Primary progressive apraxia of speech (PPAoS) is a neurodegenerative syndrome characterized by speech apraxia at its onset; as it progresses, it often evolves into total mutism. Even though this syndrome is increasingly recognized, its early differential diagnostic is still complex. The objective of this study was to illustrate why a fine evaluation of speech and language is essential for the differential diagnosis of PPAoS. This longitudinal case study presents the progression of a PPAoS patient over a period of 5 years. Periodic neurological and speech-language assessments were carried out to follow the progression of neurological, memory, language and speech symptoms. The different diagnostic labels established over time were also reported. The evolution of the patient’s communication profile was characterized by a preservation of language components and episodic memory, in parallel with a progressive deterioration of speech which gradually reduced intelligibility, and was associated with signs of spasticity, resulting in a complete anarthria. This case study sheds light upon the evolution of a patient with PPAoS. A better understanding of the clinical profile and progression of PPAoS is necessary in order to improve early diagnosis and adequate care for these patients.

Residents in long-term care (LTC) often require physical rehabilitation (PR) to maintain/improve physical function. This scoping review described the breadth of literature regarding PR in LTC to date, synthesizing PR interventions that have been evaluated, outcomes used, and tools for determining service eligibility. A structured search, conducted in six licensed databases and grey literature, identified 381 articles for inclusion. Most interventions were delivered and evaluated at the resident level and typically were multicomponent exercise programs. Performance-based measures, activities of daily living, and mood were the most frequently reported outcomes. A key knowledge gap was PR in relation to goals, such as quality of life. Future studies should reflect medically complex residents who live in LTC, and length of residents’ stay should be differentiated. Intervention studies should also explore realistic delivery methods; moreover, tool development for determining service eligibility is necessary to ensure equality in rehabilitative care across the LTC sector.

The objective was to translate into French the American questionnaire “Nursing Home Survey on Patient Safety Culture” and to test the feasibility of its use in a sample of nursing homes. The questionnaire was translated by a multidisciplinary group of six experts and tested on a sample of people working in nursing homes. The questionnaire was then administered in five nursing homes. A first version of the French NHSPSC is proposed in this article. Despite similarities between items and ceiling effect for one item, the choices made were conservative to allow international comparisons. The administration of the questionnaire in five nursing homes confirmed the feasibility of the approach, with a participation of more than 50 per cent. This work made a French version of the NHSPSC available and confirmed that it is a feasible method for evaluating safety culture in nursing homes.

This study sought to develop frailty “identification rules” using population-based health administrative data that can be readily applied across jurisdictions for living and deceased persons. Three frailty identification rules were developed based on accepted definitions of frailty, markers of service utilization, and expert consultation, and were limited to variables within two common population-based administrative health databases: hospital discharge abstracts and physician claims data. These rules were used to identify persons with frailty from both decedent and living populations across five Canadian provinces. Participants included persons who had died and were aged 66 years or older at the time of death (British Columbia, Alberta, Ontario, Quebec, and Nova Scotia) and living persons 65 years or older (British Columbia, Alberta, Ontario, and Quebec). Descriptive statistics were computed for persons identified using each rule. The proportion of persons identified as frail ranged from 58.2-78.1 per cent (decedents) and 5.1-14.7 per cent (living persons).

Visual inscriptions (e.g., graphs, illustrations) are a defining feature of scientific discovery to aid in data analysis, interpretation, and communication (e.g., Latour, 1990; Lynch, 1985). Our purpose was to examine how visual inscriptions are used to present data in gerontology journals. We compared 357 articles sampled from 24 peer-reviewed gerontology journals published between 1995 and 2009. Approximately 11 per cent of page space was dedicated to data presentation with more page space occupied by tables (9.13%) than graphs (2.32%). Graph use in gerontology was lower than in psychology (6.6% of page space) and higher than in criminology and criminal justice (1.7% of page space). Following Latour (1990), we argue that visualisations provide an understandable summary of complex data by effectively presenting multifaceted results. When inscriptions are used in dissemination, researchers become less reliant on complex statistical jargon and can communicate easily with a diverse audience (researchers, health care practitioners, clients).

