We present the development of a regional dementia strategy in Southwestern Ontario, Canada. We worked with stakeholders in a regional health authority to develop a dementia strategy. We conducted interviews with persons with dementia and their care partners (n = 26) and health care administrators and policy makers (n = 33); and administered a priority-setting survey (n = 64). Both participant groups identified provider compassion, professionalism, and care in the early stages of dementia as system strengths. Both groups also highlighted a need for more integration and coordination, a need for more person-centred care, support for care partners, and more flexibility in the provision and receipt of services. The highest-ranked priorities were improving care partner support, improving access to care, and improving system-wide quality. We integrate these strengths, needs, and priorities in a strategic framework, “Whole Person, Whole Journey”. Organizations developing a dementia strategy may use this framework as a springboard for their own work.

Most older adults perceive themselves as good drivers; however, their perception may not be accurate, and could negatively affect their driving safety. This study examined the accuracy of older drivers’ self-awareness of driving ability in their everyday driving environment by determining the concordance between the perceived (assessed by the Perceived Driving Ability [PDA] questionnaire) and actual (assessed by electronic Driving Observation Schedule [eDOS]) driving performance. One hundred and eight older drivers (male: 67.6%; age: mean = 80.6 years, standard deviation [SD] = 4.9 years) who participated in the study were classified into three groups: underestimation (19%), accurate estimation (29%), and overestimation (53%). Using the demographic and clinical functioning information collected in the Candrive annual assessments, an ordinal regression showed that two factors were related to the accuracy of self-awareness: older drivers with better visuo-motor processing speed measured by the Trail Making Test (TMT)-A and fewer self-reported comorbid conditions tended to overestimate their driving ability, and vice versa.

During large-scale crises such as the COVID-19 pandemic, the precarity of older people and older volunteers can become exacerbated, especially in under-serviced rural regions and small towns. To understand how the pandemic has affected “older voluntarism”, this article presents a case study of three volunteer-based programs in rural Ontario, Canada. Interviews with 34 volunteers and administrators reveal both challenging and growth-oriented experiences of volunteers and the programs during the first wave of COVID-19. The findings demonstrate the vulnerability and resiliency of older volunteers and the adaptability and uncertainty of programs that rely on older voluntarism, as the community and its older residents navigate pandemic-related changes. The article advances a framework for understanding the pandemic’s impacts on older voluntarism in relation to personal, program, and community dimensions of sustainable rural aging. Further, it explores ways that older volunteers, organizations that depend on them, and communities experiencing population aging can persevere post-pandemic.

Person-centred care is recognized as best practice in dementia care. The purpose of this study was to evaluate the effectiveness of a stakeholder engagement practice change initiative aimed at increasing the provision of person-centred mealtimes in a residential care home (RCH). A single-group, time series design was used to assess the impact of the practice change initiative on mealtime environment across four time periods (pre-intervention, 1-month, 3-month, and 6-month follow-up). Statistically significant improvements were noted in all mealtime environment scales by 6 months, including the physical environment (z = -3.06, p = 0.013), social environment (z = -3.69, p = 0.001), relationship and person-centred scale (z = -3.51, p = 0.003), and overall environment scale (z = -3.60, p = 0.002). This practice change initiative, which focused on enhancing stakeholder engagement, provided a feasible method for increasing the practice of person-centred care during mealtimes in an RCH through the application of supportive leadership, collaborative decision making, and staff engagement.

Based on findings from a study examining the lived experiences of dementia carers in their neighbourhoods, this article offers a vision of what dementia-friendly communities could look like from a carer perspective and in a Canadian context. Twelve carers in Ottawa and its surrounding regions were interviewed using a combination of social network maps, mobile interviews, and participant-driven photography. The findings, organized according to the categories “relationships”, “places”, and “everyday practices”, reveal that many of the carers’ choices regarding businesses, services, home location, outings, and everyday practices, are based on a desire to maintain social connections and social citizenship. The article concludes with recommendations for consideration in the planning of dementia-friendly neighbourhood initiatives.

