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CAG2016: Fostering Innovation in Research on Aging, October 20-22, 2016, Montreal, Quebec
ACG2016 : Favoriser l’innovation en recherche sur le vieillissement : 20-22 octobre 2016, Montréal (Québec)
Abstracts / Résumés
Oral Presentations ............................................. 1
Poster Presentations........................................ 97
Latebreaker Posters....................................... 227
Symposium Presentations ............................. 255
Workshops ..................................................... 348
Oral Presentations/Presentations orales
O1
The roles of facility-level characteristics and a
primary care coordination model on resident
health outcomes in long term care facilities. A
report from the Care by Design Study
Emily Gard Marshall, Barry Clarke, Greg Archibald,
Melissa K. Andrew
Dalhousie University, NS, Canada
Objectives: Care by Design (CBD), a model of
coordinated primary care in Long Term Care
Facilities (LTCF), was introduced in Halifax NS
with the goal of improving resident care. This study
investigates whether facility-level characteristics
were associated with changes in residents’ health
and care post-CBD.
Methods: Resident-level data for all 911-involved
and a sample of 200 non-911-involved residents
were abstracted through LTCF chart reviews pre(N=203) and post-CBD (N=374). Health/care
measures included pressure wounds, wound-care
protocol adherence, influenza vaccination, fall
rates, Potentially Inappropriate Medication (PIM)
use, and polypharmacy (>10 medications). LTCF
administrators reported facility-level characteristics
(bed number and for-profit (FP) vs. not-for-profit
(NFP) status). Differences pre- and post-CBD were
stratified by facility characteristics. Analyses
included t-tests for means and Chi square tests for
rates.
Results: Six facilities (474 beds) were FP; three
facilities (734 beds) were NFP. Rates of pressure
wounds did not significantly differ, but adherence
to wound-care protocols was higher in NFP vs. FP
facilities both pre- (p=0.003) and post-CBD
(p=0.03). PIM use was higher in FP facilities preCBD (95.5% vs 75.9%, p=0.01); post-CBD their
use fell to the level of NFP (p=0.12). The
polypharmacy rate dropped markedly between
time periods (p=0.02), principally due to the drop in
the FP rate (p=0.02). Rates of falls and influenza
vaccination did not differ by time period or profit
status.
Conclusions: Some resident healthcare measures
significantly improved post-CBD. Facility-level
characteristics were associated with important
differences. In these cases, CBD may have played
an equalizing role to bring FP up to NFP
standards.
O2
L'intégration des services sociaux et de santé
en français destinés aux aînés francophones
dans l'Est ontarien : Barrières et facteurs
facilitants
1
1
2
1
J. Savard , S. Savard , Y. Couturier , M. Drolet ,
1
1
L.A. Kubina , S. van Kemenade
1
2
Université d'Ottawa, Ottawa, Canada, Université
de Sherbrooke , Sherbrooke, Canada
Problématique: L'accès à des services sociaux et
de santé dans leur langue maternelle est très
important pour les ainés chez qui la compétence
en langue seconde peut diminuer en raison, entre
autres, de diverses conditions de santé. En
Ontario, certains services sociaux et de santé sont
offerts en français, mais ils sont souvent épars et
peu connus. Dans ce contexte, les données
probantes présentent l'intégration des services
comme une option appropriée pour en augmenter
la qualité.
Objectif: Présenter les résultats préliminaires
d'une recherche participative sur les services
destinés aux ainés francophones dans l'Est
ontarien. L'étude cherchait à identifier les facteurs
qui facilitent l'accès à des services intégrés en
français, et ceux qui le rendent difficile, pour
élaborer des lignes directrices favorisant
l'intégration de ces services.
Méthode: Plus d'une trentaine d'entrevues semidirectives individuelles et six groupes de
discussion auprès de personnes âgées
francophones, gestionnaires d'établissement et
professionnels de la santé et des services sociaux
ont été réalisés.
Résultats: La désignation francophone ou bilingue
d'un établissement et l'offre active de services en
français ressortent comme facteurs facilitant
l'accès aux services en français. Cependant, peu
d'efforts de coordination tiennent compte de la
langue, ce qui entrave la capacité de l'offre active
à avoir les effets espérés.
1
Conclusion: Les résultats suggèrent un besoin de
sensibilisation aux services linguistiquement
adaptés et d'outils favorisant l'offre active de
services sociaux et de santé intégrés en français
afin de contribuer au bien-être des ainés.
O3
Delivering Care on the Coast: The Development
and Delivery of Specialized Geriatric Clinics on
the James Bay Coast in Northeastern Ontario
1
1
Jo-Anne Clarke , Melanie Briscoe , Crystal
1
2
2
McComb , Jessica Carter , Crystal Culp , Valerie
1
3
Scarfone , Carol Philbin Jolette
1
North East Specialized Geriatric Centre, Sudbury,
2
Ontario, Canada, Weeneebayko Area Health
3
Authority, Moose Factory, Ontario, Canada, North
East Local Health Integration Network, North Bay,
Ontario, Canada
Purpose. This presentation will share learnings
from the planning, development, and delivery of
specialized geriatric clinics to remote communities
along the James Bay coast in northeastern
Ontario. The purpose of these clinics is to bring
specialized, multidisciplinary teams to deliver care
to Elders in community and hospital, and to
implement care plans that can be executed by
local healthcare providers.
Method. These geriatric clinics are the product of
intense collaboration and co-design between
community leaders and Elders, the Weeneebayko
Area Health Authority, the North East Local Health
Integration Network, and the North East
Specialized Geriatric Centre. Consequently, new
care models were developed that focus on
education and building capacity for identification,
triage, and assessment by local healthcare
providers.
Further, not only have Elders in these communities
received the specialized care that they require, but
local practitioners are better able to identify and
treat frail Elders, thus keeping them home and in
their communities for as long as possible. Key
learnings from the community engagement and codesign process will be shared and discussed.
O4
The relationship between the acute care
geriatric practice environment and nursing
practice in predicting the overall quality of care
for older adults and their families
1
1
2
Mary Fox , Hugh McCague , Deborah Tregunno ,
1
1
Malini Persaud , Jeffrey Butler
1
York University, Toronto, Ontario, Canada,
2
Queen's University, Kingston, Ontario, Canada
Objective: This study aimed to explore the
mechanisms underlying the overall quality of care
for older adults and their families as a
consequence of the geriatric nursing practice
environment (geriatric resources, interprofessional
collaboration, and organizational value of older
people's care) and geriatric nursing practice
(patient-centred care, family nursing practice, and
function-focused care).
Methods: A cross sectional survey design was
used. A survey containing several validated scales
with questions on the geriatric nursing practice
environment (GNPE) and geriatric nursing practice
(GNP) was completed by a randomly selected
sample of 2005 Ontario staff nurses. Structural
equation modelling was used to test a conceptual
framework derived from the theory of
organizational interdependence that proposes the
practice environment influences geriatric nursing
practice which, in turn, impacts the overall quality
of care for older people and their families.
Results. Since January 2014, four clinics have
operated and 119 Elders across five communities
have been identified by local providers as requiring
specialized assessment through these geriatric
clinics. Moreover, the imperative to adapt
inappropriate standardized assessments to the
local contexts have resulted in novel approaches
that deliver more culturally-safe and appropriate
care.
Results: GNPE had a statistically significant direct,
positive relationship of large magnitude with both
GNP (standardized beta = 0.52) and overall quality
of care (standardized beta = 0.92). However, the
mediated effect of GNPE through GNP on overall
quality of care was not significant. The model fit
was acceptable with RMSEA=0.068, CFI=0.932
and TLI=0.868.
Conclusions. The continued success of these
clinics is a direct result of the deep collaboration
and community engagement that preceded them.
Conclusion: A strong geriatric nursing practice
environment positively and directly influences
geriatric nursing practice and the overall quality of
2
care for older adults and their families. However, a
strong geriatric nursing practice environment does
not appear to influence overall quality of care
indirectly through geriatric nursing practice.
O5
Nurse perspectives on interprofessional team
collaboration in the function-focused care of
acutely-ill older people
Jeffrey Butler, Mary Fox
York University, Toronto, Ontario, Canada
Objective: This study aimed to explore the
perspectives of acute care staff nurses on: (1)
interprofessional collaboration (IPC) in functionfocused care (FFC) for older people, and (2)
strategies for optimizing IPC in FFC.
Method: A qualitative descriptive design was used.
Thirteen focus groups were conducted with a
purposeful, criterion-based sample of 57 nurses
(33 registered nurses and 24 registered practical
nurses) working in teaching and non-teaching
acute care units across Ontario. Narrative data
were thematically analyzed.
Results: Two overarching themes related to
communication characterized nurses’ perspectives
on IPC in FFC for older people: (1) nurses are
often excluded from interprofessional decisionmaking, and (2) interprofessional teams should
cultivate a dialogical “culture of questioning” that
leverages nurses’ unique knowledge and
expertise. The first theme focuses on nurses’ view
that their voices are often devalued in team
communication in FFC. Interprofessional rounds
were identified as the primary venue for nurses to
contribute to care planning, decision-making, as
well as patient and family advocacy, but the deprioritization of nurses’ attendance was seen as
closing off their meaningful participation. The
second theme illuminates the need to re-envision
interprofessional team communication by
encouraging nurses to actively contribute to
decision-making in FFC and challenge team
decisions that may undermine older people's
functioning.
Conclusions: IPC in FFC can be improved by
fostering open, egalitarian dialogue between
nurses and interprofessional team members.
Ensuring that nurses are included in
interprofessional rounds will help teams draw on
nurses’ expertise and leverage their detailed
knowledge of older people's functional capabilities
and vulnerabilities.
O6
Integrating Inter-professional Primary Care
Teams, Volunteers, and eHealth Technologies
to Optimize Care of the Elderly: The Health
TAPESTRY Intervention
Ruta Valaitis, Lisa Dolovich, Doug Oliver, Jenny
Ploeg, Gina Agarwal, Dee Mangin, Cathy Risdon,
Laura Cleghorn, Nola Fuller, Jessica Peter, Fiona
Parascandalo
McMaster University, Hamilton, Canada
Objectives: To discuss the normalization and
integration of key components of a one-year multifaceted intervention in two sites of a Family Health
Team in Hamilton, Canada. The Health
TAPESTRY (Teams Advancing Patient
Experience: Strengthening Quality) program
integrated trained community volunteers, e-Health
technologies, and inter-professional primary
healthcare teams and system navigation to foster
optimal aging for older adults living at home.
Method: A qualitative descriptive design involved
audio-recorded, transcribed face-to-face, semistructured interviews and focus groups [health care
providers (n=25), volunteers (n=16), and clients
(n=30)] at 4 months and 12 months after initiation
of a randomized controlled trial. Normalisation
Process Theory provided a sensitizing framework
for data collection as well as analysis. NVivo 10
was used to help determine emerging themes
using the constant comparative method.
Findings: Inter-professional teams leveraged
existing processes and practices while grappling
with "new information:" health surveys,
questionnaire, and goals collected by volunteers in
clients' homes using eHealth technologies. Clients
valued volunteer visits with perceptions of impacts
related to goal-setting and clinical follow up.
Appraisal of the intervention by individuals and
groups over time revealed successful integration
between volunteers and clients, although some
challenges in communication and collaboration
between volunteers and inter-professional teams
remained. Integration of some eHealth
technologies posed significant challenges, while
others facilitated teamwork and collaboration.
Conclusion: In a relatively short implementation
time-frame, key players achieved "coherence" or
3
sense-making, to clearly articulate benefits of the
intervention. Participants also collectively
operationalized new practices to normalize them in
usual practice despite implementation challenges.
first step and supports engagement opportunities
in learning and curriculum development for
residents and families.
O8
O7
Enriching undergraduate nursing education in
continuing care through an enhanced learning
partnership
1
1
Heather Moquin , Lorraine Venturato , Cydnee
1
2
2
Seneviratne , Dennie Hycha , Doreen Wilson
1
University of Calgary, Calgary, Canada,
2
Covenant Care, Alberta, Canada
Objectives: An innovative, education-driven care
model is being created through an enhanced
learning partnership (ELP) between the University
of Calgary Faculty of Nursing and Covenant Care,
a non-profit continuing care organization. This
model has three components: 1) an undergraduate
nursing positive placement program (+PPP); 2)
research and advanced learning opportunities for
graduate nursing students; and 3) workforce
development and in-house learning for site staff,
residents and families.
The study is evaluating how an intentional serviceacademic partnership can enhance an
undergraduate placement program within
continuing care. It considers implementation
facilitators and barriers, students’ attitudes towards
older adults and professional identity concepts, as
well as person-centred care and learning culture in
the continuing care setting.
Methods: This study is using participatory action
research through four cycles of the undergraduate
placement program. Two sites are included, one
utilizing the +PPP and the second utilizing a
traditional clinical model.
Results: Initial results from the first cycle of focus
groups with students, staff, residents and families
will be presented, with a discussion of the systemic
barriers and facilitators involved in starting up a
care model of this type in continuing care.
Conclusions: This project aims to embed a
learning environment within continuing care to
enrich quality of care and quality of life for
residents, families and staff. A positive clinical
placement model enhancing the interests of
students in working with older adults is a valuable
Continued evaluation of an online dementiaspecific educational intervention in a
baccalaureate collaborative nursing degree
program
1
1
Lori Schindel Martin , Daria Romaniuk , Kristine
1
1
2
Newman , Nancy Purdy , Audrey Kenmir , Sandy
3
2
2
Wiesenthal , Marg Verkuyl , Michelle Hughes ,
1
4
Patricia Julian , Victoria McLelland , Patricia
4
Boucher
1
2
Ryerson University, Toronto, Canada, Centennial
3
College, Toronto, Canada, George Brown College,
4
Toronto, Canada, Advanced Gerontological
Education, Hamilton, Canada
Purpose: First year nursing students may interact
with patients with dementia during clinical
placements yet have limited knowledge of
communication strategies that help to reassure
individuals who exhibit responsive behaviours.
Limited understanding in this area contributes to
student anxiety and avoidance of working with
older adults, which is problematic given the
growing incidence of dementia. This study was the
second year of an ongoing evaluation of the
effectiveness of exposing over 400 first year
undergraduate nursing students and their clinical
instructors to an online version of a dementiaspecific educational intervention, Gentle
Persuasive Approaches (GPA).
Method: We used a mixed methods approach.
Quantitative measures included: 1) self-efficacy
and 2) competence in dementia care scales,
administered pre- and post-intervention, as well as
3) satisfaction measures and a 4) 10-item multiple
choice knowledge test. Qualitative measures
consisted of themes extracted from group
interviews conducted immediately pre- and postintervention. Bandura's social learning theory
(1985) underpinned the study, whereby selfefficacy enhances role performance.
Findings: Participants demonstrated significant
improvements in both self-efficacy (p<.001) and
competence (p<.001) in dementia care after
completing the intervention. Qualitative findings
revealed that participants successfully applied
person-centred and relational care strategies
during clinical placements. Post-intervention,
4
participants were able to explain, implement, and
evaluate theoretical principles behind dementiaspecific communications and person-centred care
strategies.
Conclusions: Results provide further evidence
from a new student cohort that the online version
of the GPA curriculum is an appropriate and
effective intervention for undergraduate
baccalaureate nursing programs. Implications for
ongoing curriculum redevelopment and further
dissemination will be discussed.
O9
What happens to the caregiver when the
caregiving ends? A Post-Caregiving Protocol
Pam Orzeck, Zelda Freitas, Isabelle Van
Pevenage, Patrick Durivage
CIUSSS du Centre-Ouest-de-l'Île-de-Montréal,
Montréal, Quebec, Canada
The University affiliated network and the Centre for
Research and Expertise in Social Gerontology
(CREGES) of the Integrated Health and Social
Services University Network for West-Central
Montreal (CIUSSS Centre-Ouest Montréal) have
developed an innovative protocol for service
providers intervening with caregivers of older
adults nearing their end of life.
Caregivers are involved in care situations that can
be very challenging and may last for many years.
This can lead to social isolation, feelings of
loneliness and hopelessness and difficulties
adapting to the multiple losses inherent in the
caregiving journey. Often an intense experience,
for some, caregiving stress and challenges can
mean complicated bereavement in the postcaregiving phase.
This project focuses on enhancing the need for
supportive services for caregivers during active
caregiving and places emphasis once the carereceiver has died and the support team is required
to terminate their interventions and close the
service user’s file. Caregivers have needs postcare that are often left unmet and unrecognized.
This project proposes a follow-up plan for the postcaregiver based on validated risk factors and
indicators for poor adaptation/adjustment to their
loss. Using a strength-based approach, this
protocol identifies and highlights the caregivers'
strengths to overcome possible challenges in postcaregiving.
This presentation aims to provide the audience
with an overview of the protocol, its application and
emphasize the provision of this service as a
preventative strategy.
O10
Une étude sur l'expérience des pairs
éducateurs dans les initiatives de promotion de
la santé des aînés
1 ,2
2 ,1
Claudé Vérité-Aubry , Johanne Filiatrault ,
3
2 ,1
Manon Parisien , Agathe Lorthios-Guilledroit
1
Université de Montréal, Montréal, Canada,
2
Centre de recherche, Institut universitaire de
3
gériatrie de Montréal, Montréal, Canada, CIUSSS
du Centre-Ouest-de-l'Île-de-Montréal, Montréal,
Canada
Introduction : L'éducation par les pairs est une
stratégie en plein essor en promotion de la santé
des aînés. Elle consiste à former des aînés pour
véhiculer des messages de santé à leurs pairs et
les inciter à adopter des comportements favorables
à la santé. Peu de chercheurs se sont intéressés à
la perspective des pairs éducateurs quant à leur
expérience dans ce rôle. Le principal objectif de
cette étude était d'explorer les motivations des
aînés à s'engager et à rester impliqués dans de
telles activités ainsi que le sens accordé à cellesci.
Méthodes : Des entrevues individuelles ont été
menées auprès de 7 aînés ayant une expérience
de pair éducateur dans le domaine de la santé.
Des questions ouvertes ont permis de décrire
l'expérience des pairs éducateurs et d'approfondir
sur le sens et la valeur accordés à ce rôle, ainsi
que les facteurs ayant influencé leur implication.
L'analyse des verbatim a été réalisée à l'aide de
QDA Miner et d'une grille basée sur le modèle
conceptuel Do Live Well.
Résultats : Le sens accordé par les participants à
leur rôle de pair éducateur s'ancre principalement
dans les dimensions de plaisir, de l'expression de
l'identité, de contribution sociale, de relations
sociales et de développement de connaissances.
Conclusions : Cette étude soutient les bienfaits
de l'implication des aînés comme pairs éducateurs
en santé. Cette stratégie s'avère un moyen
5
prometteur pour permettre aux aînés de demeurer
des citoyens actifs et engagés dans leur
communauté.
O11
"Have you thought about advance care
planning and can we talk about it?" A
promising approach to promoting capacity for
Advance Care Planning and Health Care
Consent in the SE LHIN (Local Health
Integration Network)
1
1
Gail Hawley Knowles , Denise Owsianicki , John
1
Puxty
1
Center for Studies in Aging at Providence Care,
2
Kingston, ON , Canada, Queens University ,
Kingston, ON , Canada
The South East Hospice Palliative Care
engagement survey revealed that 77% of health
care providers surveyed expressed a lack of
comfort in facilitating Advance Care Planning
(ACP) conversations and the need for further
education to increase knowledge and capacity.
To help demystify the challenges of initiating and
guiding Advance Care Planning conversations, the
Center for Studies in Aging and Health at
Providence Care, Kingston, ON developed a series
of online e-learning courses and resources based
on a common Ontario based curriculum.
The overall goal of the program was to promote
timely and accurate ACP and Health Care Consent
conversations to support the delivery of high
quality person centered care through informed
decision making and promote more effective and
efficient use of health care resources.
The materials and process were piloted with a
variety of health care providers from Long Term
Care, Community Care and Primary Care. Results
of the pilots revealed that 78-87% of the
participants felt their knowledge on the topic had
increased and 90-100% would use the information
in their work.
We will show case the resources and describe our
next steps in the dissemination and delivery
strategy across health care providers in SE
Ontario.
O12
Gerontology in Practice: An Innovative
Community Service-Learning Course in Health
Sciences
Aleksandra Zecevic
Western University, London, Ontario, Canada
Objective: The objective of this presentation is to
introduce Gerontology in Practice, an award
winning community service-learning course in
which small teams of Health Sciences students
work alongside community partners on projects
related to health and aging. By researching
authentic real-life problems, students explore the
theoretical factors behind the issue at hand,
discern and critically evaluate available solutions
and develop a proposal to advocate for change.
Methods: The course combines principles of
service-learning, flipped classroom, student
engaged and student-centered learning, reflection,
teamwork, and empowered critical thinking.
Deliverables include a presentation, video and
implementation report that suits future needs of the
community partners.
Results: Over four years the course has been
offered it engaged 166 students and 24 community
partners on 31 community projects. "Gerontology
in Practice was the best experience (not just a
course) of my undergraduate degree" (4th year
student). The impact of this innovative approach to
teaching gerontology is demonstrated by student
presentations, project continuation through
research, independent studies, volunteering,
manuscripts and enrollment in graduate programs.
Pre- and post-course research evaluation of a)
knowledge and skills, b) academic engagement, c)
community engagement, and d) attitudes towards
the elderly, showed significant positive changes.
Impact on community partners and older adults is
undeniable.
Conclusion: Gerontology in Practice is considered
gold standard for service-learning at Western
University. It received The Pillar Nonprofit
Innovation Award for Community Collaboration in
2012, and an international Brightspace Innovation
Award in Higher Education in 2015. This course
offers inspiring insights for everyone in educational
gerontology.
6
O13
The Influence of Physical and Social
Environments on Aging in Place in NORC and
Cohousing in Canada
Catherine Bigonnesse, Habib Chaudhury
Simon Fraser University, Vancouver, BC, Canada
Context: 85% of Canadians over 55 years-old
want to age in their home and community as long
as possible even in the face of decline in health
status and physical functioning. Many physical
environmental and social factors of the
neighbourhood influence aging in place. Naturally
Occurring Retirement Communities (NORC), and
more recently, Cohousing communities are among
the initiatives that have generated interest among
older adults and the research community as strong
potential for aging in place in the broader
community. However, empirical research on NORC
and cohousing in Canada is very limited.
Objectives: The purpose of this study is to gain an
understanding of the influence of physical and
social environments of home and neighbourhood
on aging in place processes among older adults in
NORC and cohousing communities.
Methods: Using a constructivist grounded theory,
this study utilized two data collection methods
(photovoice and semi-structured interviews) with
20-24 cognitively intact, independently mobile
older adults living in two NORCs and three
cohousing communities in British Columbia,
Canada.
Results: Preliminary results suggest that
community-based services (i.e., accessible transit
system, senior centre, health clinic, grocery, bank)
located within 1 km from older adults' home
support independence, mobility and social
participation. Giving and receiving informal social
support from neighbours and friends contribute to
feeling safe, independent and socially connected.
Cohousing communities tend to provide higher
levels of opportunities for social support compared
to NORC. However, regardless of the type of
community, services close to home are crucial for
aging in place.
O14
Quarks, strangeness, and charm: Exploring
resilience in older adults
2
1
Dolores Furlong , Clive Baldwin , Marcea
1
1
Ingersoll , Sue McKenzie-Mohr , Elizabeth
1
1
2
McKim , William Randall , Jennifer Estey
1
St Thomas University, Fredericton, New
2
Brunswick, Canada, University of New Brunswick,
Fredericton, New Brunswick, Canada
In this paper we use the metaphor of quarks,
strangeness, and charm, taken from particle
physics, to explore the resonances, tensions, and
contradictions we have found in using multiple data
collection methods in our research on resilience,
narrative, and older adults. Just as there are
flavours of quarks – up, down, top, bottom,
strange, and charm – and just as the different
forms of quarks are found by different means, and
have different properties, multiple data collection
methods produce data with different properties.