We conducted a scoping study to examine how interprofessional health care teams improve the outcomes of older adults experiencing cognitive challenges. We searched Ovid, Medline 1946, and MEDLINE In-Process and other non-indexed citations, using the concepts multi or interdisciplinary care teams, confusion or cognitive impairment, and elderly adults. Of 4,554 articles the review yielded, 34 relevant to our inquiry, using Arksey and O’Malley’s methodological framework. Twenty-nine per cent of authors reported on the processes interprofessional teams use to achieve positive outcomes for older adults. They highlighted the importance of communication, staff strategies, and education interventions in achieving outcomes with older adults and in supporting interprofessional collaboration. The review revealed knowledge gaps about the processes teams use to collaborate in caring for older adults experiencing cognitive challenges, and how to best incorporate older adults and their families’ perspectives in team decisions. More research to understand processes interprofessional teams use is needed.

This study investigated the state of gerontology content in health and social service education programs in Ontario, and readiness indicators for change among administrators and faculty. We conducted a survey of teaching faculty (n = 100) and deans or directors (n = 56) of 89 education programs, which revealed mixed evidence on readiness for change. Most respondents thought their programs were adequate but needed enhancement. However, they were unaware of published gerontological competencies with which to evaluate their curricula. Beliefs about capacity for change varied, with half the participants indicating that their programs had sufficient faculty expertise in gerontology and geriatrics. Factors influencing readiness for change include lack of gerontological expertise; need for institutional and management support; need for additional teaching resources; and recognizing the need for change. There is an opportunity, by committing resources and time, to capitalize on the faculty and administrators who thought their programs should improve.

We used a web-based mixed methods survey (HowsYourHealth – Frail) to explore the health of frail older (78% age 80 or older) adults enrolled in a home-based primary care program in Vancouver, Canada. Sixty per cent of eligible respondents participated, representing over one quarter (92/350, 26.2%) of all individuals receiving the service. Despite high levels of co-morbidity and functional dependence, 50 per cent rated their health as good, very good, or excellent. Adjusted odds ratios for positive self-rated health were 7.50, 95 per cent CI [1.09, 51.81] and 4.85, 95 per cent CI [1.02, 22.95] for absence of bothersome symptoms and being able to talk to family or friends respectively. Narrative responses to questions about end of life and living with illness are also described. Results suggest that greater focus on symptom management, and supporting social contact, may improve frail seniors’ health.

We examined the relations between perceived health (e.g., self-perceived health status) and driving self-regulatory practices (e.g., frequency of driving, avoiding challenging driving situations) as mediated by driving attitudes and perceptions (i.e., driving comfort, positive and negative attitudes towards driving) in data collected for 928 drivers aged 70 and older enrolled in the Candrive II study. We observed that specific attitudes towards driving (e.g., driving comfort, negative attitudes towards driving) mediate the relations between health symptoms and self-regulatory driving behaviours at baseline and over time. Only negative attitudes towards driving fully mediated the relationships between changes in perceived health symptoms and changes in driving behavior. Perceived health symptoms apparently influence the likelihood of avoiding challenging driving situations through both initial negative attitudes towards driving as well as changes in negative attitudes over time. Understanding influences on self-regulatory driving behaviours will be of benefit when designing interventions to enhance the safety of older drivers.