This study documented the provision of services and issues experienced by community organizations supporting older adults and caregivers in the province of Quebec during the coronavirus disease (COVID-19) pandemic, as well as promising strategies to adapt the provision of services in this context. A cross-sectional electronic survey using open- and closed-ended questions was conducted in July 2020. Almost three-quarters of the 307 respondents (71.4%) reported having maintained services at least partially throughout the lockdown, and the majority (85.3%) adapted their services. Among key challenges, participants reported difficulties identifying and supporting older adults at greater risk of vulnerability (54.8%), managing health risks for service users (60.2%), and recruiting volunteers (59.5%). Promising strategies included strategies to reach out to older adults and understand their needs (e.g., systematic phone calls) in addition to direct interventions supporting them (e.g., activities promoting social ties); implementing prevention and protection measures; accessing and using technologies; human resources management (e.g., recruiting new volunteers); finding financial support for their organization; developing intersectoral partnerships (e.g., multisectoral crisis cell); and promoting a positive view of older adults. The integration of multiple perspectives from different stakeholders may help identify strategies potentially transferable to other crises in order to meet older adults’ needs.

Approximately 30 per cent of those over the age of 65 living in the community fall at least once each year, and a similar proportion are at nutrition risk. Screening is an important component of prevention. The objective of this study was to understand how to add nutrition risk screening to a falls risk screening program in family health teams (FHTs). Interview participants (n = 31) were staff/management, regional representatives, and clients from six FHTs that had started integrating screening. Thematic analysis was conducted. Themes identified how to develop screening programs: setting up for successful screening, making it work, and following up with risk. An overarching theme recognized “it’s about building relationships”. Adding nutrition risk to a falls risk screening program takes effort, and is different for each FHT based on their work flow and client population. Determining how to integrate screening into the work flow and planning to address identified risk are necessary components.

Supportive housing, including retirement homes and assisted living, is increasingly touted as a suitable living option for Canadian older adults. This scoping review describes the nature and content of studies that explore underlying factors that motivate older adults to relocate to supportive housing. We conducted a search of PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Web of Science, and PsycINFO, which identified 34 articles for review. Articles reviewed employed a variety of methods and guiding theoretical frameworks, of which the push and pull framework appeared to be most common. This review suggests that health and functional deficits are important reasons for relocation to supportive housing for older adults. Further longitudinal data are required to more comprehensively describe medical and social determinants for relocation and its consequences, in order to better describe this growing population and better align policies with the needs of older adults contemplating or undergoing relocation.

This study describes changes in dining practices and provider perspectives on meal-related challenges due to the coronavirus disease (COVID-19) pandemic. An online survey was disseminated between July and September 2020 through stakeholder networks and social media with 1,036 respondents. Altered dining practices included residents eating in rooms (54.3%), spacing residents in common areas for meals (69.3%), and disposable dish use (44.9%). The most common mealtime challenges were reduced socializing opportunities at meals (29.3%), inadequate staffing (22.8%), reduced family/volunteer help (16.7%), and assisting residents to eat (10.5%). Many participants (72.2%) felt conflict balancing safety and relationship-centred care. Geographic region, home size, building age, respondent’s job title, pre-pandemic relationship-centred practices, and mealtime satisfaction, and some pandemic-initiated practices were associated with mealtime challenges and feeling conflicted in binary logistic regression analyses. Considering trade-offs between safety and relational aspects of mealtimes during the pandemic is crucial.

Our qualitative descriptive study compared how older patients and their informal caregivers experienced the care transition from acute care or rehabilitation to home. We recruited patients 65 years of age or older, or their informal caregivers, from in-patient units within acute care hospitals and rehabilitation facilities to participate in semi-structured interviews. We identified emergent themes via thematic analysis. In all, 16 patients and four patient caregivers participated. Across all care settings, caregivers were integral in facilitating the transition as well as experiencing variable discharge preparation, health care providers’ optimizing transitions, and missed care and medication discrepancies at transition points. Orthopedic and rehabilitation patients more commonly voiced prior transition experiences in discharge preparation, including having to unexpectedly coordinate and wait for outpatient services. Differing responses between acute care and orthopedic settings suggest that transitional care practices and policies favor an individualized approach that considers patients’ previous experiences, needs, and care expectations.

