Empirical evidence on the influence of music therapy on persons with dementia in residential care homes is fairly limited. Residents often experience a low quality of life due to the prevalent medical model of care that focuses on health-related outcomes, rather than a person-centered approach to support and care for the whole person. This qualitative study explored the influence of group music therapy on quality of life in residents with dementia living in a special care unit. Data were generated through focused, ethnographic observations, interviews, document analysis and a focus group. The data provide a rich and in-depth understanding on the process and outcomes related to group music therapy’s influence on residents’ care home experience. The findings provide substantive insights on the role of music therapy in improving the quality of life for residents with dementia and have practice implications for music therapy programming in residential care facilities.
Care practices in long-term care facilities have typically been guided by the biomedical approach to care. In the past two decades, there has been a growing movement in transforming care for residents from a medical model to a person-centered model in long-term care. This capstone project reviews and synthesizes current literature on person-centered care, with a focus on care practices and organizational issues. An extensive literature review was conducted using databases such as Ageline, PsychINFO, Medline, Google Scholar, CINAHL and the Simon Fraser University library catalogue. A total of 69 articles that addressed the research questions were identified and incorporated in this review. Empirical evidence indicates that implementing person-centered care practices that honor the dignity and choice of residents, strengthen resident and care staff relationships and utilize nonpharmacological care to preserve the personhood of residents can improve the caring experience. In addition, there is evidence that person-centered care can improve the well-being and quality of life of residents and improve job satisfaction for care providers. This paper also examines the organizational facilitators such as culture change, staff training and management’s role, and environmental design as well as the organizational barriers in implementing person-centered care.
The purpose of this project is to develop a logic model and process evaluation framework for a therapeutic garden program at Banfield Pavilion, a residential long term care facility located in Vancouver, B.C. A six-step process evaluation design developed by Saunders, Evans, and Joshi (2005) is used to develop the evaluation framework. Steps of the framework include (1) describing the program, (2) describing complete and acceptable delivery of the program, (3) developing the potential list of questions, (4) determining methods, (5) considering the program’s resources, context, and characteristics, and (6) the final process evaluation plan. The logic model connects program elements to concepts drawn from Ulrich’s (1984) stress reduction theory (SRT) and theory of supportive garden design (1999). A central consideration of the evaluation is whether the program should focus more on spontaneous or structured activities and garden interactions. Both the logic model and evaluation framework can be used for the Banfield program and/or other therapeutic garden programs.
This project presents a research grant proposal based on the Canadian Institutes of Health Research (CIHR) Project Scheme: 2016 1st Live Pilot guidelines. The proposed study aims to have a comprehensive understanding of the objective and subjective factors impacting older adults’ decision making process to implement home modifications (HMs). The study will utilize a mixed methods research approach. Community-dwelling older adults from urban and rural British Columbia will take part in surveys and home environment assessments using the Housing Enabler (North American version) tool. A sub-set of participants will receive HM recommendations and take part in semi-structured interviews about their decision to adopt and implement HMs. The study findings will provide conceptual and substantive insights into the various factors that influence the decision making process. Additionally, the findings will inform professionals in occupational therapy and housing policy on the influencing factors and multidimensional characteristics of older adults’ decision making process.
This capstone project provides a critical synthesis of literature examining family-friendly workplace policies with a focus on Canada and the U.S. The review covers the caregiving context, health, stress and well-being, job satisfaction of family caregivers, and the effects of these policies on the organizational structure of the workplace. The literature is assessed against the backdrop of a feminist political economy framework. A number of policy issues are identified and critically reviewed, and several recommendations that could potentially benefit both the caregiver and the employer are discussed. These include: reducing organizational barriers for the adoption of family-friendly policies, enhancing flexibility in the work lives of caregivers, increasing government funding of work-life balance policies, and supporting technological innovation. Future research is needed to better understand the barriers to policy adoption, best practices in family-friendly approaches, as well as comprehensive evaluation of the intended and unintended consequences of current and emerging policies.
This project provides an exploratory examination of the relationship between residential school attendance and health status in later life among First Nation Elders in B.C. The sample population (n = 539) was obtained from regional data collected during the First Nation and Inuit Regional Health Survey in 1997. It is hypothesized that attendance at a residential school will result in negative health outcomes in later life. In addition, a further hypothesis is that there will be familial effects of attendance at the residential school system.
To date, most research into the impact of residential school experiences have been of a qualitative nature that focuses primarily on the inter-generational, psycho-social effects of the system. This project is an attempt to fill in the existing gaps in the literature, specifically in relation to the quantitative perspective. A theoretical framework, which draws upon aspects from the Life Course Theory and Population Health perspective, is used to examine the relationship between residential school attendance and health status in later life.