We investigated whether convenience sampling is a suitable method to generate a sample of older drivers representative of the older-Canadian driver population. Using equivalence testing, we compared a large convenience sample of older drivers (Candrive II prospective cohort study) to a similarly aged population of older Canadian drivers. The Candrive sample consists of 928 community-dwelling older drivers from seven metropolitan areas of Canada. The population data was obtained from the Canadian Community Health Survey – Healthy Aging (CCHS-HA), which is a representative sample of older Canadians. The data for drivers aged 70 and older were extracted from the CCHS-HA database, for a total of 3,899 older Canadian drivers. Two samples were demonstrated as equivalent on socio-demographic, health, and driving variables that we compared, but not on driving frequency. We conclude that convenience sampling used in the Candrive study created a fairly representative sample of Canadian older drivers, with a few exceptions.

Ontario has the highest proportion of for-profit nursing homes in Canada. These facilities, which are known in Ontario as long-term care (LTC) homes, offer 24-hour custodial as well as nursing care to individuals who cannot live independently. Increasingly, they are also operating as members of multi-facility chains. Using longitudinal data (1996–2011) from the Residential Care Facilities Survey (n = 627), our analysis revealed discernible differences in staffing levels by profit status and chain affiliation. We found for-profit LTC homes – especially those owned by a chain organization – provided significantly fewer hours of care, after adjusting for variation in the residents’ care needs. Findings from this study offer new information on the impact of organizational structure on staffing levels in Ontario’s LTC homes and have implications for other jurisdictions where a growing presence of private, chain-affiliated operators has been observed.

Often older people, while maintaining a level of independence, rely on family members to provide care and assistance. Caregivers who are also registered nurses (RNs) may provide a different perspective around the experience when their older relative is admitted to acute care. The aim of our research was to investigate and develop theory regarding nursing care provision as described by RNs, who were family caregivers to older adults, when that older adult was admitted to acute care. Over a six-month period in 2011, RNs meeting this criterion (n = 12) were interviewed individually. We identified two central categories: “Culture of Neglect” and “Vigil by the Bedside”. The core category “Normalization of Neglect” was identified as the theory, grounded in the data the participants provided which described a culture of neglect that had normalized poor nursing care. These findings highlight the issue of neglect and abuse, and further investigation is warranted.

Terror management theory (TMT) posits that cultural worldviews function to allay concerns about human mortality. Preliminary research with older adults has indicated that seniors do not respond to death reminders in the same way as their younger counterparts. The purpose of the current study was to test a developmentally relevant construct that may buffer death anxiety in later life. It was hypothesized that Erikson’s concept of generativity may encompass death-denying properties for older adults. One hundred and seventy-nine seniors were recruited to determine if subtle mortality salience inductions would lead participants to rate their own generativity as higher than after a blatant induction, or no induction, after controlling for pre-induction generativity. As expected, participants exposed to subtle death primes rated themselves as having higher levels of generativity than the other two groups after co-varying pre-induction generativity. Explanations are discussed in light of the literatures on TMT and generativity.

The aim of this study was to explore policies and procedures to support employees who retire from the emergency services. Interviews were conducted with participants who were familiar with existing policies and procedures in a large ambulance (n = 8) and fire (n = 6) service in Ireland. Four key themes were identified: (1) “I don’t think it’s a job at 65 to be running out on an emergency ambulance”; (2) “They do genuinely feel a wee bit isolated”; (3) improving the “cultural shock”; and (4) “I just keep going and hope for the best”. Findings point towards retirement as a major life change and highlight a need for more structured, effective pre-retirement preparation. Factors unique to emergency service personnel include the physical and emotional stress involved in emergency service; a strong identification with the service; and a lack of clarity about rules and entitlements, requiring better information and preparation.

This 2014 mapping exercise sought to identify and describe all bereavement support programs and services in the province of Alberta, and compare these to those available four years previously. Bereavement is a common life experience, especially among older persons, with support often needed to assist recovery. We sought program and service information through systematic searches and the snowball technique to identify providers and interview them. Although considerable (330%) growth, and more diversity in providers, programs, and services was evident, bereavement programs were no longer publicly funded. Instead, programs and services were now grassroots in origin, with individuals and community groups largely designing and providing bereavement support services. Bereavement programs are important, particularly for elderly persons who may be the most impacted by the death of a loved one. Whether governments should fund and/or provide these programs is a question that also needs to be addressed.