Older adults are rarely consulted on health care restructuring. To address this gap, our study explored older adults’ views on “repositioning”, a restructuring initiative to support independent living for older adults with complex chronic disease (CCD). We collected and analysed data from 83 older adults living in one small city and nine rural small towns where “repositioning” of primary and community care was occurring. Average participant age was 75 years; 56 (67%) were women, 44 (53%) had CCD, and 20 (24%) identified as Indigenous or South Asian. The four themes were: unfamiliarity with repositioning; optimism versus skepticism; improving primary and community care (through better home care, improved transportation, and more doctors); and, playing an active role to effect change. For repositioning to be successful, diverse service users must be fully included; rural-dwelling older adults’ priorities for primary and community care need to be addressed, rather than using a “cookie-cutter” approach.

This article uses findings from qualitative interviews to examine the experiences of members of Saskatoon’s Chinese-Canadian older-adult community in terms of their realities of aging and access to important geriatric resources. Promoting an understanding of both group experience and a broader conceptualization of age-friendly development, we argue that the notion and implications of a spatial ethnic enclave are replaced in the Saskatoon context by a social enclave. This network of social support is evident in Chinese-Canadian older adults’ access to housing, recreation, transportation, and health services. The article concludes with lessons learned that would help enhance culturally pluralistic age-friendly development. This work underlines the significance of social capital development within more marginalized older-adult communities, both as a reaction to outside discrimination, and as a means of ensuring healthy and inclusive community aging.

Public libraries are community hubs that can both create opportunities and address challenges often associated with later life and population aging. Using a thematic analysis of 18 in-depth interviews with public librarians, this study investigates common practices and challenges experienced while developing programs for older adults. This analysis is augmented by an environmental scan of older-adult programming offered in member libraries of the Canadian Urban Library Council (CULC). Results indicate that public librarians leverage community partnerships and staff training to develop programs that foster digital, financial, language, and health literacy and create opportunities for both intergenerational and peer social connection. At the same time, they face challenges related to limited space, budgets, and staff capacity, difficulty meeting the extensive and often conflicting interests of various groups within the library, and marketing programming to older adults. Findings indicate that public libraries may be key players in mitigating challenges often associated with having an aging population, and indeed highlight the many benefits of valuing and providing services to this population.

The measures implemented to limit the spread of COVID-19 affect the social relationships of the elderly. The aim of this article is to understand the effects of the pandemic on residents and resident-to-resident aggression (RRA). In total, 21 individual interviews were conducted with three groups of actors of four independent living facilities who have experienced RRA (residents) or who intervene in this type of situation (members of staff and external stakeholders). The participants reported that the pandemic has effects on residents and, specifically, on RRA. Among other things, the management and resolution of these situations have changed, and new manifestations of RRA are observed. To our knowledge, this study is the first to examine the effects of the pandemic on residents living in independent living facilities and on RRA. It raises the need to further consider residents’ voices in this context and to combine them with those of other actors to better understand how RRA manifest itself.

Montessori-based interventions (MBIs) were developed to promote guided participation in meaningful activities by people with dementia patients. In this study, we assessed nursing home volunteers’ fidelity to an MBI, relying primarily on a qualitative descriptive design. We completed a deductive content analysis of eight volunteer interviews using the Conceptual Framework for Intervention Fidelity. We also calculated average volunteer and resident scores on the Visiting Quality Questionnaire (VQQ), which assesses volunteers’ and residents’ perceptions of visits. We found good evidence that volunteers attended scheduled visits, made use of pre-designed activities, and attended to training recommendations. Most reported enjoying the visits (VQQ $ \overline{x} $ = 6.12, standard deviation [SD] = 0.75) and receiving a positive response from residents (VQQ $ \overline{x} $ = 5.46, SD = 0.88). Nevertheless, use of pre-designed activities and response to the MBI was lower for volunteers working with residents who had late-stage dementia. Therefore, overall, fidelity depended on the cognitive status of the resident.