We are in the process of analyzing data from two
studies on narrative and older adults. The first
focused primarily on resilience and data were
collected via questionnaires and individual lifestory interviews. In the second we collected data
via the same questionnaires, life-writing exercises,
and individual interviews. What is becoming
apparent through data analysis is that each of the
three data collection methods provide insight into
the resilience of older adults, yet also generate
tensions or contradictions. For example, how is it
that someone who scores low on a formal scale
(the Connor-Davidson Resilience Scale) appears
remarkably resilient when telling his/her life story?
And what do such findings tell us about the
strengths, limitations, biases, and blind-spots of the
data collection methods themselves?
Here we will present outlines of the two studies,
focusing on methods of data collection and
analysis, present a number of tensions,
resonances and contradictions in the data, reflect
upon the reasons for these, and discuss the
implications for further research.
O15
Context matters: Understanding older adults'
perceptions of risk and reward of disruptive
energy exploration in rural Kansas
Rosemary Wright, Richard Muma, Teresa
Radebaugh
Wichita State University, Wichita, KS, USA
7
Like many areas of Canada, some small rural
communities in Kansas have experienced a boom
and bust cycle because of sudden disruptive oil
and gas exploration by large energy companies
using high volume hydraulic fracturing and
horizontal drilling. This has resulted in dramatic
changes in the daily lives of residents of these
communities, many of whom are age 65 and older.
To date, there has been little research examining
these effects on older adults.
The primary objective of this study was to examine
differences among residents in perceptions of risks
and rewards of disruptive energy exploration in a
small community in Kansas. Specifically, we
wanted to learn what differences if any existed
between the perceptions of older adults and those
of younger community stakeholders. This
qualitative study was informed by grounded theory
methods, and used focus groups to explore
perceptual differences among older adults,
community leaders, and local ministers.
We found that while all participants welcomed
positive economic effects, older adults compared
to other participants had a more nuanced view of
the benefits associated with exploration activity,
personalized both risks and rewards more, and
had more temporal perceptions of energy activity.
We were surprised to discover that none of our
participants were concerned about either
environmental or health effects of exploration as
found in other studies, and in spite of inconvenient
community change, none expressed antipathy
toward the large energy companies doing
exploration. A social ecology model integrated with
life span aging theories was useful in
understanding differences among groups.
O16
interlocking social factors (e.g. ethnicity, age,
gender). To effectively capture place-based
experiences and preferences of older minoritized
persons necessitates a framework that considers
various modes of differentiation (e.g., racializing,
gendering, additional methods of othering), which
drive social and health inequities. Intersectionality
is an analytic perspective and framework that
encourages reflections on how multiple social
categories can cumulatively shape an individual’s
social identities, life experiences, and
opportunities. An intersectional framework that we
have entitled the “Multidimensional Intersectionality
Framework (MIF)” was used to explore successes
and challenges of aging-in-place among older, lowincome Chinese persons transitioning into
affordable housing. MIF was informed by Collins’
(2000) notion of intersectionality as an
interweaving of multiple systems of oppression;
specifically, how these systems are organized
through interrelated domains of power. This
framework was developed and applied to case
studies to identify a person’s positions in society,
identities they assume or are imposed upon them,
and the oppressions and often successes
experienced within the dominant community, as
well as organizational and policy contexts.
Findings from the case studies will be used to
demonstrate how intersectionality can be an
effective analytical framework to incorporate older
people’s varied experiences of aging-in-place,
particularly for those situated in positions where
they are less able to exert control, express
preferences, access resources, and navigate
social systems.
O17
The Social Integration of Immigrant and Visible
Minority Women in Canada
1
Intersectionality as an Effective Analytical
Framework to Elucidate Minoritized
Experiences of Aging-in-Place
Mei Lan Fang
,2
1 ,2
3
, Judith Sixsmith , Ryan Woolrych
1
1
School of Energy, Geoscience, Infrastructure and
Society, Heriot-Watt University, Edinburgh, UK,
2
Gerontology Research Centre, Simon Fraser
3
University, Vancouver, Canada, Institute of Health
and Wellbeing, University of Northampton,
Northampton, UK
Rich experiences of place are highly complex,
often shaped by a variety of combined and
2
3
Daniel W. L. Lai , Gabrielle D. Daoust , Lun Li
1
Department of Applied Social Sciences, The Hong
Kong Polytechnic University , Hong Kong, Hong
2
Kong, Department of International Relations,
3
University of Sussex, Sussex, UK, Faculty of
Social Work, University of Calgary, Calgary,
Alberta, Canada
Women account for over half of all immigrants to
Canada, contributing to the increasing ethnocultural diversity of the Canadian population and to
overall population growth. However, both existing
literature and statistical data indicate that
immigrant women face particular challenges to
social integration. In this context, this study,
8
commissioned by Citizenship and Immigration
Canada, aimed to facilitate a more critical and
comprehensive understanding of the specific
experiences, needs, and barriers to social
integration faced by diverse immigrant and visible
minority women in Canada. A comprehensive
review of 88 recent journal papers and secondary
analysis of four national population survey
datasets revealed that compared to Canadian-born
and Caucasian women, and to immigrant and
visible minority men, immigrant and visible minority
women face a range of challenges in interconnected areas of acculturation and sense of
belonging, social engagement, physical and
mental wellbeing, service access, experiences of
victimization and discrimination, and employment
and economic status. Regression analysis
indicated that immigrant and visible minority status
predicted generally negative economic, social, and
health outcomes, with outcomes generally worse
for women than men. The findings of the literature
review and the secondary data analysis illustrate
the need for integrated, holistic responses to
immigrant women’s integration at the policy,
programmatic, and community level, addressing
intersecting integration predictors, challenges, and
outcomes.
O18
Factors Associated with Complete Mental
Health among Older Immigrants in Canada
1
2
Esme Fuller-Thomson , Hongmei Tong
1
University of Toronto, Toronto, Canada,
2
University of Calgary, Calgary, Canada
The objectives of this study were 1) to identify the
prevalence of complete mental health (CMH)
among Canadian immigrants aged 55+, and; 2) to
determine factors associated with CMH among
older immigrants. CMH is a concept
operationalized by Keyes to encompass each of
the following three elements: 1) happiness and/or
life satisfaction, 2) psychological well-being (e.g.,
one’s life is meaningful), and/or social well-being
(e.g., having warm and supportive relationships)
and 4) the absence of mental illness in the past
year (e.g. no mood disorders, suicidal thoughts, or
substance abuse). Data for this study were
obtained from Statistics Canada’s 2012 Canadian
Community Health Survey-Mental Health (n=9,524
of whom 147 were immigrants who had arrived
less than 20 years ago and 1,430 had arrived 20 or
more years ago). Long-term immigrants (20+years
since immigrants), but not more recent immigrants,
had significantly higher levels of CMH than nonimmigrants. Older immigrants who had been in
Canada 20+ years had 20% higher odds of CMH
than their peers born in Canada (OR=1.20; 95%
CI-1.05, 1.38), even after adjustments for 13
potential confounders. A sub-analysis of the 1577
older immigrants showed that being female, being
older, having a high income and having a confidant
were associated with higher odds of CMH.
Immigrants with chronic insomnia, disabling
chronic pain, and ADL limitations had lower odds
of CMH. Generally these findings provide a hopeful
message indicating 4 in every 5 long-term older
immigrants have CMH.
O19
Who Cares? Who Should Care?
Representations of Caregiving in Popular
Catholic Magazines
Dana Sawchuk
Wilfrid Laurier University, Waterloo, ON, Canada
Objectives: Print media representations can both
reflect and shape cultural understandings of aging
and older adults, but few studies have examined
how religious magazines treat issues related to the
aging process. This paper explores how lay
Catholic magazine articles portray certain
challenges surrounding caregiving for older adults.
Methods: This study involved an analysis of 111
articles published from 1994 to 2013 in three
national Catholic magazines from the United
States: America, Commonweal, and U.S. Catholic.
The research was informed by similar previous
research on the secular print media, and a
qualitative and inductive thematic content analysis
was performed.
Results: The magazine articles emphasized the
stress and burden experienced by family
caregivers. Moreover, the articles focused heavily
on the idea that the Church institution needs help
to care for its own aging priests and religious.
Finally, the articles did not resort to the framework
of apocalyptic demography but instead employed
notions of the societal responsibility and moral duty
to care for vulnerable older citizens.
Conclusions: The findings of this study broaden
our understanding of faith-based approaches to
caregiving. Efforts to understand these Catholic
approaches are warranted given the numbers of
9
Catholic individuals who are caregivers either as
family members or in their professional lives, but
also given the ways in which such approaches
both reinforce and potentially challenge more
mainstream understandings of individual and
societal experiences of caregiving.
O20
Besoins des proches aidants pour mieux
s’orienter vers les ressources disponibles : un
projet-pilote
1 ,2
3 ,4
3 ,4
K. Latulippe , V. Provencher , M. Guay , A.
5 ,2
6 ,2
7 ,8
9 ,2
Giguère , A. Sévigny , V. Poulin , S. Éthier ,
10 ,12
2
11 ,2
V. Dubé
, M. Carignan , D. Giroux
1
Université Laval, Québec, Département d'études
sur l'enseignement et l'apprentissage, Canada,
2
Centre d'excellence sur le vieillissement de
Québec, Québec, CHU de Québec, Canada,
3
Université de Sherbrooke, Sherbrooke, École de
4
réadaptation, Canada, Centre de recherche sur le
5
vieillissement, Sherbrooke, Canada, Université
Laval, Québec, Vice-décanat à la pédagogie et au
développement professionnel continu, Canada,
6
Université Laval, Québec, Département de
médecine familiale et d’urgence, Canada,
7
Université du Québec à Trois-Rivières, TroisRivières, Département d'ergothérapie, Canada,
8
Centre interdisciplinaire de recherche en
réadaptation et intégration sociale (CIRRIS),
9
Québec, Canada, Université Laval, Québec, École
10
de Service social, Canada, Université de
11
Montréal, Montréal, Canada, Université Laval,
Québec, département de réadaptation, Canada,
12
Centre de recherche du Centre hospitalier de
l’Université de Montréal (CRCHUM), Montréal,
Canada
Les proches aidants peuvent agir en partenariat
avec des organismes afin de favoriser la réponse
aux besoins des ainés en perte d’autonomie
(Fleury, 2013). Or, il leur est difficile d’identifier les
ressources disponibles pour eux ou l’ainé à qui ils
apportent du soutien et peu d’outils sont
disponibles pour faciliter cette démarche sans
l’aide d’un professionnel de la santé (Collette,
2012). Objectif : Identifier les besoins des proches
aidants concernant les outils capables de les
orienter vers les ressources disponibles. Méthode :
Dans le cadre d’une étude pilote, la perception des
besoins a été explorée avec 10 proches aidants
(entrevues individuelles semi-structurées) et 24
organismes communautaires (questionnaires en
ligne). Une analyse synthèse a été réalisée en
utilisant l’approche par questionnement analytique
(Paillé et Muchielli, 2012). Résultats : Les proches
aidants souhaitent avoir un outil qui centralise
l’information concernant les services disponibles
afin d’éviter la multiplication des démarches. Les
barrières et les facilitateurs nommés dans le
processus d’identification des ressources et dans
le choix de les utiliser ou non sont de plusieurs
ordres : personnel (ex. : sentiment d’intrusion),
organisationnel (ex. : délais d’attente), expérientiel
(ex. : utilisation positive d’un service),
informationnel (ex. : être redirigé vers le bon
service) et relationnel (ex. : refus de l’aidé).
Conclusion : Les proches aidants perçoivent un
besoin pour un outil les soutenant dans
l’identification des ressources et établissent la
pertinence de s’intéresser au développement d’un
tel outil.
O21
Frailty and Care: Vulnerability and Relationality
in Late Life
Amanda Grenier
McMaster University, McMaster University,
Canada
Care practices in late life remain organized around
constructs of frailty that are measured via
functional assessments of older women's bodies.
Despite ten years of critique focused on the
biomedicalization of frailty, the narrative of decline,
and the ‘fourth age', dominant approaches to frailty
continue to gain ground based on the
measurement and treatment of frailty as an
objective bodily phenomenon. The bodies and
power relationships within care practices for the
frail often remain unrecognized. Rooted in critical
gerontology, this paper returns to literal and
cultural definitions (OED), interviews with older
women, cultural constructs/messages, and grey
literature on frailty (Grenier, 2007) to reconsider
frailty in light of recent research and theoretical
debates. Three central aspects that continue to be
overlooked are carefully considered: frailty as a
political and economic condition; notions of fragility
and vulnerability as central to frailty; and bodies
and relationality as a means to reconstruct care
practice. In particular, the paper draws on Judith
Butler's notion of precarity as a means to
reconsider what it means to be ‘frail' in late life. I
conclude with suggestions to re-organize care
practices to account for inequalities, recognize the
politics of frailty, and incorporate understandings of
vulnerability and relationality in late life into policies
and practices of care.
10
1
O22
Microaggressions of Caregiver Employees
1
1
2
Gulcin Con , J. Jill Suitor , Megan Gilligan
1
2
Purdue University, West Lafayette, IN, USA, Iowa
State University, Ames, IA, USA
2
Bharati Sethi , Allison Williams
1
Kings University College, Western University,
2
London, ON, Canada, McMaster University,
Hamilton, ON, Canada
Statement of Objectives: The primary purpose of
this study was to explore the lived experiences of
immigrant caregivers working in paid employment
in the health sector in Grand Erie, while
simultaneously providing unpaid care to an adult
family member or friend. Our goal was to
understand the interplay between paid caregiving
and familial caregiving on participant’s economic,
social, physical and psychological health. This
presentation presents limited findings on their
experiences of microaggressions and racism while
providing paid caregiving.
Method: Data was collected through qualitative
intensive style interview techniques to gather an indepth understanding of the 13 immigrant female
participants paid and unpaid caregiving roles, and
access the hidden nuances of their post migratory
lives. Interviews were analysed using constructivist
grounded theory and intersectionality theoretical
framework. Intersectionality theoretical framework
is rooted in social justice epistemology and
concerned with the lived experiences of
marginalized populations
Results: Participants’ narratives capture multiple
experiences of overt and aversive racism as their
everyday reality; however, they continued to work
amidst difficult and discriminatory work conditions
as they needed their job to support their family in
Canada and in their country of origin.
In this paper, we utilize within-family data collected
from adult siblings participating in their mothers'
care in Turkey and the U.S to explore crossnational variations in the dynamics of caregiving
when mothers are in need of assistance for a
recent health event. Using samples of 14 Turkish
and 14 American families matched on family size
and gender of siblings, we use qualitative data
from two adult children in each family to identify
themes explaining how adult siblings experience
conflict and cooperation in the process of meeting
the caregiving responsibilities for their older
mothers. Our findings reveal that in both cultures,
patterns of conflict and cooperation among siblings
during caregiving are shaped by gender, gender
norms, gender composition of the sibship, and
mothers' preferences and expectations for
particular offspring. However, the particular ways in
which these factors exert influence on adult
siblings' cooperative and conflictual relationships
during caregiving differ to a great extent by cultural
context. These cultural differences are particularly
relevant and crucial regarding the role of gender in
reports of within-family differences in sibling
relations during caregiving. The findings show that
gendered expectations are based on societal
norms in Turkey, and on familial norms in the US
that identify particular siblings as better suited for
this role. In single-gender sibling groups,
cooperation is much more equal among both
American and Turkish adult children caring for their
older mothers. In both Turkish and American
families, daughters were more likely to report that
conflict arose because of unequal participation.
O24
Conclusions: Given the deleterious caregiver
outcomes and negative outcomes of
microaggressions, literature is needed to unmask
microaggressions experienced by a particular
group such as immigrant caregivers in urban and
rural regions of Canada. Study findings highlight
the urgency of practitioners and policy makers to
take an active role in combating racism through
anti-racist organizing and diversity training.
Chronic disease prevention and lifestyles of
aging populations: Do we promote health
equity and community development?
O23
Aging of the population increases the burden of
chronic diseases in Canada. Public health now
emphasizes the importance of prevention,
especially in respect to most vulnerable
populations. Biomedical research has
Conflict & Cooperation among Siblings during
Caregiving: Comparisons between Turkey and
the U.S.
1
1
1
Mélisa Audet , Mario Paris , Suzanne Garon , Alex
2
Dumas
1
Université de Sherbrooke, Sherbrooke, Québec,
2
Canada, Université d'Ottawa, Ottawa, Ontario,
Canada
11
demonstrated that lifestyle is one of the
cornerstones of diseases prevention. However,
current results of preventive initiatives remain
limited, especially with regards to heath equity.
Public health now promotes the acquisition of
knowledge and skills related to healthy lifestyles in
concert with collective strategies aiming to develop
supportive environments. When health and
wellbeing of aging individuals are considered,
theses initiatives raise questions: are preventive
public health strategies favourable to the wellbeing
of all aging subgroups? Do they respect premises
of community development? This study confronts
theoretical premises of public health preventive
discourse with empirical experiences of two
projects on the health of aging subgroups from
Quebec. First, semi-structured interviews captured
the individual experience of current preventive
discourse of 20 underprivileged aging women.
Secondly, case studies of 4 age-friendly cities
investigated, with observations, interviews and
questionnaires, how current disease prevention
strategies harmonize with community-building
approaches, especially in respect with health
equity. Analysis highlight stakes bound to the
incompatibility of preventive discourse with both
experience of underprivileged subgroups and
specific premises of community development when
time comes to interact on the local level. Based on
these findings, new directions are discussed in
order to support decision-makers and communities
to promote equity in disease prevention and
community development strategies that are
respectful of all aging individuals’ values and
needs.
Methods. Based on cross-sectional design, a total
of 60 older adults (20 CHI, 20 patients with MCI,
and 20 patients with mild-to-moderate AD) were
recruited in the memory clinic of Angers, France.
All participants completed a self-administered
questionnaire in paper format composed of 33
items exploring age, gender, nutrition, place of
living, social resources, drugs daily taken, memory
complaint, mood and general feeling, fatigue,
activities of daily living, physical activity and history
of falls. Participants then underwent a full clinical
examination by a physician exploring the same
domains.
Results. High concordance between the selfadministered questionnaire and physician's clinical
examination was showed. The few divergences
were related to cognitive status, answers of AD
and MCI patients to the self-administered
questionnaire being less reliable than those of CHI.
Conclusion. Older adults are able to evaluate their
own health and functional status, regardless of
their cognitive status. This result needs to be
confirmed and opens new perspectives for the
quantified self-trend and could be helpful in daily
clinical practice of primary care.
O26
The benefits and barriers to technology
acquisition: Understanding the decisionmaking processes of older adults with agerelated vision loss (ARVL)
1
O25
Quantified self and comprehensive geriatric
assessment: Older adults are able to evaluate
their own health and functional status
1
2
Olivier Beauchet , Christine Vilcocq
1
McGill university, Montreal, Québec, Canada,
2
Biomathics, Paris, France
Background. There is an increased interest of
individuals in quantifying their own health and
functional status. The aim of this study was to
examine the concordance of answers to a selfadministered questionnaire exploring health and
functional status with information collected during a
full clinical examination performed by a physician
among cognitively healthy adults (CHI) and older
patients with mild cognitive impairment (MCI) or
mild-to-moderate Alzheimer disease (AD).
1 ,2
Colleen McGrath , Arlene Astell
1
Ontario Shores Centre for Mental Health
2
Sciences, Whitby, ON, Canada, University of
Toronto, Toronto, ON, Canada
Objectives. With the global population rapidly
aging, low vision rates among older adults are
steadily increasing. The most common low vision
conditions include age-related macular
degeneration (AMD), glaucoma, and diabetic
retinopathy, with such conditions often collectively
referred to as age-related vision loss (ARVL).
While research has investigated the factors
influencing acquisition and use of
technologies/assistive devices by older adults, few
studies have addressed the decision-making
processes regarding technology adoption of older
adults with age-related vision loss.
12
Method. This ethnography, informed by critical
social theory, engaged ten older adults with agerelated vision loss in narrative interviews,
participant observation sessions, and semistructured in-depth interviews in an effort to
understand their decision-making processes
related to the acquisition and use of low vision
assistive devices to support occupational
engagement.
Results. Study findings focused on the benefits
and barriers to technology acquisition and use.
Benefits of technology acquisition included:
independence; safety; enhanced occupational
engagement; insurance; and validation of the
disability, while the barriers to technology
acquisition included: cost; usability; lack of
awareness of low vision rehabilitation services;
fear of being taken advantage of and; desire to
preserve a preferred self-image.
Conclusion. Considering the low uptake of vision
rehabilitation services, the study findings are
important to healthcare providers, particularly
rehabilitation personnel. A better understanding of
the perceived benefits and barriers to technology
adoption from the perspective of older adults will
help rehabilitation personnel maximize treatment
planning designed to enhance the activity
engagement of older adults aging with vision loss.
O27
Octogenarians and Over: Undergoing
Minimally-Invasive Cardiac Procedures in Later
Life
1
undergoing a THV therapy at a provinciallycoordinated centre in Vancouver, British Columbia.
Thirty-one participants, whose average age was
83, were recruited and followed from the time of
referral to post-procedure follow-up. A subset of
participants were also interviewed at one-year post
procedure. Findings provide several insights into
patients’ experiences, such as: i) the need to
embed evolving care practices, such as minimal
hospital stays, in patient education and discharge
teaching; ii) undergoing care at a provinciallycoordinated centre can be arduous, particularly for
frail, older adults living in rural and remote areas;
and iii) the complexities of co-morbidities meant
that the THV procedure did not necessarily lead to
long-term improvements in overall, long-term
quality of life. Our research illustrates the value of
exploring patients’ perspectives to augment
quantitative research on clinical outcomes. For
frail, older adults in their 80s and 90s the option of
minimally-invasive procedures ought to be
considered within the larger context of their health
and life goals.
O28
Environmental barriers for seniors with agerelated vision loss (ARVL): A critical
ethnographic study
1
2
Colleen McGrath , Debbie Laliberte Rudman ,
3
4
2
Marlee Spafford , Barry Trentham , Jan Polgar
1
2
Sciences, Whitby, ON, Canada, Western
3
University , London, ON, Canada, University of
4
Waterloo , Waterloo, ON, Canada, University of
Toronto, Toronto, ON, Canada
1
Jennifer Baumbusch , Sandra Lauck , Tamar
1
1
1
O'Shea , Sarah Wu , David Wood , Davina
2
1
1
Banner-Lukaris , Robert Boone , John Webb
1
University of British Columbia, Vancouver, BC,
2
Canada, University of Northern British Columbia,
Prince George, BC, Canada
Advances in medical technology have made it
possible to undergo minimally-invasive cardiac
procedures in later life. These procedures, known
as Transcatheter Heart Valve (THV) therapies, are
an alternative to open heart surgery for frail older
adults with advanced cardiac disease who are no
longer eligible for surgery. While research has
shown positive clinical outcomes for patients who
undergo these procedures, there is a paucity of
research about patients’ perspectives, which our
study begins to address. We conducted a focused
ethnography about patients’ experiences of
Objectives: The prevalence of age-related vision
loss (ARVL) is steadily increasing and seniors now
constitute the fastest growing segment of the
population with low vision conditions, including
macular degeneration, glaucoma, and diabetic
retinopathy. Although research has demonstrated
that older adults with ARVL experience significant
activity challenges to self-care, leisure, and
productivity, attention to the environmental
production of disability amongst older adults with
ARVL has been limited. As such, the primary
objective of this study was to reveal the ways in
which environmental barriers produce and
perpetuate disability for older adults with ARVL.
Method: A critical ethnographic approach was
utilized for this study. Ten older adults with ARVL
were recruited to participate in three methods of
13
data collection including: 1) a narrative interview;
2) an observation session and; 3) a semistructured in-depth interview.
Results: To demonstrate the various ways that
environmental elements contribute to the shaping
of disability for older adults with age-related vision
loss, findings are illustrated via three commonly
discussed activities: shopping, eating, and
community mobility. Findings reveal how disability
is shaped for older adults with ARVL when they
encounter environmental features that are
embedded in both ageist and disablist social
assumptions.
Conclusions: The results of this study raises
awareness of how the activity participation of
seniors with ARVL is shaped and negotiated in
relation to various environmental features.