In order to test the two hypotheses, five main dependent variables are investigated in the analyses. They are "tuberculosis", "high blood pressure", "heart problems", "perceived health", and an additive "illness scale". Four residential school variables were used in the analyses: "did you attend", "years attended", "brother attended" and "sister attended" along with five sociodemographic covariates. A bivariate analysis was conducted with the five dependent variables, the residential school variables and the socio-demographic variables (see page 51 for a summary). Support was not found for hypothesis iiione at the bivariate level, however, there was partial support for hypothesis two, which states that there will be familial effects of residential school attendance. The two hypotheses were further tested at the multivariate level using a logistic regression and linear regression analysis. Ten hierarchical models were tested in the multivariate analyses. The multivariate analyses reveal a positive relationship between health status and residential school attendance (see page 55 for summary). "Years attended" residential school was found to be positively associated with "tuberculosis" yet negatively associated with "heart problems". The independent variable "brother attended" residential school was a predictor for "tuberculosis", "high blood pressure and for the additive "illness scale" variable.
In summary, there was partial support for an association between the residential school experience occurring in early life and the health status of First Nation people in later life. Stronger analyses are found for familial effects on health through the attendance of siblings. These findings support a life course - developmental perspective. However, the limitations of this study and preliminary nature of this initial analysis of these residential school data suggest that further work is needed before final conclusions as to the causal relationship between health status and residential school attendance can be ascertained. Gerontological research must include additional research and theoretical development that encompasses all of the unique aspects of First Nation health and aging, including the residential school experience.
The design of community and built environments is integrally linked to independence, participation, and mobility for older adults. This capstone project reviews literature that explores the accessibility of grocery stores based on their location within the community and their interior built environments. The results indicate a trend towards fewer grocery stores in areas of low SES and population density, and they identify barriers and facilitators related to shelving, signage, labels, way finding, aisles, lighting, noise level, flooring, shopping carts, in store seating, lighting, and check outs. The evidence highlights issues such as income, availability of transportation, the utility of universal design features, to promote independence in grocery shopping for older adults who wish to age in place. This paper builds upon Lawton and Nahemow’s Ecological model of Aging and proposes a conceptual model that shows how location and interior-built environments are linked to independent grocery shopping.
This capstone project entails a literature review focusing on the influence of outdoor nature settings on health and well-being for residents in long-term care facilities. This review identifies key evidence-based benefits and barriers to garden use for residents and design guidelines for outdoor spaces in the empirical and descriptive literature. In recent years, there is a growing recognition of the importance to shift from the medical model-of-care to a holistic person-centered care approach. Well-designed outdoor environments can play an important role in creation of a person-centered care environment. Empirical evidence supports a wide range of health and well-being benefits from nature environment exposure. These include improvements to residents’ agitation, stress, depression, pain, psychosocial well-being, sleep and circadian rhythm, attention restoration, social interaction, independence, sense of purpose, wandering behaviour, reminiscence, and sensory stimulation.
This qualitative study explored the dining experience of residents with dementia living in specialized care units, with a focus on person-centered care aspects in staff practices. Data were collected by multiple methods: participant observation, informal and formal interviews with care staff, and examination of relevant documents at a long term care facility in British Columbia, Canada. Data analysis revealed five person-centered categories in relation to dining: (1) Relaxed Pace/ Outpacing, (2) Respect/ Disrespect, (3) Connecting/ Distancing, (4) Empowerment/ Disempowerment, and (5) Inclusion/ Ignoring. Analysis also identified the ways in which staff understood person-centered care, and factors affecting its delivery. These categories provide insight into the psychosocial and physical environmental factors that affect residents’ dining experience. The findings suggest that while staff practices reflect several aspects of person-centered care, a biomedical undercurrent continues to hinder the evolution of dementia care.
Fear of falling (FOF) has been described as "a potential health problem of equal importance to a fall” (Zilistra, Van Haastregt, Van Eijk, Van Rossum, Stalenhoef & Kempen, 2007, p.304). Therefore, the focus of the proposed study is to conduct a comprehensive investigation of FOF amongst community-dwelling older adults focusing on physical environment and social support factors. A mixed methods approach will be used and includes: SWEAT-R, an environmental audit, to analyze 3 urban and 3 suburban neighbourhoods, a four part survey to be completed by older adults living in these neighbourhoods, and, Photovoice, a participatory tool with a discussion group component. The grant proposal, found in Chapter 5, will follow the guidelines of the CIHR Project Scheme: 2016 1st Live Pilot grant. The primary objective of the proposed study is to uncover what factors of the physical environment and social supports are linked to FOF among community-dwelling older adults.