With an increasing number of older drivers who are prescribed antidepressants, the potential consequences of antidepressant use on driving skills in an aging population are becoming a pressing issue. We conducted a systematic review using MEDLINE, targeting articles specifically pertaining to antidepressants and driving in a population or subgroup of older adults (≥ 55 years of age). The search yielded 267 references, nine of which pertained to the effects of antidepressants on driving in older adults. The single experimental study found imipramine to have detrimental effects on highway driving, whereas nefazodone did not. Seven of eight population-based studies reported a significant increased risk of involvement in a collision associated with antidepressant use. Although the studies indicated a negative effect of antidepressants on driving, the epidemiological designs cannot exclude the possibility that the underlying illness, generally major depression, is the culprit.

Navigators help rural older adults with advanced illness and their families connect to needed resources, information, and people to improve their quality of life. This article describes the process used to engage experts – in rural aging, rural palliative care, and navigation – as well as rural community stakeholders to develop a conceptual definition of navigation and delineate navigation competencies for the care of this population. A discussion paper on the important considerations for navigation in this population was developed followed by a four-phased Delphi process with 30 expert panel members. Study results culminated in five general navigation competencies for health care providers caring for older rural persons and their families at end of life: provide patient/family screening; advocate for the patient/family; facilitate community connections; coordinate access to services and resources; and promote active engagement. Specific competencies were also developed. These competencies provide the foundation for research and curriculum development in navigation.

This article explores potential differences in yoga practice between middle-and older-aged adults. A health belief – life course model frames this research, and a mixed-methods analytic strategy is employed to examine life course pathways into yoga and motivations to practice, as well as perceived barriers and health benefits. For the quantitative analyses, a convenience sample of 452 participants was collected using an online questionnaire. For the qualitative analyses, face-to-face interviews were conducted with a sub-set of 20 participants. Unique differences between the age groups (both current age and age when started yoga) as well as by gender were found for selected pathways, reasons/motivations, and barriers to engage in yoga as well as for perceived health benefits. In addition, results underscore the importance of informational cues and social linkages that affect how individuals adopt and experience yoga. Implications for health promotion programs that target older adults are discussed.

This proof-of-concept pilot study explored virtual simulation methodology to quantify blind-spot line-of-sight using avatars derived from an older driver database (n = 100). Siemens Jack software simulated the blind spots of eight older driver avatars (four female). The male and female avatars were scaled to be small (25th percentile) and large (75th percentile) based on the height distribution for the older driver database, and had either “normal” (65 degrees) or “abnormal” (50 degrees) neck range of motion (ROM). A virtual model of a Volkswagen Beetle was used to illustrate left and right blind-spot line-of-sight for each avatar. Average line-of-sight between blind spots was 22.3 per cent and 10.4 per cent in the “normal” and “abnormal” rotational neck ROM conditions, respectively. Older drivers with functional impairments affecting neck ROM are more likely to have problems with left blind-spot line-of-sight. Findings are discussed with regard to vehicle design considerations for older adults.

This study explored qualitatively how residents of long-term care (LTC) facilities feel about and adapt to the care they receive. We interviewed and observed a purposeful selection of elderly residents in seven facilities purporting to provide person-centred care. Interpretative descriptions from 43 personal interviews with 23 participants answered the question: How do residents perceive the care rendered in LTC facilities purporting to offer person-centred care? Three themes emerged: (1) the caring environment; (2) preservation of dignity; and (3) maintenance of personal autonomy. Participants were sympathetic to the nursing staff’s workload, but felt distant from the staff. Participants gave examples of poor care and lack of empathy, human indignities, and violations of personal autonomy caused by institutional policies they felt inhibited their ability to receive care based on their preferences. Overall, they challenged the claims of person-centred care, but adapted to cope with an environment that threatened their dignity and autonomy.