Findings suggest that addressing the
environmental production of disability requires
inclusive social policy, advocacy, and a focus on
education to develop and sustain age and low
vision-friendly environments.
O30
Knowledge Broker’s Influence on Use of
Dementia Care Evidence in Canadian Northern
Home Care Centres
1
2
Dorothy Forbes , Catherine Blake , Andreea
1
1
1
Mohora , Rozina Rajan , Elom Adzovie , Pauline
1
1
3
Lea , Laurel Strain , Shelley Peacock , Cindy
4
4
5
Harmata , Terri Woytkiw , Pamela Hawranik ,
3
6
Debra Morgan , Anthea Innes
1
University of Alberta, Edmonton, Alberta, Canada,
2
University of Western Ontario, London, Ontario,
3
Canada, University of Saskatchewan, Saskatoon,
4
Ssaskatchewan, Canada, Alberta Health Services,
5
North Zone, Alberta, Canada, Athabasca
6
University, Athabasca, Alberta, Canada, University
of Stirling, Stirling, Scotland, UK
Objective: To identify the influence of a
knowledge broker (KB) in two northern, rural home
care settings on use of dementia care evidence in
providing care.
Method: A case study approach included a
convenience sample of administrators, managers,
nurses, allied health workers, health care aides
(HCAs), family caregivers and persons living with
dementia (PWD, n=30). The role of the KB was to
facilitate knowledge exchange by building
relationships, facilitating access to best available
evidence, identifying best practices and supporting
the transformation of the home care workplace
culture. Interviews were conducted during the
project at baseline, three months and six months.
Transcripts were analyzed using thematic analysis.
Main ideas and topics were identified and coded
using key phrases that emerged from the data. By
comparing and contrasting the coded data, subthemes and themes, interrelationships, and
patterns were revealed.
Results: In one centre, the KB worked with staff to
develop and distribute a dementia education
package that included local dementia service
information and a dementia care toolkit of websites
for nurses. Staff also plan to conduct a
presentation to Senior Management leaders about
the dementia crisis in their communities. In the
other centre, the HCAs have taken the U-First
online modules and are using this resource with
PWD and their caregivers to provide individualized,
therapeutic respite and daily care.
Conclusion: The KB has been instrumental in
influencing the development and implementation of
dementia care integrated knowledge translation
strategies and in changing the culture of these
settings in providing evidence-based dementia
care.
O31
Situated practical judgments of the cognitive
function of hospitalized older people: A
focused ethnography
Elaine Moody, Alison Phinney, Geertje Boschma,
Jennifer Baumbusch
UBC School of Nursing, Vancouver, BC, Canada
Nurses’ understandings of older patients’ cognitive
function are central to how they determine and
enact nursing care of older people in hospital. The
nursing literature concerned with how nurses
understand cognitive function tends to be based on
technical-rational views of reasoning, but emerging
literature suggests an innovative approach to
understanding judgment that recognizes the
diverse knowledge used in nursing practice, and
the particular situations in which judgments are
made. This study aimed to make explicit the
complex, situated practical judgments of nurses
about the cognitive function of older people in
hospitals. A focused ethnographic study was
conducted on two units in an urban general
14
hospital over one year. Data were collected from
21 nurse informants through observations and
interviews, and an analysis of documents used in
their practice. Nurses’ judgments about the
cognitive function of older patients were complex
and reflected a nuanced understanding of the
person which enabled them to enact care that was
relevant to the person’s particular situation.
Furthermore, ensuring safety and physiological
stability emerged as the goals of nursing care
related to the cognitive function of older patients
and provided direction for practical judgments,
including what evidence was sought and how it
was used in deliberations about action. This
articulation of nurses’ practical judgments about
cognitive function is a foundation for further inquiry
into the context of nursing practice, educating new
nurses on the complexity of judgments and
examining policy related to the structures guiding
acute care nursing.
indicate that the approach is feasible and
acceptable to family and formal caregivers. By a
renewed curiosity, families and caregivers had a
new perception of the older person. In partnership,
they are creatively capable of changing their habits
to influence older people including their screams.
Many strategies helped implement the approach
(e.g. staff training) and other strategies that would
help were identified by participants (e.g. improving
continuity of care). This study helped to identify the
critical aspects to consider in implementing this
approach. The approach has the potential to
improve the quality of care of vulnerable older
people while having a positive impact on their
family members and caregivers.
O32
Adriana M. Rios-Rincon , Antonio Miguel-Cruz
1
Lili Liu
1
University of Alberta, Edmonton, Canada,
2
Universidad del Rosario, Bogotá, Colombia
O33
How digital storytelling is used among older
adults: A systematic literature review
1 ,2
Effects of an intervention approach to optimize
the well-being of older people living with
Alzheimer’s disease who scream: results of an
action research
1
1
Anne Bourbonnais , Francine Ducharme , Philippe
2
1
Landreville , Marie-Hélène Lavallée , Marie1
Andrée Gauthier
1
Université de Montréal, Montréal, Québec,
2
Canada, Université Laval, Québec, Québec,
Canada
In long-term care facilities (LTC), 48 to 82% of
older people living with Alzheimer’s disease
scream. This behaviour has negative
consequences on their well-being as well as on
their family members and caregivers. An innovative
intervention approach based on the meanings of
screams was developed to reduce screams and
increase the well-being of older people, families
and caregivers. We present an action research
pilot project that aimed to implement the approach
and to assess its acceptability, feasibility and
preliminary efficacy. The approach was
implemented in five LTC. Using a mixed methods
triangulation design, qualitative (individual
interviews) and quantitative data (behaviours
frequency and disruptiveness, well-being, decisionmaking in partnership, and empowerment at four
time-points) were collected with thirteen triads that
included an older person, a family member and a
caregiver. Group interviews were also conducted
with caregivers acting as local leaders. Results
1 ,2
,
Objective: To conduct a systematic literature
review to identify: 1) how digital storytelling is
among older adults, 2) what methods are used to
produce the digital storytelling, 3) what content and
themes are shared in the stories, and 4) the main
outcomes reported in literature.
Methods: We searched six databases for studies
that investigated the use of digital storytelling in
people older than 50 years. The interrater rater
reliability among readers applying inclusion criteria
was 92.1%.
Results: Twenty-two studies were analyzed.
Participants in the studies were healthy older
adults, and those with medical conditions such as
dementia, cognitive impairment or cancer. Digital
storytelling is used to promote social engagement
and reminiscence in older adults, to preserve
traditions and to facilitate connectedness between
older adults and young people including students.
Four papers included participants from aboriginal
cultures. The technologies used were multimedia
that combined family photographs, film clips, audio
narration, and music along with documentary
video-making. Themes in the stories included older
adults’ lives, experiences living with cancer, stories
of one’s home, and factors that contribute to
longevity. Positive changes in older adults were
improvements in confidence and speech, a sense
15
of purpose and fellowship, social engagement,
motivation, and intent to change one’s health
behavior. Young adults who interacted with older
adults reported a positive impact in their own
attitudes about aging.
Conclusion: The literature on digital storytelling is
in its early stages. More research is needed to
identify the impact of digital storytelling on the lives
of older adults.
and humorous individuals. Finally, they highlighted
their highly personable characters, portraying
themselves as trustworthy and caring.
Conclusions: We discuss the findings in relation
to the literatures on civic engagement (Pancer,
2015) and successful aging (Rowe & Kahn, 1997).
O35
Intimacy and Identity in Later Life: Experiences
of Filipino Gay Seniors in Canada
O34
"I am very active and healthy and...enjoy the
simple things in life": Older adults' selfrepresentations in online dating profiles
1
2
Mineko Wada , Laura Hurd Clarke , Ben
2
Mortenson
1
Gerontology Research Centre - Simon Fraser
2
University, Vancouver, BC, Canada, The
Canada
Objective: This paper discusses how older adults
(aged 60+) present themselves in online dating
profiles, paying particular attention to how their
representations vary by age, ethnicity, and gender.
We further examine how older adults' use of
language reflects and reinforces underlying
societal assumptions about femininity, masculinity,
successful aging, and the social and physical
realities of later life.
Method: Stratifying based on age, ethnicity, and
gender, we randomly selected 320 online dating
profiles posted on Plenty of Fish by Canadian
heterosexual older adults who self-identified as
"Asian," "Black," "Caucasian," or "Native
American" (categories used by Plenty of Fish). We
conducted a thematic analysis, drawing upon
Braun and Clarke's (2006) constructionist
approach.
Results: Our analysis revealed five primary ways
in which older adults portrayed themselves. First,
the profiles emphasized that the older men and
women were active and busy in a variety of
adventurous, cultural, artistic, and social activities.
Second, they highlighted that they were physically
healthy and intellectually engaged. Third, they
referenced a myriad of ways that they were
productive through work and volunteer activities.
Fourth, they accentuated their positive approach to
life, identifying themselves as happy, fun-loving,
Fritz Luther Pino
University of Toronto, Toronto, Canada
This paper reports the findings of an ethnographic
study on the experiences of Filipino gay seniors in
Toronto, Canada. Started in 2012, the study
utilized participant observation and in-depth
interviews with 10 community-dwelling Filipino
seniors who identify as gay. All participants live in
the downtown core of the city of Toronto. Their
ages range between 65 and 88 years old. Two
significant themes were revealed in the study: (1)
intimacy, and (2) identity. In terms of intimacy,
participants describe their ambivalent relationship
with their three significant support groups, namely,
family, friends, and romantic partners. With regards
to identity, participants describe the social and
political factors that shape their changing queer
identity, including their transnational experiences
and racialized position in Canada. Both themes
revealed the participants’ struggles and
negotiations of the dominant and normative
discourses around aging, sexuality, and
queerness. As well, revealed in both themes are
the participants’ stories of constant negotiation for
belonging in both queer and ethno-racial spaces in
Canada. In conclusion, the study has the following
contributions: (1) the ways in which notions of
intimacy and identity among racialized gay
immigrant seniors expose the limits of state
programs centered on successful aging discourse;
and (2) the utility of an intersectionality theory that
is informed by a queer diasporic concept – a
concept that considers the ways in which
transnational and diasporic subject positions
impact racialized queer seniors’ lives and aging
experiences.
O36
Using poetry in research with older adults: An
example from a narrative study
16
Jasmyne Rockwell
University of British Columbia, Vancouver, British
Columbia, Canada
The process of moving to assisted living (AL) can
be a major life transition for older adults, involving
not only a change in domicile but also possible
disruptions to lifestyle, goals, and self-identity.
Recognizing the challenges faced by incoming
residents as they settle into their new lives is a key
aspect to creating welcoming environments and
helping older adults prepare and adjust.
The purpose of this explorative study was to record
the relocation narratives of older adults (n=4) in
order to better understand the experience of
moving to AL. In addition to broader narrative
analysis, I used an approach called poetic
transcription, which involves the creative
arrangement of interview data so that the voices of
participants themselves express salient aspects of
the research topic. In this project, participant
accounts were used to construct poetic vignettes
that introduce participants to the reader and
convey the particular essence of their relocation
experiences.
Poems were created by reviewing the transcripts of
each participant, drawing out evocative quotes,
and arranging them into stanzas addressing a
particular theme. The resulting poems provide an
interactive way of connecting to the participants'
stories, as well a means of foregrounding
participants' voices amid formal academic analysis.
Incorporating poetic transcription into qualitative
studies may be of interest to researchers wanting
to highlight participant experiences in a creative
and poignant way.
essentialism that typifies much of the research on
immigrant older adults. Yet there is little
methodological guidance regarding the application
of such a framework. Our research combined a
structural life history approach (which explores how
personal narrative and history are influenced by
cultural themes within the broader society,
institutions and social history) with photovoice, to
address this gap.
Methods: We conducted in-depth qualitative
interviews with 20 ethnocultural minority older
adults aged 60+ in British Columbia and Quebec.
Participants were selected to represent maximal
diversity across axes of identity such as language,
ethnicity, religion, type of migration, SES, and
length of time in Canada, but all were marginalized
in some form. Interview one established a timeline
of the participants' lives. In interview two
participants expanded on key themes, especially
encounters with structural inequity, and we asked
them to photograph things that gave shape to their
experiences as immigrant older adults in Canada.
Participants explained the meaning of these
photographs in interview three.
Results: This methodology facilitated the in-depth
exploration of multiple identities and experiences
with oppression and facilitated the incorporation of
complexity and diversity into our data collection
and analysis.
Conclusions: While refinement of the
methodology is necessary to overcome ethical and
logistical challenges, this approach successfully
explored the intersections of identity and
interlocking oppressions that have shaped the lives
of older immigrants in multiple ways.
O37
O38
Utilization of critical life history and photovoice
methods to explore intersecting identities and
oppressions
The role of neighbourhood associations in
facilitating a sense of belonging among older
adults
1 ,2
3
3
Sharon Koehn , Ilyan Ferrer , Shari Brotman ,
1
Melissa Badger
1
Simon Fraser University, Vancouver, B.C.,
2
Canada, Providence Health Care, Vancouver,
3
B.C., Canada, McGill University, Montreal,
Quebec, Canada
Objectives: Intersectionality has been identified as
an important concept to the development of
understanding complexity that avoids the
1
1
2
Sarah Byrne , Lindsay Kalbfleisch , Darla Fortune
1
University of Waterloo, Waterloo, Ontario,
2
Canada, Concordia University, Montreal, Quebec,
Canada
Much has been written about the ways in which
neighbourhoods provide a context for socially
supportive relationships that contribute to a sense
of belonging. For older adults who may be at risk of
social isolation, neighbourhoods can be a vital
source of continued support and connection. In this
17
presentation, we report on the findings of a study
that explored how neighbourhood associations
(NAs) in one Ontario city work to promote a sense
of belonging among residents. A particular focus
was on the ways NAs support older adults to
connect with others in their neighbourhood. We
conducted interviews with nine active members of
different NAs and asked their perceptions of how
their NA addresses the belonging needs of
different members of their community. Our findings
reveal that a primary focus of NAs is on facilitating
a sense of belonging among young families with
children and protecting mutual self-interests when
it comes to things like property values and
neighbourhood image. Findings also show that
little effort is being made to connect people across
different age groups and cultural backgrounds. We
discuss the implications these findings can have
for older adults’ sense of belonging and inclusion
in their neighbourhoods. We draw from this study
to argue that as our neighbourhoods continue to
age and become more diversified, it is necessary
for NAs to broaden their focus in order to offer
services and programs that promote the belonging
and inclusion of all neighbourhood residents.
O39
Later life learning and wellbeing: From
qualitative and quantitative evidence to policy
implications
Miya Narushima, Jian Liu, Naomi Diestelkamp
Brock University, St. Catharines, Canada
The objective of this presentation is to highlight key
findings from our research over the last several
years on the benefits of continuous learning on
wellbeing and health in late adulthood. "Active
ageing" and "aging in place" have been widely
adapted as a global policy framework over the last
decade. Lifelong learning for older adults,
however, has not been fully integrated into this
discourse. Using a case study approach of a public
continuing education program in Toronto, we
examined whether and how older adults'
participation in affordable and accessible public
learning program affects their psychological
wellbeing and health. It started with an in-depth
ethnographic qualitative study (n=15, 5 classes),
and was expanded into a larger program-wide
survey (n=699, 148 classes). The results suggest
that continuous participation helps older adults
sustain their general wellbeing to keep them going,
and that these benefits are even greater for
"vulnerable" seniors (e.g. those with multiple
chronic conditions or with low income and
education). Older learners see themselves as
"well" when engaging in activities and relationships
that they value. These findings are consistent with
a growing body of large-scale studies in the UK
and Europe. Melding qualitative and quantitative
evidence, we advocate for allocating more
resources for lifelong learning for older adults as
an equitable means for wellbeing and health,
explicitly including it as a priority agenda in ageing
in place policies.
O40
Civic involvement among citizens aged 75+ in
Sweden: profiles and patterns of change
Eva Jeppsson Grassman
Linkoping University, Norrkoping, Sweden
In current demographic trends, older people are
often viewed as recipients of care and as a burden.
In contrast to this, old age is, in other contexts,
described as a time of freedom and opportunity, in
line with active aging. This positive description of
active older people generally refers to people in
their "third age" and seldom in relation to people
older than 75. The presentation will challenge this
view by exploring the role of 75-84 year-old people
in Sweden as active citizens.
The presentation is based on a national survey
repeated five times in the period 1992-2014.
Volunteering in the age group 75+ had increased.
This group volunteered almost as much as other
groups and did more hours. Their involvement in
informal caregiving had also increased. They
carried out a range of unpaid tasks. People aged
75+ who were involved in civic activities did not
have better health than those not involved in such
activities.
The results challenge the image of older people.
Many people 75+ are actors in civil society - in fact
they were the single age group in which
volunteering had increased the most in the past
years. Good health is not a necessary requirement
for civic involvement in old age. The concepts of
"the fourth age" and "active aging" need a
reassessment. The findings challenge the common
view on the role of the welfare state - it has an
enabling function, particularly for the people aged
75+.
18
O41
Qualité de vie - Les aînés à domicile avec
incapacité s'expriment : perceptions, dits et
non-dits
G. Brûlotte
Université de Montréal, Montréal, Canada
Cette recherche, dans le cadre d’une thèse de
doctorat, poursuit l’objectif : de définir la qualité de
vie selon la perception des aînés vivant à domicile
avec incapacité. Bien que le concept Qualité de vie
justifie les programmes et services qui leur sont
concacrés, à ce jour, la définition de la qualité de
vie selon les aînés demeure inexistante au
Québec. Or, au cours des entretiens semi-dirigés
réalisés auprès d’aînés âgés en moyenne de 82
ans, vivant à domicile avec incapacité, ceux-ci ont
défini la qualité de vie en huit concepts récurrents.
Nous postulons que la qualité de vie est tributaire
d’un engagement et d’une responsabilité de quatre
acteurs clés nommés : la contribution quadripartite
à la qualité de vie : celle de l’aîné qui désire
maintenir une qualité de vie aussi longtemps que
possible, celle d’un entourage aidant, de la
communauté et de l’État/la société. Selon
l’approche par la capabilité selon Amartya Sen, qui
sert de cadre de référence à cette recherche, la
majorité des aînés interviewés perçoivent avoir
une « liberté d’accomplissement » alors que
d’autres ont émis des conditions ou ont clairement
précisé qu’ils n’ont pas cette liberté
d’accomplissement. Finalement, les cinq
« dits explicites » relevés qui sont : solitude,
paternalisme, vivre à risque, négligence et suicide,
donnent lieu à une interprétation en « non-dits
implicites » dénotant compromis et paradoxes.
planning of age-friendly communities. Particular
gaps in understanding, however, include
differences related to accessibility, cultural
appropriateness and intergenerationality. These
are underscored by the recognised need to
enhance the inclusiveness of age-friendly planning
processes to consider the diversity of individual
experiences, community dynamics and policy
contexts. This paper seeks to answer, from a
critical inquiry perspective, what lessons can be
learned about the opportunities for and challenges
of inclusion for consideration in developing agefriendly communities? It draws on a case study of
an age-friendly planning initiative currently
underway in a mid-sized Canadian city and rural
region (Peterborough, Ontario) in which ‘inclusion’
as a guiding principle has emerged in various
forms throughout the planning process – from the
conceptual to the logistical. Employing institutional
ethnography and critical reflexivity, the case study
documents the regional approach to age-friendly
planning in the Peterborough region, and analyses
Age-Friendly Peterborough committee meetings,
public consultation surveys, focus groups and
interviews, and committee members’ reflections to
identify and assess inclusion as a principle across
the different domains of age-friendly planning.
Particular emphasis is given to community support
and health services as illustrative of the
opportunities for and challenges of inclusivity
within and across jurisdictional scales and in
relation to accessibility, marginalized populations
and intergenerational issues. The implications for
developing informed age-friendly planning
processes and outcomes for age-friendly
communities are discussed.
O43
Nature Teaches Us To Grieve: The place of
parks and nature at end of life
O42
Opportunities and Challenges of Inclusion in
Age-Friendly Planning
1 ,4
2
Ann MacLeod , Sarah Cullingham , Chris
3
4
Kawalec , Mark Skinner
1
Trent/Fleming School of Nursing, Trent University,
2
Peterborough, Ontario, Canada, Age-Friendly
Peterborough, Peterborough, Ontario, Canada,
3
City of Peterborough, Peterborough, Ontario,
4
Canada, Trent Centre for Aging & Society, Trent
University, Peterborough, Ontario, Canada
Ten years on from the launch of the WHO AgeFriendly Cities framework, important lessons have
been learned about how to best support the
1
1 ,2
Sonya Jakubec , Don Carruthers Den Hoed ,
1
1
Heather Ray , Ashok Krishnamurthy , Michael
1
Quinn
1
Mount Royal University, Calgary, Alberta,
2
Canada, Alberta Parks, Edmonton, Alberta,
Canada
More evidence is becoming known about how
natural environments impact both our physical and
spiritual well-being. Little is known, however, about
the place of parks and nature at end-of-life, or the
impact of parks and nature on quality of life during
palliative care or bereavement experiences. A
2015 study aimed to develop a better
19
understanding of peoples' (including those at endof-life, caregivers and those experiencing grief)
beliefs and experiences about the connection of
parks and nature at end-of-life. The study
combined an initial online survey (n=118) and
narrative research process, whereby a subgroup of
participants (n=15) were interviewed in an openended story-telling approach. Analysis focused on
the meaning of people's stories and narratives
using concepts derived from ecopsychology theory
concerned with nature connection, individual
wellness and social/earth justice.
Over 80% believed that visiting a park or natural
place is worth the risk involved and over 90%
expressed that they personally would like to have
end-of-life experiences in parks and nature. The
narrative process uncovered three dominant
themes: 1. Death brings people to parks and
nature, 2. Nature teaches people to grieve, and 3.
Parks and nature reveal death and life. Animal
companions, observing the cycles of natural decay
and renewal, and observations of nature as
something bigger than death were emphasized.
These discoveries will help develop the
foundations for policy and practice within parks
and health sectors that promote access and
enjoyment of parks and nature for people during
end-of-life experiences.
O44
Informing municipal policy implementation of
social participation strategies for aging baby
boomers
1
2
Jennifer Hewson , Daniel Lai
1
Faculty of Social Work, University of Calgary,
2
Calgary, Canada, Department of Applied Social
Sciences, The Hong Kong Polytechnic University,
Kowloon, Hong Kong
Stakeholder engagement is a vital component of
developing age-friendly policy and ensuring that
policy is implemented into agency practice. Using
Calgary as a case example, this SSHRC funded
study explored stakeholder perspectives about one
age-friendly domain - social participation - to obtain
insight into how agencies can prepare to meet the
social participation needs of diverse community
dwelling baby boomers as they age. The study
aimed to develop recommendations which could
inform the City of Calgary's Seniors Age-Friendly
Strategy (SAFS) and implementation plan. Semistructured interviews (n=20) and online surveys
were completed (n=32) by service providers. Five
focus groups were conducted in Cantonese,
Mandarin, Tagalog, Punjabi, and Hindi and 12
focus groups were conducted in English with baby
boomers (n=122). A pre-focus group survey was
completed by all focus group participants. Data
sets were analyzed individually and then merged
to generate recommendations for implementation
of the SAFS participation and inclusion priority
area. The findings revealed that while social
participation was a focus area for programming,
few agencies indicated a high level of
organizational readiness and had policies in place.
Service providers expressed uncertainty about
how to engage baby boomers in planning, while
baby boomers indicated that enhanced
accessibility, affordability, and community
connections could increase participation of diverse
older adults. These findings will contribute to
informing practitioners about how to move from a
strategic plan to an implementation phase when
creating an age-friendly environment.
O45
The Instrumental Activity of Daily Living (IADL)
Profile in Aging
1 ,2
2 ,3
Nathalie Bier , Patricia Belchior , Guillaume
1
1
Paquette , Émilie Beauchemin , Ariane Lacasse1
1
Champagne , Chantal Messier , Marie-Line
1
1
4
Pellerin , Marisol Petit , Eneida Mioshi , Carolina
1 ,2
Bottari
1
2
Université de Montréal, Montreal, Canada, Institut
universitaire de gériatrie de Montréal, Montreal,
3
Canada, McGill University, Montreal, Canada,
4
University of Cambridge, Cambridge, UK
Objectives: Decline in functional abilities is part of
the normal aging process, however the point at
which the functional decline becomes pathological
is difficult to determine. The aim of this study was
to investigate the feasibility of a new tool with the
potential of evaluating the subtle functional
declines experienced by the older adult population.
