethics approval. By examining the current state of using touch screen tablets to support older people with dementia in care settings, this scoping review can offer useful insight into users’ needs (eg, patients’ and care providers’ needs) and inform future research and practice. We will share the scoping review results through conference presentations and an open access publication in a peer-reviewed journal.

Document type: 
Article
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The Benefits of and Barriers to Using Social Robot PARO in Care Settings: A Scoping Review

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2019-08-23
Abstract: 

Background

Given the complexity of providing dementia care in hospitals, integrating technology into practice is a high challenge and an important opportunity. Although there are a growing demand and interest in using social robots in a variety of care settings to support dementia care, little is known about the impacts of the robotics and their application in care settings, i.e., what worked, in which situations, and how.

 

Methods

Scientific databases and Google Scholar were searched to identify publications published since 2000. The inclusion criteria consisted of older people with dementia, care setting, and social robot PARO.

 

Results

A total of 29 papers were included in the review. Content analysis identified 3 key benefits of and 3 barriers to the use of PARO. Main benefits include: reducing negative emotion and behavioral symptoms, improving social engagement, and promoting positive mood and quality of care experience. Key barriers are: cost and workload, infection concerns, and stigma and ethical issues. This review reveals 3 research gaps: (a) the users’ needs and experiences remain unexplored, (b) few studies investigate the process of how to use the robot effectively to meet clinical needs, and (c) theory should be used to guide implementation.

 

Conclusions

Most interventions conducted have been primarily researcher-focused. Future research should pay more attention to the clinical needs of the patient population and develop strategies to overcome barriers to the adoption of PARO in order to maximize patient benefits.

Document type: 
Article
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Measurement Instruments for Quantifying Physical Resilience in Aging: A Scoping Review Protocol

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2019-01-14
Abstract: 

Background:  Physical resilience is the ability to optimize or recover motor function in the face of disease, injury, or aging-related decline. Greater knowledge of how some individuals regain or maintain function despite pathology may help identify protective factors and approaches that promote healthy aging. To date, a scoping review on physical resilience has not been conducted. The aims are to (1) identify measurement instruments for physical resilience, (2) synthesize and map the key concepts of physical resilience, and (3) identify gaps and make recommendations for future research.

Methods:  A scoping review of Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Medline Ovid, PsycINFO, and AgeLine databases will take place using the search strategy “resilience” AND (aging OR elderly OR older adult). The initial electronic search will be supplemented by hand searching the reference lists and review articles to identify any missing studies. Two parallel independent assessments of study eligibility will be conducted for the title, abstract, and full-text screens. To meet study inclusion criteria, the term “resilience” must be applied in relation to the physical health of older adults. Any disagreement will be resolved by consensus and a third reviewer consulted to make a decision if consensus is not achieved initially. Physical resilience information to be extracted are measurement instruments that describe the core domains of (1) body function or structure (signs or symptoms, etc.), (2) activity and participation (quality of life, etc.), and (3) societal impact. Tables and/or charts will map the data with distribution of studies by core domains. Finally, the amalgamation of results will be an iterative process whereby reviewers will refine the plan for presenting results after data extraction is completed so that all of the contents of the extraction may be included in the results.

Discussion:  The information gleaned in this scoping review will be essential to understand how physical resilience is currently measured and identify gaps for further research.

Document type: 
Article
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Conceptualising and Operationalising Resilience in Older Adults

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2019-03-28
Abstract: 

Context: As a result of increases in life expectancy and decreases in fertility, the proportion of the population entering later life has increased dramatically in recent decades. When faced with age-related challenges, some older adults respond more positively to adversity than would be expected given the level of adversity that they have experienced, demonstrating ‘resilience’.

Objectives: Having a clear conceptual framework for resilience is a prerequisite to operationalising resilience in a research context.

Methods: Here we compare and contrast several approaches to the operationalisation of resilience: psychometric-driven and data-driven (variable-centred and individual-centred) methods.

Results: Psychometric-driven methods involve the administration of established questionnaires aimed at quantifying resilience. Data-driven techniques use statistical procedures to examine and/or operationalise resilience and can be broadly categorised into variable-centred methods, i.e. interaction and residuals, and individual-centred methods, i.e. categorical and latent class.

Conclusions: The specific question(s) driving the research and the nature of the variables a researcher intends to use in their adversity-outcome dyad will largely dictate which methods are more (or less) appropriate in that circumstance. A measured approach to the ways in which resilience is investigated is warranted in order to facilitate the most useful application of this burgeoning field of research.

Document type: 
Article
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Performance Comparison of Linear and Nonlinear Feature Selection Methods for the Analysis of Large Survey Datasets

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2019-03-21
Abstract: 

Large survey databases for aging-related analysis are often examined to discover key factors that affect a dependent variable of interest. Typically, this analysis is performed with methods assuming linear dependencies between variables. Such assumptions however do not hold in many cases, wherein data are linked by way of non-linear dependencies. This in turn requires applications of analytic methods, which are more accurate in identifying potentially non-linear dependencies. Here, we objectively compared the feature selection performance of several frequently-used linear selection methods and three non-linear selection methods in the context of large survey data. These methods were assessed using both synthetic and real-world datasets, wherein relationships between the features and dependent variables were known in advance. In contrast to linear methods, we found that the non-linear methods offered better overall feature selection performance than linear methods in all usage conditions. Moreover, the performance of the non-linear methods was more stable, being unaffected by the inclusion or exclusion of variables from the datasets. These properties make non-linear feature selection methods a potentially preferable tool for both hypothesis-driven and exploratory analyses for aging-related datasets.