Le vieillissement de la population invite à étudier les résidences privées pour aînés, notamment sous l’angle du lien social. Après leur emménagement en résidence, plusieurs aînés veulent continuer de participer activement à la société. Cette recherche qualitative exploratoire a pour objectif de mieux comprendre les perceptions et les expériences d’aînés vivant dans une résidence privée par rapport à leur participation sociale, sur le plan de leurs relations interpersonnelles et de leurs activités de loisirs. Onze entrevues individuelles ont été menées auprès de personnes vivant dans des résidences privées pour aînés de la région de la ville de Québec, au Canada. Sur le plan personnel, les facteurs centraux pour la participation sociale sont l’adaptation au nouveau milieu de vie, l’implication dans ce milieu, notamment par le biais du bénévolat, ainsi que l’état de santé de la personne. En ce qui concerne l’environnement social, les facteurs importants sont la proximité géographique de l’entourage, une offre variée d’activités et la stabilité du personnel. Au final, des recommandations sont formulées au sujet des stratégies d’intervention et des pistes de recherche, lesquelles donnent suite aux constats énoncés, et ce, afin de mieux soutenir la participation sociale en résidence privée pour aînés.

Shortly after the COVID-19 pandemic was declared, strict visitor restrictions were issued for long-term care facilities (LTCFs). A year later, restrictions are still in place and they continue to impact family members who have limited or no in-person contact with their relative in LTCFs. The goal of this qualitative longitudinal focused ethnography was to understand the experience of family members who have a relative in a LTCF where visiting has been restricted during the pandemic. Seventeen family members participated in two interviews that were 6 months apart. Data analysis highlighted five key drivers, defined as the workforce, communication deficits, characteristics of care, public health directives, and autonomy of relative which in turn resulted in three main themes: psychological distress, surveillance, and visiting challenges. This study provides a glimpse into the difficult experiences of families with a relative residing in a LTCF in the province of New Brunswick.

Previous studies suggest that intergroup contact has a positive effect on older workers’ perception of ageism and satisfaction. This study aims at assessing such relationships amongst Canadian younger workers. Precisely, in light of the intergroup contact theory (ICT), it was first hypothesized that a positive perception of intergenerational workplace climate (IWC) and knowledge sharing practices (KSP) increase younger workers’ awareness of ageist behaviors targeting older peers. Second, it was hypothesized that such awareness has a positive effect on young workers’ level of satisfaction. Relying on a cross-sectional design composed of 612 participants, path analysis was conducted. Findings suggest that whereas KSP increases younger workers’ awareness of ageist behaviors towards older workers, this is not the case for IWC. On the other hand, both IWC and KSP have a direct and positive impact on younger workers’ level of satisfaction. Theoretical and practical implications of findings are discussed.

Although some studies have revealed practitioner disempowerment in cases of older adult mistreatment, this experience is poorly understood. In addition, dementia and contextual influences further complicate cases; yet,  little is known about the experience of practitioners with this complexity. This critical inquiry, based on Critical social theory, critical consciousness, and professional agency, aimed to address these gaps. Fifty-one practitioners from diverse health care and social service disciplines from rural and urban communities in Northeastern Ontario participated in interviews, journals, and focus groups. Analysis of data revealed the need for empowerment within a perpetual cycle of non-resolution, to refocus on legal clarity and intervention versus the current legal complexity and education focus, and to develop adequate infrastructure to support interprofessional efforts. The infusion of this knowledge into policy, practice, and research has great potential to improve outcomes for older adults with dementia who are mistreated in their homes.

Meaningful social engagement in everyday activities can enhance resident quality of life in nursing homes. In this article, we draw on data collected in a multidisciplinary, international study exploring promising practices in long-term care homes across Canada, Norway, and Germany, to investigate conditions that either allow for or create barriers to residents’ social participation. Within a feminist political economy framework using a team-based rapid ethnography approach, observations and in-depth interviews were conducted with management, staff, volunteers, students, families, and residents. We argue that the conditions of work are the conditions of care. Such conditions as care home location, building layout, staffing levels, and work organization, as well as governing regulations, influence if and how residents can and do engage in meaningful everyday social life in/outside the nursing home. The presence of promising conditions that facilitate resident social participation, particularly those promoting flexibility and choice for residents, directly impacts their overall health and well-being.