While most functional tools assesses global
behaviors, the IADL Profile assesses specific
characteristics of functional performance.
Method: A group of 40 elderly aged 65 years and
over and living in the community took part in the
study. Six evaluators administered the IADL Profile
to participants. The IADL Profile is a performancebased measure that involves 3 different scenarios:
preparing a meal for an unexpected guest,
obtaining information and, making a budget.
Information on feasibility was categorized
according to two criteria: the impact of the
20
administration of the tool on participant burden and
the impact on evaluator burden.
Results: The IADL Profile was found to be feasible
to use with older individuals; the tool also showed
sensitivity to the difficulties experienced by this
population in everyday functioning.
Conclusion: The IADL Profile is a promising
ecological tool to evaluate independence in aging
and may help to differentiate normal from
pathological functional decline. This tool may also
contribute to the development of tailored
interventions to enhance everyday functioning in
the older population.
O46
Cross-sectional and longitudinal associations
between cognition and mobility and their
underlying mechanisms among older adults:
Results from the FRéLE study
1 ,2
3 ,4
Dominic Julien , Nathalie Bier , François
1 ,8
5 ,6
Béland , Johanne Desrosiers , Marie-Jeanne
3 ,7
3 ,4
Kergoat , Louise Demers
1
Groupe de rechcerche Solidage, Montréal,
2
Canada, Département de psychologie, Université
3
de Montréal, Montréal, Canada, Centre de
recherche, Institut universitaire de gériatrie de
4
Montréal, Montréal, Canada, Faculté de
médecine, École de réadaptation, Université de
5
Montréal, Montréal, Canada, Faculté de
médecine, École de réadaptation, Université de
6
Sherbrooke, Sherbrooke, Canada, Centre de
recherche sur le vieillissement du CSSS-Institut
universitaire de gériatrie de Sherbrooke,
7
Sherbrooke, Canada, Faculté de médecine,
Département de médecine, Université de Montréal,
8
Montréal, Canada, École de santé publique,
Département d’administration de la santé,
Background. Associations between cognitive
functioning and life-space mobility have been
observed among elders, but cross-sectional
associations (states) may be different from
longitudinal associations (change). In addition, the
associations may be mediated by psychosocial
factors and moderated by physical factors.
Objective. The aim of this study was to investigate
associations between cognitive functioning and
life-space mobility and their underlying
mechanisms among older adults.
Method. Community-dwelling older adults (N =
1,643) were assessed at three time points over a
period of two years. Growth mixture models with
mediation and moderation analyses were
conducted to investigate associations between
cognitive functioning and life-space mobility.
Potential mediators were depressive symptoms
and locus of control; potential moderators were
grip strength and gait speed. Analyses were
controlled for age, sex, schooling, annual income,
and urban area.
Results. The direct association between state
scores for cognitive functioning and life-space
mobility was significant, mediated by depressive
symptoms scores and locus of control, and
moderated by gait speed and grip strength.
However, there were no direct associations
between change in cognitive functioning and
change in life-space mobility; the change scores
were mediated only by gait speed.
Conclusions. Growth-models with mediation and
moderation models allow a simultaneous
investigation of cross-sectional and longitudinal
data, as well as underlying mechanisms. Results
showed that change in relation to cognitive
functioning and life-space mobility is not yet well
circumscribed in aging. A clearer conceptualization
of the mechanisms linking changes in those
variables would allow future research to capture
the impact of cognitive impairments more
comprehensively.
O47
Effets à court terme d'un programme
communautaire de marche avec bâtons sur les
capacités physiques de personnes âgées
1 ,2
1
3 ,4
B. Fournier , M.-E. Mathieu , J. Filiatrault , N.
3 ,4
2
1 ,5
Bier , M. Parisien , S. Laforest
1
Département de kinésiologie, Université de
2
Montréal, Montréal, Québec, Canada, Centre de
recherche et d'expertise en gérontologie sociale
(CREGÉS), Centre intégré universitaire de santé et
de services sociaux du Centre-Ouest-de-l'Île-de3
Montréal, Montréal, Québec, Canada, École de
réadaptation, Université de Montréal, Montréal,
4
Québec, Canada, Centre de recherche de l'Institut
universitaire de gériatrie de Montréal (CRIUGM),
5
Montréal, Québec, Canada, Institut de recherche
en santé publique de l'Université de Montréal
(IRSPUM), Montréal, Québec, Canada
21
Objectifs
Cette étude visait à examiner les effets à court
terme d'un programme bihebdomadaire de 12
semaines de marche avec bâtons sur les capacités
physiques de personnes âgées vivant dans la
communauté.
Méthode
Cette recherche quasi-expérimentale a impliqué
six organismes communautaires, qui ont recruté 63
personnes âgées de 60 ans et plus. Les
organismes ont agit soit comme groupe
expérimental (participants au programme, deux
sessions de 60 minutes/semaine) soit comme
groupe témoin (liste d'attente de trois mois). Les
participants ont été évalués avant et après le
programme au moyen d'une batterie de tests,
incluant ceux du Senior Fitness Test. Les
comparaisons entre les groupes au fil du temps
ont été effectuées avec des ANOVA à mesures
répétées ajustées pour l'âge, la taille et le fait de
vivre seul.
Résultats
78% des participants ont participé au post-test
(n=49; âge moyen: 70 ans; 86% de femmes). Les
analyses multi-niveaux ont indiqué une plus
grande amélioration de la force des membres
supérieurs et inférieurs pour les groupes
expérimentaux par rapport aux groupes témoins
(p<0,05). En effet, les participants des groupes
expérimentaux étaient, en moyenne, en mesure de
faire 10,6% plus de répétitions au test du Arm Curl
(diminution de 4,5% pour le groupe témoin)
mesurant la force des membres supérieurs et 8,9%
plus de répétitions au Chair Stand (diminution de
3,1% pour le groupe témoin) après le programme.
Conclusion
Le programme de marche avec bâtons semble
avoir contribué à une amélioration significative de
la force musculaire des membres supérieures et
inférieurs. Ces données préliminaires sont donc
prometteuses.
O48
Gait speed at the end of life in older adults: a
time for change
Sathya Karunananthan, Christina Wolfson
McGill University, Montreal, Canada
When examining the association between gait
speed and survival time in older persons,
researchers have typically used a single measure
of gait speed taken at the time of study entry, and
applied survival analysis. However, survival from
time of entry into a study is not of much relevance
when examining the association between gait
speed and survival in older persons. Here, I
propose examining changes in gait speed in
relation to time-of-death as an alternative approach
to improve our understanding of the role of gait
speed as an indicator of longevity.
Objective: To estimate the association between
time-from-death and gait speed in older persons.
Analysis: Using annual measurements of gait
speed taken from a sample of 4,150 elderly from
the Cardiovascular Health Study, I apply mixed
models to describe change in gait speed in the
time preceding death, in men and women
separately. These results are compared to models
of change in gait speed with respect to age.
Results: In men and in women, there is a
significant association between time-to-death and
gait speed. However, a model with age rather than
time-to-death, provides better model fit. Moreover,
after controlling for the effects of health and
lifestyle factors, the association between time-todeath and gait speed is attenuated, whereas the
effects of age remain unchanged.
Conclusion: Using multiple measurements of gait
speed and other lifestyle and health factors, we
find a modest relationship between gait speed and
time-to-death.
O49
Is Mortality Associated with Frequency of Falls
and Head Impact? A Prospective Cohort Study
in Long-term Care
1 ,2
2
Yijian Yang , Kimberley van Schooten , Lukas
2
1
3
Grajauskas , Joanie Sims-Gould , Fabio Feldman
,2
2
, Stephen Robinovitch
1
2
Canada, Simon Fraser University, Burnaby, BC,
3
Canada, Fraser Health Authority, Surrey, BC,
Canada
Introduction: Falls are a leading cause of death
among older adults, and up to 50% of fall-related
deaths are due to traumatic brain injury. We
examined how rates of falls and fall-related head
22
impacts associated with mortality in two long-term
care (LTC) facilities.
Methods: Between 2007 and 2015, we followed
194 residents (mean age 82±9 years) whose falls
were documented in incident reports. A camera
network captured video footage of falls in common
areas. We analyzed each fall video to determine
the occurrence of head impact.
Results: Among all participants, the median rate of
falls was 2.5 falls/year (range 0.15-39.2). 60% of
participants were observed on video to have at
least one head impact, and the median rate of
head impacts was 0.4 times/year (range 0.13-6.7).
117 residents died during the study, after an
average follow-up period of 3.6±1.7 years. In the
multivariate survival analysis, an increase of one
head impact per year was associated with a
hazard ratio of 1.43 (95% CI 1.15–1.78) for
mortality, while an increase of one fall per year was
not significantly associated with mortality (1.02,
0.98–1.05). Men had higher mortality than women
(1.82, 1.24–2.66). A one-year increase in age also
associated with increased mortality (1.03, 1.00–
1.05).
Conclusion: Mortality among older adults in LTC
is associated more strongly with the occurrence of
head impact during falls, than with the frequency of
falls. This highlights the need to focus on strategies
for preventing and reducing the consequences of
falls that lead to head impact.
O50
Physical Activity and Mobility: Experiences and
Perceptions Older Men
1
1
3
Alison Phinney , Manpreet Gill , Myrthe Heijnen ,
2
1
Dawn Mackey , Joanie Sims-Gould
1
2
Canada, Simon Fraser University, Burnaby, BC,
3
Canada, Wageningen University, Wageningen,
Gelderland, The Netherlands
There is strong evidence that physical activity has
clear benefits for the health and well being of older
people, although research has repeatedly shown
that people become less physically active with age,
and older men may be at particular risk of
sedentary behavior. There is a need for new
knowledge that can be used to support efforts
toward increasing activity levels of older men. The
purpose of this qualitative study was to understand
older men’s experience and perspectives of their
mobility and involvement in physical activity as
they age, situating this understanding in a socioecological framework that draws attention to the
influence of relationships, community and social
factors, and issues of masculinity. We conducted
semi-structured interviews with 15 community
dwelling-men (age range 69-88 yrs), to understand
their views on what makes them more able and
less able to move about, and how they view the
importance of mobility and physical activity in the
context of their daily lives. Analysis revealed that
the men valued their mobility and found ways to
stay active even as their capacity was changing.
The importance of physical activity in their daily
lives focused around themes of location,
embodiment, and sociality. We will discuss
implications of these results for research and
practice: e.g. how findings are being used in the
context of a larger innovative study to understand
and promote men’s physical activity as they age,
and how these results might shape future
programs, policies, and services to better meet the
self-identified needs of older men.
O51
Middle-aged and older adults’ information and
communication technology access: A realist
review
1
1
Sarah Canham , Lupin Battersby , Rozanne
1
1
2
Wilson , Mei Lan Fang , Judith Sixsmith , Andrew
1
Sixsmith
1
Simon Fraser University, Vancouver, BC, Canada,
2
University of Northampton, Northampton, UK
Information and communication technologies
(ICTs) can have a role in providing access to
goods and services; maintaining a safe and secure
independent living environment; managing agerelated challenges; and promoting social
participation. Given the centrality of ICTs to
supporting quality of life, it is critical to identify and
address inequities in access, particularly for aging
adults. Having a comprehensive understanding of
the existing knowledge on the digital divide among
middle-aged and older adults is a first step in
maximizing equitable access to and use of ICTs
and getting information to adults most in need. The
current evidence on the characteristics of middleaged and older adults being excluded (and the
factors affecting exclusion) from ICT use were
examined in a realist synthesis review. This
methodology allowed examination of the literature
to ask: Which technologies do middle-aged and
23
older adults use? Which social groups are included
or excluded from the use of technologies? What
social circumstances facilitate or create a barrier to
digital uptake? If the digital divide does exist, why?
Using an intersectional framework this paper
discusses the ways in which social and structural
inequities contribute to the digital divide and
describes how and why certain social groups have
better access to or knowledge of and thus make
use of and benefit from technologies, while other
groups are unable to access, have little knowledge
of, or are unable to use and benefit from
technology.
O52
Bodies, technology, and aging: Older drivers'
perspectives on learning to drive a high-tech
automobile
Jessica Gish
With population aging, older people will be driving
more than ever before. At the same time,
advanced vehicle technologies (AVTs) are
becoming characteristic features of the automobile.
AVTs are sophisticated computer and
electronically-mediated communication systems
that provide information to support driving. AVTs
alter the way a driver controls a car, and in doing
so, reshape boundaries between bodily memory,
technology, and the material world. To date, little is
known about how older drivers incorporate
advanced technology (e.g., back up camera,
adaptive cruise control) into the ‘driving-body.' To
explore the process of learning to drive with AVTs,
in-depth interviews were conducted with 35 older
drivers (20 men; 15 women) aged 60 to 85 who
owned a vehicle equipped with at least two AVTs.
Although participants did not describe use of AVTs
as particularly difficult for them, they reported
needing to acquire new embodied competencies,
sensory skills, and driving techniques in order to
drive safely. This research finds that driving with
advanced vehicle technology requires ‘driving
work' or practical, sensory, and embodied exertion
that occurs at both intentional and unintentional
levels. Concluding comments reflect on the forms
of knowledge and bodily training that are needed
to ensure safe driving in a high-tech automobile.
O53
Ageing and technology - what factors influence
acceptance or rejection?
1 ,2
3
Arlene Astell , Faustina Hwang , Elizabeth
2
4
2
Williams , Libby Archer , Sarah Harney-Levine ,
5
6
Dave Wright , Maggie Ellis
1
2
Sciences, ON, Canada, University of Sheffield,
3
South Yorkshire, UK, University of Reading,
4
5
Berkshire, UK, Age UK, London, UK, Brighton
6
University, Sussex, UK, University of St. Andrews,
Fife, UK
Objectives: As part of the Challenging Obstacles
and Barriers to Assisted Living Technologies
(COBALT) project, this study set out to explore
how older adults make decisions about adopting or
abandoning technology, something that is rarely
addressed in the current literature
Method: A range of new methods were developed
to engage older adults including ‘Show and Tell’,
‘Technology Interaction’, and Technology Tours.
Twenty-nine older adults aged 65 and over took
part in Show and Tell and Technology Interaction
session with a further 8 completing Technology
Tours.The sessions were recorded and transcribed
and subject to Thematic Analysis.
Results: Themes that emerged relating to liking or
adopting technology were linked to positive
benefits the technology brought to an individual’s
life. Themes relating to rejection or abandonment
were linked to limitations of the technology or
related items, such as poor instructions.
Conclusion: This research supported the complex
nature of decision-making around technology
adoption and highlighted the value of interactive,
activity-based group sessions to encourage
maximum participation and discussion from older
adults.
O54
Lessons from Innovation Boulevard: A case
study of a regional innovation ecosystem to
support the development of technologies in
health and aging
1
3
Josephine McMurray , Heather McNeil , Andrew
4
1
3
Sixsmith , Natalie Waldbrook , Paul Stolee , Heidi
2
Sveistrup
1
Wilfrid Laurier University, Brantford, Ontario,
2
Canada, University of Ottawa, Ottawa, Ontario,
3
Canada, University of Waterloo, Waterloo,
4
Ontario, Canada, Simon Fraser University, Surrey,
B.C., Canada
24
Introduction: Our increasingly networked society
links individuals and organizations globally, yet
local networks are enduringly relevant. Regional
innovation ecosystems (RIEs), a connected
network of entities enabling invention, are well
documented in other sectors, less so in health and
aging, where radical innovation is needed to
sustain our aging population. We present results of
the first in a series of case studies, part of a multistage research project examining development of
regional health innovation ecosystems (RHIEs).
Methods: We conducted and audio-recorded
semi-structured interviews and one focus group
with stakeholders (n=30) from government,
industry, universities, and civil society, instrumental
in the conceptualization and development of
Surrey, B.C.'s Innovation Boulevard. Archival
documentation and verbatim transcripts of the
interviews were imported into NVIVO-11© and
analysed using open and axial coding.
Results: We found a number of factors supporting
the early stage evolution of a RHIE that are
common across sectors such as the importance of
location, an entrepreneurial mindset, government,
industry and university partnership, a clear vision
and value proposition, transformative leadership
and stage-relevant governance. However, the
health and aging domains present unique
dynamics when building and sustaining innovation
collaboratives including rigid funding mechanisms,
risk-averse organizational and professional culture,
and non-clinicians' understanding of trickle-down
effects with new technology.
d'Ingénierie et de Gestion du Canton de Vaud, la
Haute Ecole d'Ingénierie et d'Architecture de
Fribourg et l'Ecole cantonale d'arts de Lausanne
ECAL, le Senior Living Lab (SLL) est un projetpilote centré sur le développement de solutions
concrètes pour le « bien-vieillir à domicile », avec
et pour les seniors. Ses activités sont structurées
autour de trois axes : la communication, la mobilité
et l'alimentation.
Basé sur une approche d'innovation sociale, le
SLL permet de répondre à des besoins sociaux
tout en générant des liens entre des personnes et
des groupes qui ne travaillent généralement pas
ensemble (associations d'aînés, associations
professionnelles, collectivités publiques, Hautes
Ecoles, entreprises). Ce laboratoire ouvert vise à
devenir un « incubateur à solutions » productrices
de valeur pour les seniors. Dès la conception, les
futurs utilisateurs sont impliqués dans un
processus de co-création, en apportant leurs
idées, expériences, frustrations et désirs.
Ces croisements de regards favorisent
l'émergence de solutions innovantes, répondant à
des besoins réels et que les futurs usagers
utiliseront. Les données ainsi co-produites
génèrent des connaissances en lien avec le
processus de vieillissement, qui peuvent être
valorisées tant sur le plan économique
(développement de produits et de services) que
scientifique (communications scientifiques et
professionnelles, contenus pédagogiques de
formation, etc.).
O56
Conclusion: There are similarities between
instrumental factors that drive successful
innovation ecosystem development across all
sectors. However, we discovered factors unique to
the healthcare and aging sectors when developing
RHIEs, and the need for a systematic innovation
research agenda within the field of gerontology.
O55
Senior Living Lab (SLL) : une approche
d'innovation sociale en gérontologie
1 ,2
Delphine Roulet Schwab
1
Institut et Haute Ecole de la Santé La Source,
2
Lausanne, Switzerland, Société suisse de
gérontologie, Berne, Switzerland
Créé en 2015, en Suisse romande, par la Haute
Ecole de la Santé La Source, la Haute Ecole
Developing tools to assess implementation
feasibility in the community
1
2
Grace Warner , Barbara Pesut , Wendy
3
2
2
Duggleby , Miranda Dalhuisen , Kelli Sullivan
1
2
Dalhousie University, Halifax, Canada, University
3
of British Columbia, Kelowna, Canada, University
of Alberta, Edmonton, Canada
Objectives: To use an evidence-based
implementation science framework to develop tools
to assess implementation feasibility of novel
community-based interventions.
Methods: The Consolidated Framework for
Implementation Research (CFIR) has identified key
domains (setting, intervention, process, and
characteristics of individuals) that affect
25
implementation of a novel intervention. Semistructured interview guides and survey tools were
developed based on CFIR domains, and an
iterative process was used to create appropriate
items. Tools were administered to individuals at
different levels of involvement in a research project
evaluating the feasibility of volunteers helping older
adults navigate the last years of life. The
framework needed to be expanded to include
community-level factors. The research literature on
community-capacity was reviewed, and an
environmental scan gathered data on community
resources available to support older adults. Tools
and scans were piloted in two provinces, with five
communities.
Results: Piloting identified modifications that could
be made to the tools so participants could interpret
complex concepts. Interviews need to be
conducted with individuals participating in different
aspects of the intervention to get a complete
understanding of implementation. Decision
makers who are tangentially involved, but
important to intervention uptake, needed additional
contextual information to accurately answer
questions. Interviewers and analysts need to be
appropriately trained in the framework to interpret
how responses relate to the framework.
Conclusion: The piloted tools are an important
first step toward being able to prospectively identify
factors that affect implementation feasibility of
innovative interventions. The addition of a
community domain is important for interventions
implemented outside of facilities.
O57
Evaluation of the Tri-stage Interprofessional
Learning Experience in Aging (TILEA)
Tricia Woo, Bonny Jung, HeeJin Kim, Anju Joshi,
Pat Miller, Annie Mo, Amanda Pereira, Alexandra
Willox
McMaster University, Hamilton, Ontario, Canada
OBJECTIVES
1) Assess learners’ change in attitudinal
competencies regarding older adults as they
progress through each stage of a 3-stage
interprofessional learning experience;
2) Assess the change in interprofessional
competencies among health professional trainees
working with geriatric clients.
BACKGROUND
Based on the Canadian Interprofessional Health
Collaborative (CIHC) interprofessional competency
framework, a longitudinal geriatric learning
experience that bridges education to clinical
practice using exposure, immersion and mastery
level interprofessional training opportunities was
developed.
Stage 1 of the tri-stage program exposed learners
to a communication workshop that introduced
effective interviewing skills with older adults from
the community. Stage 2 offered a range of
workshops that immersed trainees into issues
concerning geriatric population. Stage 3 paired
learners with a health professional mentor to
collaborate on a geriatric learning plan unique to
each participant. Students were given the option to
choose one or more stages to participate.
METHODS
A mixed methods design using repeated measures
evaluated change in students’ attitude towards
older adults. Pre and post-intervention attitudinal
change was measured and analyzed in each
learning stage using the Aging Semantic
Differential and Geriatric Attitude Scale, as well as
an in-depth debrief through focus groups and
interviews.
RESULTS & CONCLUSION
Results showed that most assessments were
statistically significant with positive attitudinal
change towards older adults. Longitudinal learning
experience is highly valued by students when it
can be individualized and competency-based.
Partnering with community-dwelling older adults in
interprofessional education can promote
sustainable learning opportunities that stimulate
career interests of health professional students in
geriatric field.
O58
Portrait de la relève en matière de ressources
humaines francophones pour la population
vieillissante du Nouveau-Brunswick
S. Dupuis-Blanchard, D. Thériault
Université de Moncton, Moncton, N.-B., Canada
Le vieillissement de la population représente un
défi pour les provinces de l'Atlantique.
Communément, la proportion de personnes âgées
au Nouveau-Brunswick s'étend maintenant à 19%
26
(Statistique Canada, 2015), soit le pourcentage le
plus élevé au pays. Afin de contrer les dépenses
élevées en santé et en service sociaux, les soins à
domicile permettent l'efficacité du système tout en
permettant aux aînés de demeurer à domicile,
sachant que c'est le désir de ceux-ci (DupuisBlanchard, et al., 2015, 2013). D'après une étude
récente, la capacité de pouvoir offrir des soins à
domicile futurs révèle un portrait inquiétant pour la
province. Les agences communautaires vivent des
défis quant à la rétention et au recrutement des
employés, en plus de connaître une moyenne
d'âge élevée de leurs employés (Thériault et
Dupuis-Blanchard, 2015). Une meilleure
connaissance des intentions de la relève en
matière de ressources humaines pour la
population vieillissante était alors nécessaire. Le
but de ce projet était de mieux connaître les
intérêts, les avantages et les désavantages d'une
carrière dans le domaine du vieillissement auprès
de la jeune population. La collecte des données a
été possible grâce à la collaboration des écoles
secondaires francophones de la province. Les
questionnaires ont été distribués aux élèves de la
e
e
10 et 11 année. Les résultats semblent
démontrer que les élèves ont peu de
connaissances et peu d'intérêts envers une
carrière dans le domaine du vieillissement. Les
résultats de cette étude sont d'ordre d'importance
quant à la planification future des ressources
humaines de la province du Nouveau-Brunswick.
adults over a period of 5 weeks. In pairs, students
considered course content in relation to stories of
life transitions they have yet to experience and
reflected on generational similarities and
differences. The overall project incorporated
biography and photo voice assignments in order to
create individual narratives for each participant in
the project. Supplementary coursework enabled
students to develop skills related to creative
representation of the stories (e.g., lessons on
photography and biography writing). This
intergenerational project concluded with an exhibit
of students' work at the end of the term, attended
by older adults, their family and friends as well as
staff at the home. Pre- and post-visit reflection
assignments show a shift in students' perceptions.