Document type: 
Article
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Appreciative Inquiry: Bridging Research and Practice in a Hospital Setting

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2018-04-18
Abstract: 

Purpose:  In this action study, researchers worked with a team of interdisciplinary practitioners to co-develop knowledge and practice in a medical unit of a large urban hospital in Canada. An appreciative inquiry approach was utilized to guide the project. This article specifically focuses on examining the research experiences of practitioners and their accounts on how the research influenced their practice development to enact person-centered care.

Method:  The project took place in the hospital’s medical unit. A total of 50 staff participants attended focus groups including nursing staff, allied health practitioners, unit leaders, and physicians. One senior hospital administrator was interviewed individually. In total, 36 focus groups were conducted to bring participants together to co-vision and co-develop person-centered care.

Results:  Analysis of the data produced three themes: (a) appreciating the power of co-inquiry, (b) building team capacity, and (c) continuous development. Furthermore, 10 key enablers for engaging staff in the research process were developed from the data. A conceptual tool, “team Engagement Action Making” (TEAM) has been created to support others to do similar work in practice development.

Conclusion:  An appreciative inquiry approach has the potential to address gaps in knowledge by revealing ways to take action. Future research should further investigate how the appreciative inquiry approach may be used to support bridging research and practice.

Document type: 
Article
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Using Video-Reflexive Ethnography to Engage Hospital Staff to Improve Dementia Care

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2018-07-11
Abstract: 

In this article, we discuss how video-reflexive ethnography may be useful in engaging staff to improve dementia care in a hospital medical unit. Seven patients with dementia were involved in the production of patient-story videos, and fifty members of staff (nurses, physicians, and allied health practitioners) participated in video-reflexive groups. We identified five substantial themes to describe how video-reflexive groups might contribute to enacting person-centered care for improving dementia care: (a) seeing through patients’ eyes, (b) seeing normal strange and surprised, (c) seeing inside and between, (d) seeing with others inspires actions, and (e) seeing with the team builds a culture of learning. Our findings suggest that video reflexivity is not only useful for staff engagement but also effective in enhancing team capacity to enact person-centered care in the hospital setting.

Document type: 
Article
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‘I am Busy Independent Woman Who has Sense of Humor, Caring about Others’: Older Adults’ Self- representations in Online Dating Profiles

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2017-12
Abstract: 

Similar to their younger counterparts, older adults (age +) are increasingly turning to online dating sites to find potential romantic and sexual partners. In this paper, we draw upon qualitative data from a thematic analysis of  randomly selected online dating profiles posted by Canadian heterosexual older adults who self-identified as Asian, Black, Caucasian or Native American. In particular, we exam-ined how the older adults’ self-presentations varied according to race/ethnicity, age and gender, and how the language they used to describe themselves and their preferred potential partners reflected and reinforced idealised images of ageing. Our analysis identified five primary ways in which the older adults portrayed them-selves. They depicted themselves as active and busy with cultural/artistic, social and adventurous activities; and also as physically healthy and intellectually engaged. Third, they emphasised the ways in which they were productive through work and vol-unteer activities. Fourth, they accentuated their positive approach to life, identifying themselves as happy, fun-loving and humorous individuals. Finally, they highlighted their personable characteristics, portraying themselves as trustworthy and caring. We discuss our findings with a particular focus on gender differences, drawing on lit-erature on masculinity and femininity, and also look at capital and power relations by considering the online dating setting as a field in the Bourdieusian sense.

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Article
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Gerontology Graduate Training in North America: Shifting Landscapes, Innovation and Future Directions

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2016-07-29
Abstract: 

As the Canadian population ages it is anticipated there will be an increased demand for students with advanced training in gerontology. In today's highly fluid and competitive environment, the challenge for gerontology graduate programs will be how to attract the best and brightest students and provide them with the knowledge base and skillsets that they will need in order to be successful. Yet, very little research has been conducted on the state of gerontology graduate education in North America with a focus on Canadian programs. Given this gap, the purpose of this report is to: a) report on current trends in gerontology graduate education and b) highlight innovations and potential future directions for the discipline in general, and the Simon Fraser University (SFU) graduate programs in gerontology, more specifically. This report was funded by the SFU, Dean of Graduate Studies SCORE program: Strengthening the Core Fund for Innovation in Graduate Education.

 

For this project a total of 40 eligible English language gerontology graduate programs (doctoral or master's level) offered by Canadian or American universities were identified. Interviews were conducted with 23/40 universities and data were collected on a number of topics such as target students, marketing and publicity methods, and program requirements. Some supplementary data were also collected from online information sources. Of the universities in the sample, 10 offer doctoral level programs (total of 12 programs) and 20 offer master's level programs (total of 24 programs). Eight of the universities are Canadian and fifteen are American.

Document type: 
Report
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