In particular, they wrote about how their
experiences disrupted assumptions they held
about older adults and retirement homes.
O59
OBJECTIVE: The higher prevalence of dementia
has been estimated for Latin America with 8.5%,
being between 5%-7% in most of the world
regions. Evidence suggests that information
communication technologies (ICT) can have some
positive impact on prevention and better
management of these conditions, given the
existing positive experience in their application in
countries with higher incomes. We aim to identify
which are the key elements involved in promoting
innovative interventions using ICT to improve the
care management of elderly patients with cognitive
impairment and their caregivers, with the objective
to evaluate its application in LMICs.
Photo narratives of older adults: Exploring
arts-based intergenerational service learning
Colleen Whyte
Brock University, St.Catharines, ON, Canada
Service-learning is a unique form of experiential
learning that combines academic study,
community involvement and critical reflection. A
growing body of literature has documented the
benefits of incorporating service-learning into postsecondary pedagogy including increased student
engagement, improved rates of knowledge
retention and stronger academic outcomes. This
paper describes an arts-based service-learning
opportunity for students in a third-year
undergraduate aging course that explores current
issues and trends in the field of aging, social
attitudes toward aging and older adults, and the
role of leisure in aging well. Partnering with a
retirement home in the Niagara Region of Ontario,
50 students gathered first-hand life stories of older
O60
Key elements to promote innovative
information communication technologies (ICT)
in care management of elderly patients with
cognitive impairment and their caregivers
2
1
Ruthy Acosta-Rojas , Beatriz E. Alvarado-Llano ,
1
Angeles Garcia
1
Queen's University, Kingston, Ontario, Canada,
2
Growth in Health Research, Barcelona, Spain
METHODS: We carry out an environmental
scanning which reviewed various information
resources, ranging from journals, policy
documents, and talks to opinion experts in the
field.
RESULTS: Among the key points to promote these
technologies among older adults, the user has to
perceive it as worth it, easy to use and
27
advantageous when compared to other available
options, as well as influenced by the user’s familial
social network, in the case of the older adults with
cognitive impairment, their caregivers. We also
identified Design Thinking and Gamification, to
allow designing and orienting interventions based
on the needs and capacity of the user, as well as
delivering them in an enjoyable and fun manner.
CONCLUSION: Design thinking and Gamification
will offer a starting point for the development or
adaptation of current effective ICT for patients and
caregivers. We will present details of these
methodologies and its possible applications in
LMIC.
Méthode Une synthèse des connaissances a
permis de dresser un portrait de l’ensemble des
données probantes et ainsi de mieux cerner,
définir et opérationnaliser les concepts pris en
compte pour décrire un environnement capacitant.
Conclusion Cette recension permettra de mettre à
profit les connaissances scientifiques afin
d’assurer à chaque citoyen canadien un avenir
florissant où le respect de la dignité des personnes
âgées présentant des troubles de santé ou
d’adaptation psychosocial sera préservé.
O62
From the Lab to Student and Industry Success:
The Benefits of Engaging in Applied Research
in the Field of Aging
O61
Vers le concept d’« environnement
capacitant » : utilisation des nouvelles
technologies pour améliorer les conditions de
réalisation des activités quotidiennes des
canadiens vieillissants dans des espaces
d’activité privé et public
1 ,2
2 ,3
2 ,4
PY Therriault , MM Lord , A Desaulniers
1
Département d'ergothérapie, Université du
Québec à Trois-Rivières, Trois-Rivières/Québec,
2
Canada, Laboratoire de recherche en ergologie,
Université du Québec à Trois-Rivières, Trois3
Rivières/Québec, Canada, Programme de
doctorat en Sciences biomédicales, Université du
4
Canada, Programme de maîtrise en ergothérapie,
Université du Québec à Trois-Rivières, TroisRivières/Québec, Canada
Contexte La technologie revêt un ensemble
complexe d’enjeux et c’est pourquoi la théorisation
la concernant se doit d’intégrer les outils, les
équipements et la technique mais aussi, les
connaissances et les méthodes nécessaires à
l’accomplissement de l’activité humaine. Plusieurs
projets d’utilisation de la technologie ont été mis de
l’avant et différentes disciplines s’intéressent au
développement, à l’utilisation, à l’introduction et à
l’évaluation des nouvelles technologies auprès des
personnes âgées dans différents contextes de vie.
Objectif Cette communication vise à dresser un
bilan des connaissances actuelles concernant
l’utilisation des nouvelles technologies pour
améliorer les conditions de réalisation des activités
quotidiennes des canadiens dans des espaces
d’activités privés et publics.
Pat Spadafora, Lia E. Tsotsos
Sheridan Centre for Elder Research, Sheridan
College, Oakville, ON, Canada
The Centre for Elder Research conducts
innovative, multidisciplinary research that
enhances the quality of life of older adults while
serving as an education and resource hub for the
Sheridan College community. Through
partnerships with academic institutions, industry
leaders and community groups over the past 13
years, the Centre has amassed a great deal of
experience translating applied research
endeavours into valuable, and viable, business
solutions. There has also been an emphasis on
providing training and mentorship for students to
develop research skills while addressing the realworld challenges and opportunities presented by
an aging population. Together, these approaches
ensure a coordinated, cohesive strategy that can
benefit older adults, support local and regional
businesses and also ensure that research results
are embedded into the curriculum at Sheridan,
producing highly qualified graduates.
This presentation will describe the Centre’s formal
approach to combining the needs of business and
industry partners with the skills and talent available
from students at Sheridan to conduct research in
the field of aging. The balancing act required to
effectively manage these collaborative and
interdisciplinary projects has resulted in major
successes and valuable learning opportunities for
all parties. The materials, resources, and internal
processes used at the Centre will be shared along
with case study examples to demonstrate how
other research groups can effectively manage
28
coordinated, large-scale projects with a diverse
group of stakeholders.
O63
Financial status of immigrant and visible
minority women in Canada: An analysis of two
national data sets
1
2
Daniel W. L. Lai , Lun Li
1
Department of Applied Social Sciences, The Hong
Kong Polytechnic University , Hong Kong, Hong
2
Kong, Faculty of Social Work, University of
Calgary, Calgary, Alberta, Canada
Financial competency is a critical aspect of
wellbeing in later life, and the financial status of
aging immigrant and visible minority women in
Canada has long been a significant concern. This
study examined financial outcomes for immigrant
and Canadian-born women aged 65 and older in
Canadian, based on secondary analysis of
National Household Survey (NHS) 2011 and
Canadian Community Health Survey (CCHS) 2012
data. Bivariate analysis of NHS data indicated that
while older immigrant women were more likely than
Canadian-born women to have a higher average
household income, be employed full-time, and to
live in family-owned housing, they were also more
likely to report lower personal income and lowincome status. Similarly, analysis of CCHS data
indicated that while older immigrant women were
more likely than Canadian-born women to be
involved in the labor market, they were also more
likely to report lower personal and household
income. Similar differences in income and
employment were identified when comparing older
visible minority and Caucasian women, although
no differences were noted in housing tenure.
Regression analyses revealed that when
controlling for demographic variables, older
immigrants and visible minority women tend to
experience disadvantaged financial status,
compared to Canadian-born and Caucasian
women. Social service providers and public policy
makers should therefore address specific financial
outcomes and challenges in order to promote
wellbeing in among diverse aging women, with a
particular focusing on reducing lower-income
status.
O64
Crise de la solidarité intergénérationnelle et
maltraitance des personnes âgées chez les
Tchaman en Côte d’Ivoire
A.C.T.S. Say, A.K.Z.D. Dayoro
Université Jean Lorougnon Guédé; Université Félix
Houphouet Boigny, Daloa;Abidjan, Cote D'Ivoire
Introduction
Les villages Tchaman, malgré l’urbanisation de la
ville d’Abidjan, actualisent leur identité. Dans les
champs religieux, socio-culturels et sociopolitiques,
les pratiques sociales traditionnelles continuent de
s’observer. Toutefois, la solidarité
intergénérationnelle de type organique s’observe
moins et en conséquence, les personnes âgées
subissent des formes de violences. Les pratiques
de déni de vieillesse et les formes de maltraitance
des personnes âgées s’observent désormais dans
cette communauté.
L’objectif de cette étude est d’analyser les facteurs
déterminants de la maltraitance des aînés.
Méthodologie
Pour 4311 personnes âgées de 60 ans ou plus
(INS, 1998), 73 hommes et 113 femmes (186) ont
été interrogés dans 9 villages Tchaman, dans le
District d’Abidjan. L’échantillon est constitué
d’individus pris à intervalles fixes dans une liste de
classes d’âge d’appartenance. Les données de
terrain ont été collectées par le biais des entretiens
individuels et de groupe.
Résultats
Les résultats se structurent comme suit.
- La dualité de la représentation sociale des
personnes âgées : "objets d’honneur", et "objets
de tous les maux".
- Les différentes formes de violences: la
maltraitance psychologique : 186 cas; les
violences physiques : 96 cas ; la maltraitance
matérielle : 63 cas ; la maltraitance financière : 102
cas.
- Les logiques de structuration du lien
intergénérationnel
Conclusion
La maltraitance des aînés est l'aboutissement d'un
processus de lassitude dans l'assistance familiale.
L’étude suggère à l’Etat de Côte d’Ivoire d’inclure
les personnes âgées dans sa politique globale.
O65
What influence the reporting behavior of
abused and exploited migrant care workers?
The case of migrant care workers in Israel
29
Ohad Green
Bar Ilan University, Ramat Gan, Israel
Centre Working CARERS Program (RCWCP),
which targets individuals with the dual role as an
employee and a dementia family caregiver.
Objective: Many migrant home care workers suffer
from exploitation and abuse. The aim of the
present study was to explore the reporting
behavior of abused migrant home care workers in
Israel, and to discover the main barriers that
prevent reporting.
Method: 187 home care workers, recruited by
snowball sampling, completed a questionnaire
regarding work-related abuse and answered
questions about reporting the abuse, either
formally (e.g to the police or a social worker) and
informally (e.g to family or friends).
Results: Less then half of the abused participants
reported the abuse. None of them reported the
abuse to the police, and the most preferred to
report it informally. A multinominal logistic
regression revealed that home care experience is
a barrier for formal reporting, while unstable
financial situation was a catalyst.
Conclusion: The findings demonstrated that while
migrant home care workers are highly vulnerable
to work-related abuse, they are not likely to report
this abuse and put an end to the cycle of violence
and exploitation. Implications for policy and
practice are discussed.
O66
Applying the life-course role identity framework
to understand work-life conflicts faced by
working dementia family caregivers
2 ,3
1 ,2
2 ,3
Mary Chiu , Sonia Meerai , Joel Sadavoy
1
Lunenfeld-Tanenbaum Research Institute, Sinai
2
Health System, Toronto, Canada, The Cyril &
Dorothy, Joel & Jill Reitman Centre for Alzheimer’s
Support and Training, Sinai Health System, Mount
3
Sinai Hospital, Toronto, Canada, Department of
Psychiatry, University of Toronto, Toronto, Canada
In Canada, high proportion of adult children and
close relatives carry out the multiple, complex
responsibilities of family care and paid employment
concurrently. Employing the life-course role
identity theoretical framework, the current study
aims at understanding how this subpopulation of
family caregivers may benefit from participation in
an evidence-informed, small-group therapeutic
skills-training intervention known as Reitman
Twenty in-depth interviews were conducted with
former RCWCP participants to explore their lived
experience, work and life responsibilities, and how
RCWCP may have impacted them in several worklife domains. Interviews were transcribed,
analyzed and coded following the narrative inquiry
approach.
The extent to which knowledge and skills acquired
from RCWCP may be applied is related to the
working caregiver's experience, which is affected
by gender-role identity, role-relationship, and worklife conflicts. Interviewees' narratives pointed to
conflicting demands across the roles of employee
and caregiver, accounting for negative experiences
faced by caregivers. This is further compounded
by the social construction of gender-role
expectations, which subsequently alter an
individual's work identity. The study also revealed
the differences in accommodation and absence
leave policies in private versus public sector.
Targeted and tailored caregiver interventions such
as the RCWCP can proactively respond to the
shifting demographics and needs of working family
caregivers. Our findings may be considered as we
continue to understand the complexity of gender
roles within Canadian society whereby work and
family dynamics are constantly changing.
O67
The merits and pitfalls of using focus groups in
a hospital setting: Trickles to Torrents
1
1
1
Lorna Guse , Barbara Tallman , Donna Martin ,
2
2
Lisa Albensi , Stephanie Van Haute , Mary
2
2
2
Montgomery , Maria Froese , Mavis Lam , Kendra
2
2
2
Gierys , Nataliya Basova , Rob Lajeunesse
1
University of Manitoba, Winnipeg, MB, Canada,
2
Seven Oaks General Hospital, Winnipeg, MB,
Canada
Objectives: Merits and pitfalls of using focus
groups in a hospital setting will be discussed.
Method: Focus groups and individual, qualitative
interviews were used to explore the perspectives of
frontline health care providers about pressure ulcer
(PU) prevention and a multi-component pressure
ulcer prevention program (PUPP) in a hospital
30
setting. Initially, recruitment was problematic. With
support from some managers, study recruitment
was enhanced. Using a semi-structured interview
guide, a facilitator and recorder gathered the
audio-recorded data. Five focus groups and seven
individual interviews were conducted. A total of 35
health care providers volunteered to participate.
Some focus groups were comprised of only three
members while others were over-capacity at 15.
Findings: Facilitators and barriers to PU
prevention were categorized according to
adequacy or lack of physical and human
resources. Health care providers described their
frustration about problems accessing items such
as shower chairs and bath tub plugs. The main
barrier to PU prevention was identified as staff
shortages. Participants voiced that PU prevention
would be enhanced with more health care aides,
turning teams, and improved communication
between all health care team members.
Conclusions: Although the logistics of focus
groups in a hospital setting were at times
problematic, the thick descriptions pointed to the
necessity to incorporate a multidisciplinary
approach and identified the need to include health
care aides in staff education. By offering
participants the option for an individual interview
and acquiring the support of unit and department
managers, we were able to collect and analyze rich
data.
function, and quality of life (QOL) of nursing home
residents with dementia (RwD).
Methods: A quasi-experimental feasibility study
with a 2-month control phase followed by a 4month intervention phase. RwD were screened for
severity of cognitive impairment, communication
abilities, depression, ADL function, and mobility
(TUG; 2-minute walk test) using validated tools.
The MWI consisted of 1) regular 30-minute to 1hour individualized walks supervised by a RN 2-4
times a week; and 2) an interactional guide based
on residents' cognitive and community
assessments, and interviews with residents' family
members and home staff. Outcomes were
assessed every 2-months over the 6-month study
period. RM-ANOVA was used to analyze the data.
Results: All RwD (N=26) experienced significant
losses in mobility (P =0.01; 0.034), ADL function (P
=0.000), QOL (P=0.03) in the control phase. The
MWI resulted in significant improvements in
mobility measures (P =0.000; P=0.000), ADL
function (P =0.000), and QOL (P =0.006) over a 4month period. Family members and staff had high
acceptance rates (>90%) towards the MWI.
Conclusion: The MWI improved mobility, ADL
function, and QOL of RwD. This study provides
evidence that the MWI is feasible and findings will
inform a future large scale RCT to further evaluate
intervention effectiveness.
O68
O69
Efficacy of a Multi-faceted Walking Intervention
on Functional Mobility, ADL Function, and
Quality of Life of Nursing Home Residents with
Dementia: Results of a feasibility study
Nursing staff preferences and perceptions
towards the clinical management of
hyperactivity syndrome in long-term care
residents with dementia
1 ,2
1
1
Charlene Chu , Martine Puts , Monica Parry ,
2 ,3
2 ,1
Dina Brooks , Katherine McGilton
1
Lawrence S. Bloomberg Faculty of Nursing,
2
University of Toronto, Toronto, Canada, Toronto
Rehabilitation Institute - University Health Network,
3
Toronto, Canada, Department of Physical
Therapy, University of Toronto, Toronto, Canada
Objective: To determine the feasibility,
acceptability and efficacy of a Multifaceted Walking
Intervention (MWI), an individualized walking
regime based on residents' cognitive impairment
and physical activity levels, to maintain the
functional mobility, activities of daily living (ADL)
1 ,2
2 ,3
Ovidiu Lungu , Marie-Andrée Bruneau ,
4
5 ,6
Philippe Voyer , Philippe Landreville , Matteo
1 ,7
7 ,8
Peretti , Machelle Wilchesky
1
Centre for Research in Aging, Donald Berman
Maimonides Geriatric Centre, Montreal, Canada,
2
Département de psychiatrie, Université de
3
Montréal, Montreal, Canada, Centre de recherche
de l'Institut universitaire de gériatrie de Montréal,
4
Montreal, Canada, Faculté des sciences
infirmières, Université Laval, Quebec, Canada,
5
École de Psychologie, Université Laval, Quebec,
6
Canada, Centre de recherche du CHU de
7
Québec, Quebec, Canada, Department of Family
Medicine, McGill University, Montreal, Canada,
8
Centre for Clinical Epidemiology, Lady Davis
31
Institute for Medical Research, Jewish General
Hospital, Montreal, Canada
BACKGROUND/OBJECTIVES: Given the wide
range of neuropsychiatric symptoms in people with
dementia, there is increased interest in grouping
symptoms into syndromes based on their
concurrent prevalence in order to adapt specific
interventions accordingly. For example,
hyperactivity syndrome includes
agitation/aggression, irritability and disinhibition.
Clinical guidelines state that non-pharmacological
approaches should be the first line of intervention
when managing these behaviors in long-term care
facility (LTCF) residents with dementia. Yet, frontline staff perspectives regarding preference,
effectiveness and frequency of use of these types
of interventions has rarely been investigated, and
no study has addressed these issues by
comparing symptoms belonging to the same
syndrome.
METHODS: Nurses and orderlies (N=63) from 2
large LTCFs were recruited. A questionnaire was
developed using the symptom description from the
Neuropsychiatric Inventory - Nursing Home
version. Staff perceptions (e.g. preference,
efficacy, use) regarding pharmacological and nonpharmacological interventions (e.g. medication,
one-on-one interaction, environmental changes)
for individual symptoms were assessed.
RESULTS: While nursing staff explicitly stated
their preference for one-on-one interaction over
other intervention options for all three hyperactivity
syndrome symptoms (in line with clinical
guidelines), they perceived pharmacotherapy to be
more effective and more frequently used than
other interventions when managing
agitation/aggression (p<0.05). In contrast,
preferences for non-pharmacological approaches
in managing disinhibition and irritability were
consistent with reported effectiveness and use of
these intervention types.
CONCLUSIONS: Our results suggest that
management strategies for individual symptoms
within the same syndrome may be different, and
that clinical guidelines may be applied selectively,
despite knowledge and familiarity with best
practice recommendations.
O70
Resilience in Family Caregivers of Individuals
with Dementia: The Impact of Caregiver Respite
Programming
Emily Roberts, Whitney Bailey, Kris Struckmeyer
Oklahoma State University, Stillwater, Oklahoma,
USA
Family members with a relative with dementia
often experience what has been called the
‘unexpected career of caregiver' facing multifaceted, complex and stressful life situations that
can have important consequences both physically
and emotionally. While family caregivers may be
motivated to provide care out of a sense of love or
duty, the impact of dementia on the family member
in its advanced states makes resilience in the
caregiving role difficult. Respite programming
(adult day center-based programs or voucher
respite programs) can be one way that family
caregivers can take time for themselves and the
aim of this mixed-method study was to determine
the impact of caregiver respite programming on
caregiver resilience. Inclusionary criteria for the
study required that the participant had been in the
caregiving role for 6 months or longer and had
participated in at least one form of respite
programming. Participants (N=101) were asked to
take an online survey with measures which
covered aspects of their daily responsibilities and
perceptions about their caregiving role. They were
then invited to take part in a follow-up interview at
a later date. Interview participants (N=29) were
asked open-ended questions about their
caregiving role and the impact of respite
programing on their daily patterns and resilience.
Data analysis pointed to positive correlations for
respite programming and resilience and coping
skills, yet interviewees described difficulties and
long wait times in completing the means testing
process for program eligibility, often leading to
higher levels of burden rather than relief in their
caregiving role.
O71
Improving Care for People with Dementia who
Become Lost through Response Training for
Toronto Police Officers
Bernice Chan
Alzheimer Society of Toronto, Toronto, Canada
Dementia-related missing incidents have become
a common issue that police face, as it is estimated
32
that 60% of people with dementia will become lost
at some point in time. Many of these lost
individuals face the risk of serious injury and even
death, due to hypothermia, dehydration or
drowning. Given the potential severe
consequences, when a person with dementia goes
missing, police are often the first to be called and
hence they must be equipped with knowledge on
dementia to respond effectively. To support the
police in their response and identifying the need for
dementia education, the Alzheimer Society of
Toronto initiated a partnership with Toronto Police
Services to deliver dementia training to front-line
officers across all 17 Toronto police divisions, as
well as volunteer Auxiliary Officers. To date, 84
training sessions have been held and training is
ongoing. Self report evaluations indicate that the
one-hour training session has increased officers'
understanding of dementia and characteristics of
wandering behaviour, which can help them identify
those with dementia more quickly and support
them in their search and rescue efforts. Results
also show that the education has enhanced
officers' knowledge of communication techniques
to use with a person with dementia, and has
helped them recognize resources for people with
dementia and their families that could be used to
prevent missing incidents. Given the positive
feedback from participants, other dementia
educators may choose to implement a similar
model to deliver targeted dementia education for
officers in their local area.
O72
Dancing with dementia: Citizenship,
embodiment, and everyday life in long-term
care
1 ,2
1 ,2
Pia Kontos , Alisa Grigorovich
1
Toronto Rehabilitation Institute - University Health
2
Network, Toronto, Canada, University of Toronto,
Toronto, Canada
Objectives: Dance scholarship and practice in the
dementia field is predominantly dominated by
cognitive science with an emphasis on
psychotherapeutic use of dance. We argue that
this has restricted understanding of this form of
self-expression in dementia and has consequently
restricted the development of opportunities to more
fully support this capacity in long-term care
settings.
Methods: Findings from an ethnographic study of
selfhood in Alzheimer's disease in a Canadian
long-term care home are presented and analyzed
using a relational model of citizenship that
recognizes that corporeality is a fundamental
source of self-expression, interdependence, and
reciprocal engagement.
Results: Self-expression through dance in the
context of everyday life in long-term residential
care includes examples from recreational and
religious social programs, and non-structured
occasions. We argue that these examples
demonstrate a pre-reflective capacity for
expression through dance that can more fully be
understood and supported with a relational model
of citizenship.
Conclusion: Relational citizenship brings a new
and critical dimension to understanding selfexpression through dance by persons with
dementia, while also addressing broader issues of
inclusivity and the ethical imperative to fully
support dance through institutional policies,
structures and practices.
O73
Nursing intervention to improve the emotional
well-being of persons with dementia living in
long term care facilities
1
2
Charlotte Berendonk , Roman Kaspar , Matthias
1
3
4
Hoben , Marion Bär , Andreas Kruse
1
Faculty of Nursing, University of Alberta,
2
Edmonton, Alberta, Canada, Cologne Center for
Ethics, Rights, Economics and Social Sciences of
Health, University of Cologne, Cologne, Germany,
3
concept.alter - Heidelberg, Heidelberg, Germany,
4
Institute of Gerontology, University of Heidelberg,
Heidelberg, Germany
We present a nursing intervention (the DEMIAN
intervention) to improve the emotional well-being of
persons with dementia (PwD) living in long term
care (LTC) settings. The intervention comprises
the repeated creation of short, individualized
positive situations (e.g., foster experiences in and
with nature: support a PwD who would like to take
care of plants).
In a first study we gathered and assessed
information on positive everyday life situations for
selected PwD, and in collaboration with care
providers we developed and implemented small
interventions to create positive situations of PwD.
33
We demonstrated that DEMIAN fostered the
emotional well-being of PwD.
Based on these positive preliminary results, we
conducted a cluster-randomised controlled trial
including 40 care units in 20 LTC facilities in
southern Germany (2007-2010). The objective of
this second study was to examine the feasibility of
applying DEMIAN in routine care, and to test its
effects on care providers’ job satisfaction,
motivation and work strain. We trained 84 direct
care providers (=intervention group) versus 96
control group care providers (care as usual).
Individualized intervention plans for selected PwD
included between three and eight suggested
interventions. Participating care providers stated
that the intervention was feasible and helped them
to improve emotional well-being of PwD.
Furthermore, we found that by applying these
small interventions with PwD over a six-week
period, care providers’ time pressure decreased
significantly in the intervention group.
The DEMIAN intervention can be considered an
effective and pragmatic contribution to
implementing a person-centered care approach in
LTC settings.
O74
Family caregivers’ information work made
(in)visible: An institutional ethnographic aging
in place policy analysis
Nicole Dalmer
The University of Western Ontario, London,
Ontario, Canada
Objectives
To make visible the degree to which different
facets of informal caregivers’ work are
acknowledged or obscured in policy, this analysis
uncovers the conceptualizations of informal
caregivers’ information work in aging in place
policy documents.
Seeking, interpreting, managing and sharing
information (examples of activities considered as
information work) are key components of care
provision. Information work saturates every facet of
caregiving, providing tools for coping, problem
solving and dealing with uncertainty through
knowledge and support. A normative emphasis on
and government endorsement of aging in place
necessitates further study to best support
caregivers who provide unpaid care for an aging,
community-dwelling family member.
Method
Policy documents from municipal, provincial and
federal agencies and organizations that discuss
aging in place, community living or age-friendly
communities were analyzed for approaches to and
acknowledgements of caregivers’ work (and, more
specifically information work). An institutional
ethnographic approach to text analysis was
implemented, examining use of language (and
power), organizational interests, and indications of
unstated assumptions to uncover how policy
documents regulate and standardize conversations
surrounding caregivers’ work.
Results & Conclusions
This study signifies an innovative shift in the ways
the complexities of searching for and using
information on behalf of an aging family member
are understood. Findings speak to the trend
towards informatization of care: the provision of
information used as a means to gradually
marginalize care. Results of this study will bring
visibility to the concept of information work as a
means to more responsively support the
information needs of informal caregivers.
O75
The City of Montreal Police Service Model to
Counter Mistreatment of Older Adults
1
2
Marie Beaulieu , Michelle Coté , Josephine
1
1
1
Loock , Luisa Diaz , Monia D'Amours , Jacques
1
Cloutier
1
U. Sherbrooke, Sherbrooke, QC, Canada,
2
Montreal Police Service, Montreal, QC, Canada
Goal: This paper aims to present the final model of
the City of Montreal Police Service to counter
mistreatment of older adults (CMPS-CMOA). It
results of a 3 years action research project (July
2013 à June 2016), funded by the government of
Canada.
Methods: The 7 steps of the action-research
process included: a needs and practice
assessment (10 data collections : an international
literature review, survey and interviews with more
than 800 police officers, etc.), development of a
practice scheme, operationalisation of the scheme
in "real" practice, a pilot project in 2 phases, an
34
imbedded evaluation of implementation and effects
(8 data collections), adjustments to the model to
produce a final model, general implementation
throughout all the MPS.
Results: The evaluation of implementation and
effects has led to a series of adjustment. The final
Model has been implemented throughout all the
CMPS in May 2016. It contains 5 major
components including a series of 5 interrelated
practices (prevention, detection, first response,
follow-up, investigation and court), strategic
managing, a series of champions, training, etc. A
practice guide has been developed for other police
services who wish to adapt the model. This
practice guide has been tested (acceptability) with
10 other police services. It is now in distribution in
Canada and in the world.
Conclusion: In Montreal the model is implemented
to stay. It has been integrated to regular practice.
The MPS-CMOA is not in knowledge transfer.
O76
Are we really listening? Older people's views of
their mistreatment
1
1
Joan Harbison , Steve Coughlan , Jeff
1
2
Karabanow , Madine VanderPlaat , Sheila
1
1
Wildeman , Ezra Wexler
1
Dalhousie University, Halifax, N.S., Canada,
2
Saint Mary's University, Halifax, N.S., Canada
Twenty-five years ago Jane Aronson asked “are
we really listening?” to what older people have to
say about their needs (1992, p. 73). She
suggested that “stepping back from the dominant
discourse” is necessary in order to grasp both the
“complexity” and “variability” of such needs (p.82).
In this paper we take a similar approach, drawing
upon examples from the expanding field of
qualitative research studies that solicit older
people’s views on their mistreatment and how to
address it. We consider participants’
characteristics including their education, social
status, cultural diversity and degree of social
inclusion, as well as how they were recruited. We
examine how, by whom, and in what context the
questions were developed and asked, and the
extent to which they represent the dominant
discourse in the field. We then reflect on if, when
and how the participants give voice to perspectives
outside of views contained in mainstream
constructions of “elder abuse and neglect”.
The findings indicate that in searching for older
people’s views on their mistreatment most
researchers employ longstanding professional
frameworks. When participants voice opinions
outside of the mainstream, these may not be heard
but reframed within the dominant discourse.
However some researchers pursue these authentic
voices of older people to “unsettle assumptions” (p.
82) in the field and urge acceptance of what they
say. We conclude that this “listening” should be
extended to work with older people to address their
mistreatment.
Aronson, J. (1992). “Are we really listening?”…
Canadian Social Work Review, 9(1), 73-87.
O77
Loneliness Matters: Invoking the Court's
Protective Jurisdiction to Help Lonely Older
Men Age-in-Place
Heather Campbell
Queen's University, Kingston, ON, Canada
Loneliness is associated with paradoxically selfdefeating behaviour, in which social contact is
simultaneously desired and rejected. This
behaviour can manifest in various ways. Lonely
older adults may unwittingly decline objectively
needed services such as home care. Combined
with their less help-seeking behaviour, men may
be particularly prone to rejecting offers of support.
While such refusals are often seen as a win for the
right to live at risk, the victory can be hollow when
it does not translate into a better quality of life. It is
fashionable to say that capable older adults are
asserting their right to make unwise and risky
decisions; that they have freely chosen to sacrifice
their psychological well-being for independence.
But in some cases, the mantra becomes hard to
defend when we consider the psychological
research showing that chronically lonely people
can become stuck in a vicious cycle of loneliness.
Often the lonely person can be persuaded to
accept services, but sometimes these efforts fail.
Concerned third parties are left with two
undesirable options: take no further action or
categorize the person as incapable to override his
decision-making rights. Drawing on a recent line of
English case law, this presentation will propose a
preferable alternative: invoking the protective
jurisdiction of a superior court. The presentation
will propose a framework for using this jurisdiction
to therapeutically nudge lonely older men into
accepting objectively needed services. Practical
35
challenges and potential constitutional concerns
will also be addressed.
O78
Les Failles dans la Protection des Personnes
Inaptes par le Curateur Public
1 ,2
1
Ura Greenbaum , Rebecca Nussenbaum
1
Association pour la défense des personnes et des
biens sous curatelle publique, Montréal, Canada,
2
Table de concertation des aînes de Montréal,
3
Montréal, Canada, Comité communataire de N-DG contre l'abus envers les aînés, Montréal,
Canada
Il y a près de 13,500 personnes sous la protection
du Curateur public et ce dernier gère leurs actifs
d'une valeur totale à concurrence de 476 000
000$, presque un demi-milliard! Près de la moitié
sont des aînés et selon les prévisions
démographiques avec le vieillissement de la
population leur nombre
augmentera inexorablement chaque année en
boule de neige jusqu'à 2050. D'après la loi, le
Curateur public doit administrer ses protégés et
leurs biens en tant qu'un administrateur du bien
d'autrui. Pourtant, déjà en 1986 le Protecteur du
citoyen avait décrit le fonctionnement du Curateur
public en < un vase clos>. Une décennie plus tard
des rapports d'enquête spéciaux ont mis au grand
jour des ratés systémiques à tous les niveaux, à
tous les paliers dans certains cas remontant à 30
ans. Un redressement à fond fut entrepris par le
gouvernement toutefois en 2003 le Protecteur du
citoyen avait constaté que le programme de
réparation des pertes financières occasionnées
aux protégés fut un échec dispendieux. Basé sur
l'expérience et des documents accumulés dans
nos archives pendant vingt ans sur le terrain, il est
notre thèse que les ratés persistants dans ce
domaine méconnu s'expliquent d'une part des
lacunes législatives et d'autre part des dérives
administratives. Le manque de transparence dans
la gestion et l'absence de toute surveillance
externe créent un trou périlleux dans le filet social
de l'État qui lèse les personnes inaptes, en
majorité des aînés.
O79
The National Study of Elder Abuse in Canada
Lynn McDonald
In 2014-2015, the National Initiative for the Care of
the Elderly (NICE) conducted a national telephone
survey to estimate the prevalence of five forms of
elder abuse in community dwelling older
Canadians who were 55 years and older. A
representative, stratified sample of 8,163
Canadians completed the survey, which provided
information about the rates of, and risk factors for,
neglect, psychological abuse, physical abuse,
sexual abuse, and financial exploitation. Five
provinces over sampled in their jurisdictions
allowing prevalence rates to be calculated for
British Columbia, Alberta, Ontario, Quebec and
New Brunswick. Unlike other prevalence studies, a
life course perspective was used as the guiding
theoretical framework. In addition, this study
compared objective and subjective views of elder
abuse as reported by the respondents. The results
indicated that the overall rate of abuse for Canada
(4 types) was 7.5 percent and when neglect was
added (5 types), the rate rose to 8.2 percent. The
population estimates suggested that 695,248 older
Canadians experienced 4 types of abuse and
766,247 Canadians both abuse and neglect. The
rate of physical abuse for Canada was 2.2 percent,
psychological abuse, 2.7, sexual abuse 1.6,
financial abuse 2.6, and neglect 1.2 percent. The
perpetrators by type of abuse will be discussed, as
will risk factors for elder abuse based on bivariate
and logistic analyses. The nature and extent of the
gap between perceived and felt abuse on the part
of the respondents will be reported in the context
of the estimation of the prevalence of elder abuse.
O80
The STELLAR Connection: Promoting
Intergenerational Relationships
Kathy Elpers
University of Southern Indiana, Evansville, Indiana,
United States Minor Outlying Islands
As our aging population continues to grow,
conducting research and developing programs
connecting youth with older adults to explore
attitudes and positive interactions is necessary
since members of this generation are the future
caregivers or service providers. The elderly, in
many communities, experience ageist attitudes
due to the negative societal stereotypes attributed
to them. Thus, it is imperative that the youth and
aging cohorts develop positive social and cultural
perceptions of each other. Ageism occurs in the
elderly and youth cohorts with both groups often
perceiving the other in a negative fashion. As
36
youth have not experienced this life span, it is
difficult for them to relate to their worldview.
Because the elder cohorts lived at a different time
in history, it is equally difficult for them to
understand the issues that are relevant to the
youths' cohort. Communication and relationships
can be difficult to foster. This presentation
discusses a university interdisciplinary student
organization that connects college students with
elders in the community. STELLAR, an acronym
for Students and Elderly Linking Around
Relationships, was developed with the purpose of
providing regular opportunities for civic
engagement and intergenerational programs with
the elderly in the community. By interacting in a
positive way, both students and the elderly can
expel these myths. Data analysis of pre and posttests, journals and other measurements show
changes in attitudes and better understanding of
the issues of aging and consideration of a career in
gerontology. This program indicates implications
for future research.
O81
Pre-implementation of the Personalized citizen
assistance for social participation (APIC):
Importance of adaptability, collaboration and
funding
1 ,2
1
Mélanie Levasseur , Mathilde Leblanc , Laurie
1
1
1
Piché , Sophie Arsenault , Nathalie Croteau
1
2
Canada, Research Centre on Aging, Sherbrooke,
Québec, Canada
This study aimed to identify the facilitators and
barriers as well as the feasibility to implement a
Personalized citizen assistance for social
participation (APIC) in the community. The APIC is
a three hours weekly follow-up achieved by formed
and supervised non-professional assistants that
aim to increase engagement in social and leisure
activities according to life projects of people living
with disabilities. This intervention has been
demonstrated to increased older adults’ mobility
(p=0.02), social participation (p<0.01), and
frequency of leisure practice (p < 0.01). An action
research study was conducted with 16 people from
the community, including managers, healthcare
professionals and representatives of community
organizations. The adaptability of the APIC, the
presence of scientific evidences, the
acknowledgement of a need for such an
intervention, as well as the expertise and the
collaboration were the main facilitators to
implement the APIC. Meanwhile, the funding,
associated with an unfavorable politic and
economic context, were barriers. Overall, the
majority of the participants perceived that the APIC
could be offered in the community by volunteers.
This new knowledge will ease the implementation
of the APIC or other similar interventions. APIC is a
promising intervention that leads to new
opportunities for older adults to increase
community integration and enhance the social
component of their lives. It can also optimise how
the needs of older adults are met, including
utilisation of personal and environmental
resources.
* This study was funded by the Canadian Institutes
of Health Research and the Quebec Network for
Research on Aging.
O82
Changes in older adult loneliness: findings
from the New Zealand health, work and
retirement longitudinal study
Dan Kerr, Fiona Alpass, Christine Stephens
Massey University, Palmerston North, New
Zealand
Objectives: Despite increasing numbers of
longitudinal studies addressing loneliness in recent
years, the ways in which variables influence
changes in loneliness over time are not well
understood. The aim of this study is to explore how
levels of reported loneliness change over time in a
sample of older adult New Zealanders.
Method: This study utilises longitudinal data
collected for the Health, Work and Retirement
Study (HWR) study. Data were collected in 2010,
2012, and 2014 via postal survey. All analyses
were conducted with respondents who participated
in at least two of the three data waves (N= 2,839).
Participants were aged 48 to 85 in 2010.
Results: Males were more likely to be lonely, as
were those with higher depression scores. High
SES, social support, older age and good health
were related to lower loneliness levels. Multi-level
modelling was used to examine the relationship of
predictors to loneliness and changes in loneliness
over time. There was a slight reduction in
loneliness over time on average, however this
decrease was less pronounced for those with
higher levels of depression and higher social
support. Individuals with activity limitations
37
increased in loneliness over time. An increase in
depression over time was related to higher
loneliness scores, whereas increases in SES and
social support resulted in lower levels of loneliness.
approach for aging research on many sensitive
topics.
Conclusions: Findings are discussed in relation to
a model of the development and maintenance of
loneliness in older adults. Implications for
addressing loneliness in this group will be
highlighted.
What is the Next Step in Critical Gerontology
Studies? A Call for the Struggle for
Recognition of Old Age
O83
Strength in stories: Examining the utility of a
life review approach for conducting sensitive
research with older adults
Mariah Malone, Brad Meisner
Dalhousie University, Halifax, Nova Scotia,
Canada
Previous research demonstrates the benefits of
using biographical approaches with older adults to
facilitate the process of reflection on their personal
histories. The present study went one step further
by exploring life review in the context of its utility as
a research method. Specifically, it examined the
value of life review as a precursor to more
conventional semi-structured interviews on the
subject of later-life sexuality in long-term care
(LTC) settings. Qualitative data were collected
from 10 LTC residents in Halifax, NS. For this
study, life review involved the compilation of a
written- and photo-record of residents' life stories.
Thematic constant comparison analysis was used
to extract central themes from these data,
producing a collective story of residents'
experiences with life review. Results demonstrated
that the life review approach has utility for both
individual participants and the research process at
large. Participants identified that the life review
sessions were: a) cathartic (sometimes difficult, but
positive overall); b) helpful for remembering events
that were previously forgotten; and c) beneficial in
that they provided someone to confide in.
Regarding research methodology, results
established that life review has the potential to: a)
strengthen rapport between the researcher and
participants; b) put participants at greater ease
when disclosing sensitive information, thereby
lending to fuller, richer data; and c) disrupt any
subconscious ageist assumptions held by the
researcher. Ultimately, this study represents an
innovative contribution to gerontological research
by examining the applications of a life review
O84
1 ,2
1 ,2
Mario Paris , Suzanne Garon
1
University of Sherbrooke, Sherbrooke, Quebec,
2
Canada, Research Centre on Aging, Sherbrooke,
Quebec, Canada
Introduction:
Critical studies in gerontology are far from having
one solo standpoint. Indeed, many social theory
approaches coexist (e.g. feminist theory, political
economy, poststructuralism, etc.) under the term
Critical Gerontology. However, researchers in
gerontology have not yet considered seriously the
latest works from Frankfurt School and applied it to
aging and old age studies.
Method:
This presentation is based on our completed
doctoral study in gerontology. Through four Agefriendly cities case studies (Yin, 2009), we
demonstrated how social participation of the
elderly shapes social recognition of old age. Doing
so, we used the theory of struggle for recognition
from the German philosopher Axel Honneth. He is
one of the leading philosophical thinkers of Critical
Theory and the actual Director of the Institute of
Social Research in Frankfurt. Based on Hegel and
Mead, he has developed a philosophical theory
that focuses on conditions of individual
achievement in modern society which take place
through three patterns of intersubjective
recognition: love, rights, and solidarity (Honneth,
1995). The Theory of recognition allows the elderly
to experience personal dignity and social integrity.
Results and discussion:
Firstly, we will present the debate around Critical
Gerontology studies and the necessity to be
inspired by Frankfurt School legacies and
contemporary thinkers like Honneth. Secondly, we
will explain the philosophical Theory of struggle for
recognition and illustrate its theoretical principles to
social problems and issues of the elderly. Finally,
we will identify new research avenues for social
gerontology that appreciate the heuristic
understanding of old age.
38
O85
Housing Canada's Seniors
Kathleen Ireton
Canada Mortgage and Housing Corporation,
Ottawa, Ontario, Canada
The number of seniors in Canada is growing, and
while many have a desire to stay in their own
homes for as long as possible, they may not have
made adequate preparation for remaining in their
homes. Allowing seniors to age-in-place will
require finding solutions to a variety of housing
needs, which may change as seniors age. Drawing
on recent research from Canada Mortgage and
Housing Corporation's Housing Needs Research
program, the presentation will provide an overview
of several studies illustrating the housing
conditions of Canadian seniors including results
from a study characterising the accessibility of
Canadian housing, which examined the extent to
which accessible features are included in
Canadian homes. The presentation will discuss the
results of a study examining the costs of including
accessibility features in new homes, highlighting
the incremental cost of including these features in
new construction of modest homes. Finally, the
presentation will offer examples of Canadian and
international initiatives to address seniors' housing
needs, and draw attention to CMHC resources on
seniors housing that can offer innovative ideas for
housing Canadian seniors.
O86
Objectives: To explore the feasibility and
acceptability of this program, to better understand
the process of the accompaniment and its effects
on the community integration of elders with
psychosocial issues, in one small urban and one
semi-rural area in Quebec.
Methods: This exploratory study used a multiple
case studies design (n=4). Accompanying citizens
and older adults with psychosocial issues,
recruited through community organisations, were
matched. Four pairs were created. Interviews and
participatory mapping were completed by elders
pre and post-intervention, and accompanying
citizens completed a diary after each meeting.
Qualitative analysis was undertaken using both
theoretical and inductive thematic analysis.
Results: Three pairs met for 14-17 weeks.
Engagement in activities increased for three
elders. One participant withdrew because of
differing goals. Each had their own trajectory,
influenced by their environment, congruent with
their specific needs.
Conclusion: A thorough assessment of needs and
goals is essential for optimal participation in APIC.
Citizen accompaniment is a promising intervention
for community integration of older adults with
psychosocial issues, larger studies are needed on
the implementation and effectiveness of this
intervention.
O87
Personalised accompaniment for community
integration of elders with psychosocial issues
The Problems and Prospects for Age Friendly
Communities as Innovation: The Case of
Toronto
G. Aubin, P.Y. Therriault, M.J. St-Pierre
Université du Québec à Trois-Rivières, TroisRivières, Canada
Meghan Joy
Ryerson University, Toronto, Ontario, Canada
Introduction: Older adults with psychosocial
issues are often affected by loneliness, exclusion
and occupational deprivation. The program Citizen
Accompaniment Project for Community Integration
(APIC), was implemented by researchers and
community stakeholders to support the integration
of these persons in their community. This
intervention consists of weekly meetings between
an elder with psychosocial issues and an
accompanying citizen, with the objective of
realizing the steps towards a more satisfying
integration in the community.
Age Friendly Communities (AFCs) are framed as
an innovative place-based policy response to
population aging meant to enhance equity for
senior citizens in local environments. AFCs attempt
to improve the ‘person-environment fit’ for seniors
by engaging policy actors from local government
and the non-profit sector in the realization of a
checklist that includes items such as accessible
and affordable health and social care,
transportation, and housing. Missing, however, is a
grounded understanding of how these local actors
understand and implement AFCs and whether we
are seeing innovative institutional mechanisms to
enhance their policy capacity to meet needs.
39
Existing literature indicates a gap between the
rhetoric and reality of AFCs and calls for further
critical policy research on AFC practice that
situates the program in a context of political
austerity, particularly in big cities. I heed this call
through a case study of AFCs in Toronto.
Interviews with politicians, bureaucrats, non-profit
organizations, and other policy experts allows for
an in-depth exploration of the institutional
structures that enable or challenge equitable
AFCs. I find an innovation gap between the AFC
checklist and the institutional rules necessary for
local actors to secure an equitable personenvironment fit for seniors. While this gap is partly
attributed to austerity politics, tensions in practice
highlight where new institutional mechanisms offer
opportunities for an innovative and equitable AFC
model in Toronto. My intention is to foster a critical
and innovative research agenda on AFC practice
that provides policy insight for how to enhance
spatial justice for senior citizens.
O88
Une capsule de vie près de chez vous
1
Andréanne Gougeon
1
Centre de santé communautaire de l'Estrie,
2
Cornwall (siège social), Canada, Bureau de santé
de l'Est de l'Ontario, Cornwall (siège social),
3
Canada, Services d'urgence de Prescott-Russell,
4
Plantagenet (siège social), Canada, Coalition des
services de soutien communautaire, Est de
5
l'Ontario, Canada, Police provinciale de l'Ontario,
6
Détachement de Hawkesbury, Canada, Pompiers
7
, Clarence-Rockland, Canada, Services
communautaires de Prescott-Russell, Hawkesbury
(siège social), Canada
Sécurité Info Santé est un programme pilote, d’une
durée de deux ans, géré par la Fédération des
aînés et des retraités francophones de l’Ontario.
Subventionné par la Fondation Trillium de l’Ontario
et chapeauté par un comité consultatif, il avait
comme objectifs d’assurer une plus grande
sécurité des francophones âgés de 50 ans et plus
qui vivent sur un territoire défini, dans l’Est
ontarien. Également, il a permis aux services
d’urgence d’avoir accès, par l’entremise d’une
capsule de vie, à des renseignements pertinents
au sujet de la santé des aînés.
La méthodologie utilisée privilégiait la distribution
de trousses incluant une capsule de vie par
l’entremise de présentations dans des clubs
d’aînés, des corporations de logement, et de
divers organismes. Également, ce programme
prévoyait le recrutement et la formation de
bénévoles qui visiteraient des personnes âgées
vulnérables dans les communautés.
Les résultats obtenus ont largement dépassé
certains de nos objectifs. Au-delà de 7 000
capsules de vie ont été distribuées
comparativement aux 1 200 prévues et près de
100 présentations ont été effectuées au lieu de la
cinquantaine anticipée. Une douzaine de
bénévoles ont été formés et au-delà d’une
centaine de personnes vulnérables a reçu de
l’information en matière de sécurité. Des
partenaires sont devenus des dépositaires de
capsules facilitant ainsi l’accès des trousses à la
population ciblée.
Pour conclure, la sécurité constitue une
préoccupation tangible pour la population rurale
vieillissante. Ce programme ancré dans la
communauté, facilement accessible, nécessitant
aucune technologie particulière peut s’exporter et
s’implanter partout.
O89
Neighbourhood characteristics associated with
social and physical participation among older
adults
1
2
Carri Hand , Bret Howrey
1
University of Western Ontario, London, ON,
2
Canada, University of Texas Medical Branch,
Galveston, TX, USA
Neighbourhoods are key contexts that can support
and restrict participation in everyday activities
among older adults. Detailed information regarding
how neighbourhood features, alone or in
combination, relate to a range of activities can
enhance understanding of this area. This study
explored 1) associations between neighbourhood
characteristics and frequency of participation in six
social and physical activities among older adults
and 2) interactions between individual and
neighbourhood characteristics as they relate to
participation. Data from the 2008 wave of the
Health and Retirement Study linked with 2010
United States Census were used. Participants
included community-dwelling adults age 65 years
or more who completed a 2008 interview and
leave-behind questionnaire (n=3574). Analysis
involved multivariate logistic regression to estimate
the odds of participation in activities. High
proportion of neighbourhood residents age 65+
40
was associated with increased odds of
participation in four activities (ORs=2.27-4.16).
High population density was associated with
increased odds of club attendance (OR=1.33, 95%
CI=1.04-1.70). High neighbourhood social
cohesion was associated with increased odds of
attending non-religious meetings (OR=1.35, 95%
CI=1.02-1.78) and exercising (OR=1.17, 95%
CI=1.00-1.34). Participants living in high-density,
socially cohesive areas had increased odds of
attending non-religious meetings (OR=1.78, 95%
CI=1.24-2.58). Interactions between walking
limitation and population density, and walking
limitation and social cohesion also related to
increased odds of participation. Findings suggest
that older adults’ participation in community life
depends on policies, practices and environments
that account for relationships among and between
neighbourhood and individual characteristics and
how these characteristics may differentially impact
types of participation.
O90
diabète et 15% des maladies cardiovasculaires.
Les aînés ont partagé leur difficulté à faire des
bons choix des aliments, ils sont préoccupés par le
coût des aliments, la présence des pesticides et
des hormones dans les aliments ainsi que leur
contenu en sel, gras et sucre.
Conclusions : Les aînés savent c'est quoi une
saine alimentation. Cependant, le coût élevé des
aliments, le manque de connaissances sur les
étiquettes nutritionnelles et la planification des
repas sont les principaux défis pour faire des choix
des aliments sains.
O91
Food Choices and Nutrition Experiences of
Very Old Canadian Men: The Manitoba Followup Study
Christina Lengyel, Amanda Gravelle, Robert Tate
University of Manitoba, Winnipeg, Manitoba,
Canada
Les perception, expériences alimentaires et
choix des aliments chez les aînés
francophones au Nouveau-Brunswick (NB)
Introduction: Good dietary practices enhance
quality of life and enjoyment at mealtimes and
reduce the risk of poor health outcomes.
L. Villalon
Université de Moncton, Moncton, Canada
Objective: To explore food choices and nutrition
experiences of men participating in the Manitoba
Follow-up Study (MFUS) who have experienced
varying levels of nutritional risk over a seven year
period.
Une étude qualitative exploratoire a été réalisée
chez les aînés francophones de 50 ans et plus au
NB.
Objectifs : Recueillir les perceptions,
connaissances et expériences alimentaires des
aînés à domicile et identifier les défis auxquels ils
sont confrontés afin de faire des bons choix des
aliments pour vieillir en santé.
Méthodes : Des groupes de discussion formés par
six à dix aînés ont permis de recueillir les données
auprès des 1351 aînés francophones provenant de
22 localités de la province du NB. Une analyse
descriptive a permis de faire le profil
sociodémographique et de santé. L'analyse de
contenu a permis de cerner les perceptions et défis
auxquels les aînés doivent faire face pour faire de
bons choix des aliments.
Résultats : 77,2% des participants au projet
étaient de sexe féminin, 54,4% étaient mariés et
près d'un tiers veuf. L'âge moyen des sujets
étaient de 69,4 ans ± 12,1. Près de la moitié des
participants souffraient d'hypertension artérielle,
17,3% présentaient de l'ostéoporose, 15,3% du
Methods: Information was collected on the
nutritional risk of MFUS members from 2007-2013.
Twenty-five participants were selected and
categorized according to: Continuous low risk
(n=6); Decreasing risk (n=7); Increasing risk (n=5);
Continuous high risk (n=7). Phone interviews were
conducted with participants with a mean age of 92
(SD=2.5) years (range = 86–97) located across
five provinces (BC, AB, SK, MB, ON). Open-ended
questions collected information on food
consumption, challenges to eating well and
successful aging.
Results: 24 hour diet recalls indicated the
participants consumed an adequate variety of
items from the fruits and vegetables (x=5.96), milk
and alternatives (x=2.12) and meat and
alternatives (x=2.40), but a low number of items
from the grain products category (x=2.96)
according to Canada’s Food Guide. Challenges to
eating well were not identified; instead participants
mentioned strategies used to ensure their food
41
intake was adequate. Participants discussed the
importance of “eating to live rather than living to
eat” with many comments about not to overeat,
receive assistance with meal preparation and to
eat with others.
Conclusions: Participants valued eating well and
they seem to utilize their available resources to
compensate for any nutritional barriers in their life.
O92
An interdisciplinary knowledge exchange
intervention may decrease use of medications
of questionable benefit for long-term care
residents with severe dementia: OptimaMed
pilot results
1 ,2
3 ,4
Edeltraut Kröger , Machelle Wilchesky ,
1 ,2
1 ,2
1
Philippe Voyer , Michèle Morin , Michèle Aubin
,2
5
1 ,2
, Nathalie Champoux , Anik Giguère , Pierre
1 ,2
6
3
Durand , Marcel Arcand , Johanne Monette ,
2
2
Pierre-Hugues Carmichael , Martine Marcotte ,
1 ,2
René Verreault
1
Université Laval, Quebec, Quebec, Canada,
2
3
Québec, Quebec, Quebec, Canada, McGill
4
University, Montréal, Québec, Canada, Donald
Berman Maimonides Geriatric Centre, Montréal,
5
Québec, Canada, Université de Montréal,
6
Montréal, Québec, Canada, Université de
Sherbrooke, Sherbrooke, Québec, Canada
Objective:
Long-term care (LTC) residents with severe
dementia receive multiple medications. When
dementia progresses, care should become
palliative and some medications should be
discontinued because their harm-benefit ratio has
changed. This study aimed to evaluate the
feasibility and effects of an inter-professional
knowledge exchange (KE) intervention to decrease
use of medications of questionable benefit in these
residents.
Method:
Published lists of "mostly", "sometimes" or
"exceptionally" appropriate medications were
tailored for LTC facilities. A 4-month intervention
took place in 3 LTC facilities. 1) Families of
participants received an information leaflet
on questionable medication use in severe
dementia; 2) the facilities' nurses, pharmacists and
physicians participated in 2 KE sessions. The
pharmacists performed 1 medication review for
each participant using the tailored lists and
discussed recommended changes with nurses and
physicians. Agitation and pain levels of participants
were monitored using the CMAI and PACSLAC
scales.
Results:
45 of 93 eligible residents were followed-up. 34
st
and 23 health professionals participated in the 1
and 2nd second KE session respectively. The
intervention was well accepted. The overall
number of used medications and those classified
as "sometimes appropriate" decreased
significantly, from 422 to 389, and from 210 to 182
respectively; both p<0.05. Levels of agitation and
comfort did not change noticeably.
Conclusions:
An interdisciplinary intervention for LTC residents
with severe dementia may decrease use of
questionable medications. Results need to be
replicated in a cluster randomized trial; a stronger
focus on psychotropic medications, improved KE
with families and shared decision making should
be integrated.
O93
Enjeux professionnels et politiques relatifs à la
mise en œuvre de réseaux de services intégrés
destinés aux personnes âgées en perte
d'autonomie fonctionnelle : le rapport à la
standardisation de la pratique professionnelle
chez les travailleurs sociaux
Dominique Gagnon
Unité d’enseignement et de recherche en sciences
du développement humain et social, Val-d’Or
(Québec), Canada
Au Québec, l'implantation de réseaux de services
intégrés destinés aux personnes âgées (RSIPA)
vise à répondre aux besoins évolutifs et complexes
des personnes âgées en perte d'autonomie
fonctionnelle. Or, l'intégration des services
nécessite de réguler l'action des multiples acteurs
et organisations concernés en introduisant
certaines formes de standardisation. La
standardisation des pratiques professionnelles fait
toutefois l'objet de débats récurrents dans les
professions relationnelles comme le travail social
(TS). Dans le cadre de notre thèse doctorale, nous
avons voulu comprendre le rapport des TS à la
standardisation dans le cadre de la mise en place
de ces RSIPA en analysant les diverses formes de
standardisation qui accompagne leur activité.
42
Selon les principes d'une méthodologie qualitative
et compréhensive, nous avons recruté huit TS
dans deux CSSS contrastés et triangulés quatre
collectes de données distinctes et
complémentaires.
Nos résultats montrent que les formes de
standardisation qui accompagnent l'usage d'outils
standardisés découlant des RSIPA sont
considérées favorablement dans la mesure où
elles peuvent soutenir l'exercice du jugement
professionnel. Une résistance se manifeste
toutefois lorsque l'usage de ces outils
s'accompagne d'une trop forte standardisation
procédurale. La capacité régulatrice de ce premier
mouvement de standardisation est cependant
fortement entravée par un mouvement de
standardisation des résultats découlant de la
logique de reddition de compte implantée
simultanément.
En conclusion, l'analyse du rapport des TS à la
standardisation nous enseigne que la mise en
œuvre du RSIPA suscite des enjeux d'adaptation
et d'arrimage dans la mise en oeuvre des
politiques qui peuvent entrer en concurrence l'une
avec l'autre.
communautaires dans les 7 MRC et par prise de
contact avec divers organismes; 3) Critères
d'inclusion : le matériel doit être encore en usage
ou doit l'avoir été il y a moins de 2 ans; 4)
Complétion d'une grille d'analyse standardisée
(descriptif de l'activité, objectifs, approche
d'animation, contenu et support).
Résultats : 21 activités furent recensées (DVD,
pièce de théâtre, jeu de poche, etc.), dont 13 sous
l'égide d'un seul organisme. À l'exception d'une
seule, toutes les activités ciblent les aînés.
Plusieurs ne comprennent pas de guide
d'animation, ce qui en rend l'appréciation quasi
impossible. Les informations seront complétées
par observation lors d'activités de sensibilisation.
Discussion/conclusion : L'absence de guide
d'animation laisse entrevoir un certain
« amateurisme » dans les pratiques de
sensibilisation des aînés. Les lacunes observées
doivent permettre de bonifier les activités
permettant aux aînés de passer de la
reconnaissance de la situation au signalement de
la maltraitance et de l'intimidation. Nos
recommandations vont dans le sens de
l'enrichissement des activités actuelles pour
qu'elles soient ensuite évaluées dans la pratique.
O94
Freins et leviers au signalement de la
maltraitance : analyse des pratiques en milieu
communautaire en Estrie
1 ,2
1 ,2
4
C.P. Pelletier , M.B. Beaulieu , C.D. Delorme
1
2
Canada, Chaire de recherche sur la maltraitance
envers les personnes aînées, Sherbrooke,
3
Québec, Canada, Centre de recherche sur le
vieillissement, Sherbrooke, Québec, Canada,
4
DIRA-Estrie, Sherbrooke, Québec, Canada
Objectifs : Exposé des analyses de contenu de
l'ensemble des pratiques de sensibilisation de la
maltraitance et de l'intimidation envers les aînés
dans les organismes communautaires estriens.
Focale sur l'identification des freins au signalement
des situations de maltraitance et d'intimidation, et
des besoins en matière de sensibilisation des
aînés afin de bonifier les pratiques.
Méthodologie : 1) Inventaire des activités à l'aide
d'un répertoire de 2010 (STOP-ABUS-AÎNÉS); 2)
Mise à jour des informations par contact
téléphonique auprès d'organisateurs
O95
Comparing Canadian long-term care homes’
food services: an M3 analysis
1
1
1
Christine Lagacé , Natalie Carrier , Lita Villalon ,
2
3
Christina Lengyel , Susan Slaughter , Heather
4
Keller
1
Université de Moncton, Moncton, New Brunswick,
2
Canada, University of Manitoba, Winnipeg,
3
Manitoba, Canada, University of Alberta,
4
Edmonton, Alberta, Canada, University of
Waterloo, Waterloo, Ontario, Canada
Objective: To compare and contrast food service
practices in 32 Canadian long-term care (LTC)
homes located in four provinces (AB, MB, ON,
NB).
Methods: As part of the Making the Most of
Mealtimes (M3) project, the context and processes
of food services were reported by home
management using a standardized questionnaire.
Results: Menu cycle length averaged 3.8 weeks
with all homes offering a 3-week menu or longer.
43
Average daily raw food cost per resident was
7.70±1.53 dollars with ON homes spending the
most (8.65 ±1.60 dollars) and NB the least
(6.70±1.70 dollars). Traditional/conventional
production systems were used in 68.8% of homes,
which included 100% of ON homes; readyprepared food systems were used in 15.6% of
homes, all of them being in NB and Manitoba.
Alberta homes were using either
traditional/conventional (63%) or both systems.
Almost every home (96.9%) allowed residents to
have access to food outside of regular meals and
snacks and most (90.6%) allowed residents to
store food in their rooms, which included 100% of
MB and AB homes.
Conclusion: There is diversity in food service
practices across Canada. M3 collected weighed
and observed food intake data on 639 residents
from these 32 homes. Further analysis will identify
those food service factors that are associated with
residents’ food intake.
O96
Results: Care aide exhaustion was inversely
related to job satisfaction. An individual's
exhaustion, professional efficacy, and cynicism
were statistically significant predictors of job
satisfaction. Factors in the organizational context
that are associated with increased care aide job
satisfaction include: leadership, culture, social
capital, organizational slack-staff, organizational
slack-space, and organizational slack-time.
Conclusions: Our findings suggest that
organizational factors account for a greater
increase in care aide job satisfaction than do
individual factors. These features of the work
environment are modifiable and predict care aide
job satisfaction. Efforts to improve care aide work
environment and quality of care should focus on
organizational context.
O97
Shared Care Goals among Families, Residents
and Staff in Residential Long-term Care
1
Individual and organizational predictors of
nursing home health care aide job satisfaction
1
1
Stephanie Chamberlain , Matthias Hoben , Janet
2 ,3
1
Squires , Carole Estabrooks
1
2
Edmonton, Alberta, Canada, School of Nursing,
University of Ottawa, Ottawa, Ontario, Canada,
3
Ottawa Hospital Research Institute, Ottawa,
Ontario, Canada
Background: Unregulated care aides provide the
majority of direct health care to residents in long
term care homes. Lower job satisfaction as
reported by care aides is associated with increased
turnover of staff. Turnover leads to inferior job
performance and negatively impacts quality of care
for residents. This study aimed to determine the
individual and organizational predictors of job
satisfaction in care aides.
Methods: We surveyed a sample of 1224 care
aides from 30 long term care homes in three
Western Canadian provinces. The care aides
reported their job satisfaction and their perception
of the work environment. We used a hierarchical,
mixed-effects ordered logistic regression to model
the relative odds of care aide job satisfaction for
individual, care unit, and facility factors.
1
Jennifer Baumbusch , Alison Phinney , Deborah
1
1
O'Connor , Paddy Rodney , Catherine Ward2
1
1
Griffin , Denise Beaton , Marie-Eve Leblanc
1
2
Canada, University of Western Ontario, London,
ON, Canada
The Alzheimer Society of Canada estimates that
by 2018, families will be contributing upwards of 60
million hours of care per year in residential longterm care (RLTC). Yet, although families have an
enduring presence in this sector, their involvement
in care, both for their relative and the broader
functioning of the facility, has often been rendered
invisible. The purpose of this presentation is to
present findings from an ongoing 4-year critical
ethnography about the negotiation of care work in
RLTC. Two facilities (a health authority owned and
operated and a not-for-profit) located in urban
centres in British Columbia are the study sites. To
date, in-depth interviews have been conducted
with 38 participants (22 family members, 5
residents, 12 staff) and 134 hours of participant
observation have been completed. The main
themes illustrate that families and staff are often
working towards the same care goals, albeit in
different ways, which often leads to conflict. These
goals include: ‘balancing risk and safety’ and
‘negotiating the boundaries of care practices’.
Further, families are focused on ‘sustaining family
identity’ while staff are focused on ‘providing
person-centered care for who the resident is now’.
44
We will discuss the implications of how dissonance
in attaining care goals can contribute to
unnecessary conflict. Moreover, shared
understandings of how to achieve these can
contribute to better relations among those who are,
ultimately, working towards the same goals.
O98
Transition des soins d'un Hôpital de
réadaptation à leur domicile en Suisse chez les
personnes âgées - Expériences de transition
chez les aînés et leurs proches : une
recherche longitudinale qualitative
1
Lina Corona-Lobos
1
Université de Lausanne, Lausanne, Switzerland,
2
Institut Universitaire d’Histoire de la Médecine et
3
de la Santé Publique, Lausanne, Switzerland, STS
Lab Université de Lausanne, Lausanne,
4
Switzerland, Institut et Haute Ecole de la Santé La
Source, Lausanne, Switzerland
Objectif La politique Vieillissement et Santé du
canton de Vaud (Suisse) intègre l'amélioration de
la continuité des soins pour mieux vivre chez soi.
Dans ce contexte, cette étude vise à expliquer les
expériences des aînés et leurs proches sur la
transition/réadaptation hospitalière-domicile des
aînés. Elle contribue à une meilleure
compréhension de la réalité microsociale de cette
transition.
Méthode Etude longitudinale, qualitative
(descriptive/interprétative) menée dans un Hôpital
de réadaptation vaudois. La collecte de données
réalisée en 3 temps (première semaine suivant
l'admission de l'aîné, avant sa sortie à domicile, 2
mois après la sortie), intègre 41 entretiens semidirectifs avec 10 aînés (≥65 ans) et 7 proches.
Résultats L'analyse des discours révèle quatre
thèmes. 1. Présentisme et passé, manque de
projection objective des aînés et proches sur
l'après sortie. 2. Retour chez soi, «retrouver ses
marques». 3. Continuité/discontinuité du plan de
soins, parcours individuel de réadaptation après
sortie. 4. Accès au soutien des proches et des
professionnels.
Les participants ont des expériences positives sur
l'hospitalisation et la préparation à la sortie. La
majorité décrit toutefois un sentiment d'inquiétude,
notamment durant les 10 premiers jours, quant aux
difficultés liées à la continuité des soins et surtout,
des activités instrumentales quotidiennes. Trois
aînés sont ré-hospitalisés (8-20 jours après sortie).
Conclusion Après sa sortie, l'aîné reste
particulièrement vulnérable. Cette vulnérabilité est
liée à la singularité de l'aîné, à sa projection de la
sortie durant l'hospitalisation, aux difficultés
d'accès au soutien formel et principalement
informel, autant d'aspects à considérer dans la
recherche sur cette transition.
O99
"When the staff are in harmony, it is good":
Residents' perspectives of care workers' peer
relationships in long-term care
1
Deanne Taylor
1
University of Calgary, Calgary, AB, Canada,
2
Interior Health, Kelowna, BC, Canada
Social and professional worker relationships are an
integral component of the daily care and work
experience within long-term care, yet little is known
about how these relationships influence residents'
perceptions of care and quality of life. This paper
presents the findings from a doctoral study that
explored residents' perspectives of workers' peer
interactions to identify if workers' peer social
interactions had an influence on residents'
experience of care and if so, how. Drawing upon
workplace culture theory and using narrative-reality
methods, residents' perspectives of workers' peer
relationships were explored within four long-term
care facilities located in a health authority in British
Columbia, Canada. The final analysis produced
three themes characterizing workers' peer social
interactions: shaming, blaming, and collegiality.
Shaming and blaming peer interactions impacted
negatively on residents' quality of care by reducing
workers' team interactions, work capacity, and care
coordination; and on residents' quality of life by
producing an oppressed environment, reduced
resident social engagement, and emphasized
resident vulnerability. Conversely, collegial
workers' peer social interactions impacted
positively on residents' quality of care through
increased communication, seamless teamwork,
and improved safety practices; and on quality of
life by residents' increased enjoyment and security,
and creation of positive environments. These
study findings underscore the quality of workers'
peer relationships as influential to residents'
perceptions of quality of care and life, highlight the
importance of supporting workers' peer
relationships in long-term facility care and the need
45
to formalize workplace relational processes, and
calls for further research that includes residents
with dementia and family perspectives.
O100
Vers une transformation du travail des
intervenants sociaux dans un programme de
soutien à domicile
1 ,2
1 ,2
1 ,2
PY Therriault , L Desrosiers , G Aubin , MM
2 ,3
4
Lord , H Carbonneau
1
Département d'ergothérapie, Université du
2
Canada, Laboratoire de recherche en ergologie,
3
Trois-Rivières/Québec, Canada, Programme de
doctorat en sciences biomédicales, Université du
4
Canada, Département d'études en loisir, tourisme
et culture, Université du Québec à Trois-Rivières,
Trois-Rivières/Québec, Canada
Problématique En 2015-2016, l’Approche de
rehaussement de la qualité de vie des aidants et
de leur proche atteint de troubles de mémoire
(ARQVAP) a été implantée dans différentes
installations du réseau de la santé auprès de
personnes vivant avec la maladie d’Alzheimer et
de leurs proches. Afin d’en étudier les effets sur les
intervenants sociaux (IS), une recherche visant à
en apprécier l’impact sur le travail a été réalisé.
Objectif Cette communication discute des
résultats d’une recherche-action menée avec des
IS d’un service de soutien à domicile.
Méthode En accord avec le cadre théorique de la
psychodynamique du travail les participants,
travailleurs et chercheurs (n=8), ont participé à
quatre rencontres échelonnées sur une période de
plus six mois.
Résultats Suite à l’exploration des rares sources
de plaisir et des nombreuses sources de
souffrance, trois grandes stratégies défensives ont
été cernées. Ces dernières constituent des
dispositifs mis en place par les IS pour contenir
l'angoisse et la souffrance liées à la réalisation des
tâches auprès de la clientèle. Plus
particulièrement, étant donné l’absence d’un
collectif de travail et de lieux de partage,
l’ensemble des stratégies défensives utilisées sont
de type partagé.
Conclusion L’implantation de l’ARQVAP, à travers
les rencontres de mentorat et de recherche-action
a transformé les rapports sociaux. Les IS estiment
que l’ARQVAP rejoint leurs valeurs
professionnelles et s’harmonise aisément à la
pratique clinique. L’implantation a favorisé le
passage à l’action et à la mobilisation des IS dans
la perspective d’une amélioration des conditions
de travail.
O101
Identifying the Experience and Needs of Young
Carers: A Participatory Action Research
Project
1 ,2
1 ,3
3
Lisa Loiselle , Fitsum Areguy , Holly Mathers ,
3
Marla Pender
1
2
Canada, Murray Alzheimer Research and
Education Program, Waterloo, Ontario, Canada,
3
The Young Carer Project, Kitchener, Ontario,
Canada
The rise of neoliberal community reforms has
caused a corresponding increase in the number of
informal and unpaid caregivers operating in
society, some of whom are children and young
adults. The young carer phenomenon is a
symptom of larger problems related to health
spending and resource redistribution. However,
this does not preclude attending to the needs of
young carers. Although there is no agreed upon
definition of a young carer in the literature, young
carers define themselves as children, youth and
young adults who experience an alteration in their
family roles as a result of a family member's
exceptional need (e.g. diagnosis of dementia) or
the unique family situation.
Using a Participatory Action Research approach, a
group of stakeholders and young carers from the
Waterloo Region were brought together to form a
steering committee and lead the development of
the project. Through a series of focus groups
spanning a period of 18 months, the committee set
out to identify the issues and needs most relevant
to young carers. We were able to identify three
broad categories where caregiving responsibilities
had a significant impact on young carers. We also
identified gaps in support in systems such as
schools, health care and community.
Our findings support the need for community
supports for young carers, in addition to the
creation of tools and resources. We need to
46
mobilize local resources and train community
support professionals to identify young carers,
understand their needs, and learn ways to support
young carers in their communities.
O102
Cultivating know-how: Carers' tacit knowledge
of the needs of people with advanced dementia
nearing the end of life
Gloria Puurveen
University of British Columbia, Vancouver, Canada
It is well recognized that carers' knowledge about
the person with advanced dementia is essential to
providing optimal end-of-life care in nursing home
settings. While there is a growing understanding of
carers' formal and on-the-job training, far less is
known about how carers, in their everyday
practice, learn about and subsequently respond to
the physical, spiritual, and psychosocial needs of
the person with dementia nearing the end of life.
As part of a larger ethnographic study exploring
the needs of people with advanced dementia
nearing the end of life, in-depth interviews with 25
carers (14 care aides, 3 licensed practical nurses,
3 managers, and 5 allied health professionals), 30
hours of video observations, and over 500 hours of
participant observations were conducted in one
not-for profit nursing home. Informed by dialogical
theory and the constructs of embodiment and
emplacement, analysis demonstrated that carers
developed a highly individualized approach to
caring for people with advanced dementia that is
based on four inter-related aspects of knowledgein-practice: relational, narrative, sensory, and
emplaced knowledge. These "paths of knowing"
were influenced by organizational practices, the
physical environment, and the carers own being-inthe-world. Study findings bring to the fore less
visible dimensions of carers' practice and offer an
understanding of how they develop knowledge that
enables them to practice empathic and responsive
care. Supporting carers to cultivate these paths of
knowing is key in the provision of optimal personcentred end-of-life care for people with advanced
dementia.
O103
Quand partager des moments plaisants entre
aidants et proches atteints de MA rime avec
répit
Hélène Carbonneau, Ginette Aubin, Julie Fortier
Université du Québec à Trois-Rivières, TroisRivières, Québec, Canada
Contexte : Une approche de rehaussement de la
qualité de vie a été développée pour soutenir
l’émergence de moments plaisants dans le
quotidien des aidants et de leurs proches atteints
de maladie d’Alzheimer. Basée sur le cadre
conceptuel des aspects positifs du rôle d’aidant
(Carbonneau, Caron et Desrosiers, 2010), cette
approche se concrétise notamment par un
programme de groupe. Cette présentation expose
les résultats de deux études réalisées en
collaboration avec une Société Alzheimer et un
centre de loisir intégrant le programme dans leur
offre de services.
Objectif : Documenter les impacts du programme
de rehaussement de la qualité de vie pour les
aidants et leurs proches.
Méthodologie : Des entrevues et des groupes de
discussion focalisée ont été réalisés avec des
aidants ayant bénéficié du programme et des
intervenants l’ayant offert. Un guide de discussion
a été développé. Le verbatim des entrevues et des
groupes de discussion a été enregistré et
retranscrit puis une analyse de contenu a été
réalisée.
Résultats : Ce programme s’est révélé bénéfique
pour renforcer les aspects positifs du rôle d’aidant
tout en contribuant à la qualité de vie des proches
atteints de MA. L’accroissement des moments
plaisants dans le quotidien des aidants et de leur
proche introduit plus de positif dans leur vie ce qui
leur procure un répit.
Retombées : Ces études confirment la pertinence
de l’approche dans une perspective de soutien aux
aidants d’un proche atteint de MA. Elles montrent
aussi le potentiel d’appropriation du programme
par le milieu de la pratique.
O104
“If he was not my father, I wouldn’t do it”: The
Confounding Role of a Frustrated Nurse and
Compassionate Adult Child—Saudi Arabian
Family Caregivers
1 ,2
3 ,4
Eradah Hamad , Ahmad AlHadi
1
Department of Psychology, Faculty of Arts and
Humanities, King Abdulaziz University, Jeddah,
47
2
Saudi Arabia, Health and Rehabilitation Sciences
Graduate Program, Faculty of Health Sciences,
Western University, London Ontario , Canada,
3
Department of Psychiatry, King Khalid University
Hospital, College of Medicine, King Saud
4
University, Riyadh, Saudi Arabia, SABIC
Psychological Health Research & Applications
Chair (SPHRAC), College of Medicine, King Saud
University, Riyadh, Saudi Arabia
As seen in other parts in the world, with the
increase in the aging population, family caregiving
of persons with Alzheimer’s Disease and other
dementias has become a critical issue in Saudi
Arabia (SA). This study examines the personal
(individual) constructs related to the experience of
family (in-home) caregiving in SA. Twenty
narratives of Saudi Arabian family caregivers,
mainly adult children and grandchildren, were
collected in semi-structured interviews. Interpretive
content analysis (ICA) guided by the theoretical
framework of personal construct theory (PCT)
reveal two common superordinate and contrasting
constructs that Saudi Arabian family caregivers
use to describe their “confounding role”: the
“frustrated nurse” and the “compassionate adult
child.” Subordinate constructs related to the two
main constructs are also defined. Findings assert
the importance of the family-caregiving approach
and proper in-home care services as a caregiving
system in SA. For positive caregiving outcomes,
providing Saudi Arabian family caregivers with
appropriate nursing skills and training is suggested
to help them fulfill the familial commitments
associated with the caregiving experience.
6,370), this study applies ordinal logistic
regressions. The two caregiving experience
outcomes are measured separately (Stressful is
1=very stressful; 2=stressful; 3=somewhat
stressful; 4=not at all stressful and Rewarding is
1=very rewarding; 2=rewarding; 3=somewhat
rewarding; 4=not at all rewarding).
Results: A more rewarding caregiving experience
was associated with caregivers who are female,
healthy, highly educated, with higher household
income. Caregiving was also more rewarding for
younger male care recipients in worse health. Yet,
caregiving was more stressful when caregivers are
married, healthy, and had lower education and
household income. Higher stress was reported
when care recipients were friends and extended
family, compared to immediate family members
(e.g., spouses, parents, or siblings), and female.
Conclusions: Characteristics of the caregiver and
care recipient influence the stressful and rewarding
aspects of caregiving. Interventions to reduce
caregiving stressors, particularly for lowereducated and lower-income individuals caring for
friends or extended family, may reduce caregiving
burden and enhance caregivers’ ability to continue
providing care over the long-run.
O106
Bringing Patient, Caregiver, and Care Provider
Voices into the Conversation: Results from the
Trans-ED-HC Study
1
O105
What Makes Caregiving Experience Stressful or
Rewarding?
1
2
1
Yeonjung Lee , Amy Roberts , Lun Li
1
2
Miami University, Oxford, OH, USA
Objectives: Previous studies on caregiving show
that providing care for the loved ones may be
either stressful or rewarding. However, not enough
studies have investigated the factors to affect
caregiving experiences differently. This study aims
to examine factors associated with different
caregiving experience of stressful and rewarding.
Method: Using the nationally representative data
from the Canadian General Social Survey 2012 –
Cycle 26 Caregiving and Care Receiving (n=
1
4
Graham Campbell , Martin Farrugia , Jeff Poss ,
4
5
George Heckman , Veronique Boscart , Andrew
2 ,1
5
Costa , Lauren Crutchlow
1
McMaster University, Kitchener, Canada,
2
McMaster University, Hamilton, Canada,
3
University of Waterloo, Waterloo, Canada,
4
Conestoga College, Waterloo, Canada,
5
University of Western Ontario, London, Canada
Introduction
Emergency department (ED) use by older adults is
increasing, and this group is at higher risk of
adverse post-discharge outcomes. There are gaps
in knowledge around patient safety events in this
context, including a lack of experiential knowledge
that can inform policy and theory development.
The objective of this project was to describe key
challenges in the ED to home care (HC) transition
process among relevant care providers, staff,
patients, and informal caregivers.
48
Methods
Patients who were existing HC clients, had a
recent ED admission, and not palliative were
recruited across three regions (rural, urban, and
suburban). In-depth, semi-structured interviews
were conducted with HC clients and informal
caregivers (n=7). Focus groups were held with
care providers in each setting, incorporating ED,
nursing, and HC staff (n=36). Transcripts were
analyzed using applied thematic analysis and
thematic network analysis.
Results
Themes were presented through restorying combining elements of participants' stories into
fictional accounts that capture themes and
incorporate real quotes while preserving
anonymity. Three major themes emerged as
salient challenges for each group:
Patient/caregiver themes included clarity of
processes, transportation safety, and safety in
home. Care provider themes included differing
expectations, lack of communication, and team
dynamics.
Conclusion
This project explores gaps in knowledge around
lived experiences of transitioning from ED to home
and HC. By preserving participants' stories in fact
sheets/training materials for care agencies, we
hope to foster greater understanding of challenges
faced by older adults in an ED/HC context.
O107
Evaluating the Reliability of a Game-Based
Cognitive Assessment for Older Adults in
Emergency Care
1
1
2
Tiffany Tong , Mark Chignell , Mary Tierney ,
2
Jacques Lee
1
University of Toronto, Toronto, Ontario, Canada,
2
Sunnybrook Research Institute, Toronto, Ontario,
Canada
Developed nations are currently facing a change in
demographics with a shift towards a higher
proportion of elderly and increasing age-related
health concerns. Older adults have a higher risk of
developing cognitive impairments including
dementia and delirium, which, along with general
frailty, can decrease their ability to live
independently and carry out daily activities such as
walking and bathing (Wild 2008). Elderly adults
often enter into the healthcare system through
emergency services (Samaras 2010). Thus,
emergency departments are an opportune
environment for frequent cognitive screening to
improve patient outcomes and quality of life.
Existing methods of cognitive assessments are not
designed for use in emergency care, are often
time-consuming, and require administration by a
trained test administrator (Wild 2008). These
barriers may limit the frequency of cognitive
screening for elderly adults, while increasing the
under-detection of cognitive decline. We are using
a game-based cognitive screening tool that is
administered on a tablet, for use by elderly adults
in emergency care. We assessed the reliability of
our game-based assessment tool at a Canadian
hospital emergency department with over 100
elderly adults at risk for cognitive impairments.
Correlations of 0.7 and 0.8, respectively, were
found between initial assessments and
assessments made at first and second follow ups
(after eight or more hours of waiting). These
reliability results supplement our earlier findings
that the serious game assessment was correlated
with the MMSE (Folstein 1975), MoCA
(Nasreddine 2005), and CAM (Inouye 1990) scores
as well as measures of executive function (Tong
2016).
O108
An Analysis of Statistical Power in Studies on
Mild Cognitive Impairment
Kevin Peters, Maureen Heffernan, Sonja Schweter,
Nicholas Hopewell
Trent University, Peterborough, Ontario, Canada
Objectives. There has been considerable interest
in mild cognitive impairment (MCI) as a possible
predictor of dementia. There has also been
increasing interest in the reproducibility and
statistical power of scientific studies more
generally. The objective of this study is to
determine whether the power of MCI studies is
significantly different than the recommended
guideline of 0.80.
Method. Following the lead of Button et al. (2013),
we searched for all available meta-analyses on
MCI. We analyzed a total of 23 meta-analyses
(215 studies). For each meta-analysis, we treated
the summary effect (Cohen’s d, odds ratio, or risk
ratio) as the population effect and then computed
the power that each of the individual studies in that
meta-analysis would have to detect its summary
effect. To determine whether the median statistical
49
power estimate was significantly different than 0.80
we computed its 95% confidence interval using a
percentile bootstrap method.
Results. The median statistical power of each
individual study to detect the summary effect of its
parent meta-analysis was 0.59. The 95% CI (0.49,
0.73) did not contain 0.80 indicating that the
median is statistically significantly lower than 0.80.
Power estimates varied considerably across the
215 studies, ranging from 0.05 to 1.
Conclusion. The median statistical power of MCI
studies included in our analysis was significantly
lower the typically recommended value of 0.80.
Low powered studies have a number of negative
effects on the scientific process, reducing the
reliability of published findings. More work needs to
be done on this important topic.
O109
measures of processing speed and verbal
memory. Little differentiation was observed
between training conditions, suggesting that
simultaneous training does not detract from the
impact of the intervention. Turning to measures of
mobility, significant pre-post performance
improvements were observed on the Sit-To-Stand
task, with greater gains noted in the consecutive
training group. Individual differences measures
(e.g., motivation to engage in cognitive challenge)
also influenced the magnitude of training-related
gains, such that individuals with lower motivation
benefitted more from a program of training than
those who are already high in motivation and might
spontaneously seek out cognitive stimulation.
O110
The role of Sex and Gender in Polypharmacy
and Dementia
1
The impact of combined exercise and cognitive
training on cognitive and motor outcomes in
healthy older adults
1 ,2
1 ,2
1 ,2
Karen Li , Laurence Lai , Halina Bruce
1
Concordia University, Montreal, QC, Canada,
2
Centre for Research in Human Development,
Montreal, QC, Canada
Background and Objectives. Recent evidence
suggests that combined aerobic exercise and
cognitive training is superior to single-modality
training for improving cognitive functions (e.g.,
memory, executive functions) and mobility
(posture, balance). However, little research has
examined whether the multi-modal training is better
delivered sequentially or simultaneously. The
current study therefore contrasted sequential and
simultaneous cognitive and exercise training
protocols to address this question.
Methods. Forty-one healthy older adults were
randomly assigned to either simultaneous or
sequential training condition, in which they
received 12 sessions of computerized divided
attention training and aerobic exercise (cycling).
Pre- and post-training neuropsychological and
physical assessments were compared to examine
training-related cognitive and motor gains.
Results and Conclusions. Significant pre-post
performance gains were observed on the trained
cognitive task, a near transfer dual task, and
1 ,2
Shanna Trenaman , Melissa Andrew , Megan
2
Rideout
1
2
Dalhousie University, Halifax, NS, Canada, Nova
Scotia Health Authority, Halifax, NS, Canada
As the population ages and dementia becomes
more common it is imperative that we fine tune our
management strategies to optimize patient care.
One area that has received little attention is that of
sex or gender differences in those with dementia.
The focus of this scoping review was to identify the
sex or gender differences with regard to
medication use in people with dementia.
MEDLINE (PubMed), Embase, CINAHL, Web of
Science and Proquest were searched from
database inception to January 2016. The following
search terms were used: sex, gender, masculinity,
femininity, and polypharmacy, deprescriptions,
drug combinations, drug therapy combination,
polypragmasy, inappropriate prescribing, over
prescribing, mulitmedication, deprescribing, and
dementia, cognitive impairment. Inclusion criteria
required the original paper was in English, focused
on those over 65 years of age with dementia and
at least one medication related parameter was
reported that provided a comparison of males and
females. The search strategy yielded 260
abstracts. Two reviewers reviewed the identified
abstracts. There were 169 abstracts identified for
full text review.
Numerous studies report on the percentage of the
population that is of male or female sex/gender but
very few studies characterize any differences,
especially any medication-use related differences,
clearly in ways that are useful for clinicians or
50
policy makers to use for sex or gender specific
initiatives to improve patient care. This represents
a significant gap in the literature and a need for
directed research of sex or gender differences in
medication use in people with dementia.
O111
O112
Multi-Modality Exercise Training May Decrease
Risk for Dementia and Improve Mobility in
Older Adults with Subjective Cognitive
Complaints
1 ,2
Women with Dementia Living Strong
1
2
2
Elaine Wiersma , David Harvey , Philip Caffery
1
Centre for Education and Research on Aging &
Health, Lakehead University, Thunder Bay,
2
Canada, Alzheimer Society of Ontario, Toronto,
Canada
Objectives: Women are affected and impacted by
dementia differently than men (Alzheimer Society
of Canada, 2015). It is important to gain a more indepth understanding of the experiences of women
living with dementia. This presentation focuses on
the stories of three women, illuminating the life
transformation and discovery after a diagnosis.
Method: Three women with young onset dementia
participated in initial interviews. In an effort to
create a short video, two meetings were held with
the three women to further discuss key elements
they wanted to be included in the video. Interviews
with each woman were also then conducted for the
purpose of filming the video.
Findings: The women experienced challenges in
life before dementia, and the strength of meeting
those life challenges extended into meeting and
overcoming challenges with dementia. While the
women experienced losses because of their
diagnoses, they also gained new meaning and
purpose in their lives through relationships,
advocacy, and hobbies. The women transformed
from private people into public people after their
diagnosis with their active involvement in
advocacy. Strong relationships and friendships
also supported new meaning.
Conclusions: The experiences of women
diagnosed with young onset dementia are
significantly different than older women, and the
impacts of a diagnosis need to be considered
within their life context. These women's
experiences go far beyond coping and adapting,
and illustrate the rediscovery that can occur with
life challenges. Women with dementia can play a
very important role in challenging the stigma of
living with dementia.
2 ,3
Narlon Cassio Boa Sorte Silva , Dawn Gill ,
1 ,2
1 ,4
Ashleigh De Cruz , Michael Gregory , Robert
2 ,3
Petrella
1
School of Kinesiology, Western University,
2
London, ON, Canada, Lawson Health Research
3
Institute, London, ON, Canada, Western Centre
for Public Health and Family Medicine, Western
4
University, London, ON, Canada, Health and
Rehabilitation Sciences, London, ON, Canada
Background: This study analyzed the influence of
multi-modality exercise training [with either mindmotor (M4) or balance (M2) exercise] on gait and
Motoric Cognitive Risk syndrome (MCRs), in older
adults with subjective cognitive complaints.
Methods: Participants (aged 67.7±7.1 years;
71.1% female) were randomized to M4 (n=53) or
M2 (n=57) and exercised for 24 weeks (60
minutes/day, 3 days/week). M2 received additional
15min of balance training, whereas M4 underwent
15min of mind-motor training (i.e., Square Stepping
Exercise, SSE). Gait parameters were assessed
using the GAITRite™ system. Participants with
subjective cognitive complaints and slow gait
velocity (i.e., ≤ 1 SD below group mean), were
classified as having MCRs. One-way ANCOVA
was applied for gait analysis. Changes in MCRs
occurrence within groups were analyzed using
McNemar’s test, whereas chi-square test was
applied for between-group analysis.
Results: At 24-weeks, M2 showed improvements
in gait velocity [mean change: 0.07 (95% CI: 0.03
to 0.11) m/s] more than M4 [-0.03 (-0.07 to 0.01)
m/s], p<0.001. M2 also demonstrated increased
step length [2.13 (0.83 to 3.44) cm] compared to
M4 [-0.87 (-2.22 to 0.49) cm], p=0.002. No
differences in stride time variability were observed
(p=0.11). The proportion of individuals with MCRs
decreased in M2 post intervention (15.8% to 3.5%,
p=0.02); this was not seen in M4 (15.1% to 20.8%,
p=0.51). The proportion of individuals with MCRs
in M2 (3.5%) post intervention differed from M4
(20.8%), p=0.02.
Conclusions: Multi-modality exercise training
improves gait in older adults and may decrease
dementia risk by reducing MCRs occurrence.
51
1
O113
COMPAS: A microsimulation model to project
the future health and healthcare use of the
Canadian population
1
2
David Boisclair , Guy Lacroix , François Laliberté1
1
Auger , Pierre-Carl Michaud
1
2
ESG UQAM, Montréal, QC, Canada, Université
Laval, Québec, QC, Canada
The team of the Industrielle Alliance Research
Chair on the Economics of Demographic Change
has built a microsimulation model that allows for
detailed projections of the Canadian population’s
health and healthcare use. Based on Statistics
Canada’s Canadian Community Health Survey and
National Population Health Survey, the dynamic
model, COMPAS, generates complete population
distributions of mortality and incidence and
prevalence of 7 major health conditions and 2 risk
factors (obesity and tobacco use) until 2050, as
well as healthcare use. Some healthcare costs,
such as those for hospital stays and medical
consultations, have also been attached to the
various individual profiles – by age, sex, disease
and risk factor presence and several other
characteristics – using regression methods.
The presentation will provide an overview of
COMPAS, as well as projections of future life
expectancy and disease prevalence for Canada
and Quebec’s elderly population. For instance, in
the baseline scenario dementia prevalence among
the 70 y.o. and older in Quebec is projected to
increase from 10% to 14% between 2015 and
2050, while heart disease prevalence is projected
to increase from 16% to 25% among the 60-70 y.o.
over the same period.
The results of various “alternative” projection
scenarios will also be shown. Examples of such
scenarios include a 50% decrease in the incidence
of obesity-related diseases, which substantially
decreases the aggregate costs of medical
consultations in 2050 but increases the costs for
long-term facilities; and a 50% decrease in the
incidence of stroke after-effects, which does not
affect aggregate healthcare costs.
O114
Interprofessional geriatric education for
healthcare professional students: focus on
transitions in care
1
1
Tina Felfeli , Ari Cuperfain , Bonnie Cheung ,
1
1
1
Amanda Chan , Elizabeth Fung , Sok-Kau Tang ,
1
1
1
Andrew Perella , David Dodington , Samir Sinha
,2
1 ,3
, Camilla Wong
1
Faculty of Medicine, University of Toronto,
2
Toronto, ON, Canada, Mount Sinai Hospital,
3
Toronto, ON, Canada, St. Michael's Hospital,
Toronto, ON, Canada
Objective: To develop and evaluate a model for
interprofessional education (IPE) that fosters
effective collaboration and optimal team-based
geriatric care for interprofessional healthcare
students.
Methods: As part of the University of Toronto,
Faculty of Medicine, Geriatrics Interest Group
initiative on IPE, we developed and implemented
an interprofessional geriatric education workshop
for medical, nursing, pharmacy, physical therapy,
occupational therapy, and physical therapy.
Students participated in a series of interactive,
case-based workshops on wound management,
palliative care, mobility issues and transfers,
mental status assessment, and others. Each
workshop was twenty minutes in length and was
facilitated by healthcare professionals in the
relevant fields. The stations were framed around a
particular fictional patient case, that of Mr. GB and
his wife, with an emphasis placed on transitions in
geriatric care. Self-perceived competencies in IPE
skills and attitudes toward interprofessional
teamwork were measured through post-workshop
surveys. Data were analyzed using descriptive and
nonparametric statistics.
Results: A total of 37 students (15 medical
students, 9 nursing students and 13 from other
disciplines) took part in the program. The workshop
stations were well received and was rated as very
useful by the students in improving their
knowledge of geriatric medicine.
Conclusion: Interprofessional education is crucial
in geriatrics where patients are vulnerable to
adverse effects across the care continuum. This
model of education holds promise as both a model
for interprofessional education and as a tool for
integrating geriatrics into the role of allied health
trainees early in their career.
O115
Further Education and Training of Care
Workers and Its impact on their Professional
52
Development, Work Situation and Quality of
Patient Care: A Quantitative and Comparative
Analysis of Germany and Canada
4 ,1
5
Zafar Mehdi , Klaus Schoemann , Hildegard
1
Theobald
1
University of Vechta, Vechta, Lower Saxony,
2
Germany, University of Saskatchewan,
3
Saskatoon, Canada, York University, Toronto,
4
Canada, Australian National University, Canberra,
5
Australia, Jacobs University, Bremen, Germany
Background: There are mandatory and volunteer
further training programs in health care and longterm care sectors in Canada and Germany, the
effects of further training of care workers on their
professional development, work situation and
quality of patient care in hospitals, home care
settings and residential care facilities are unclear.
Objectives: The objectives of this study were set
to investigate the association between further
training of care workers (nurses, elder carers and
care assistants) and their professional
development, work situation and quality of patient
care in the two countries and to examine how this
association is influenced by the different training
systems in both countries.
Methods: Backed with lifelong learning theories, a
quantitative approach – multiple regression
analysis - was applied based on national survey
data. German Socio-economic Panel (GSOEP)
data 2010, Canadian Survey of Labour and
Income Dynamics (SLID) data 2010 and Canadian
National Survey of the Work and Health of Nurses
2005) built the basis for the analysis
Results: Further training of care workers has a
statistical significant and a positive association with
their professional development, career
advancement, work situation and quality of patient
care in health care and long-term care settings,
however, there are country differences in findings
between Canada and Germany.
Conclusion: This study found that further training
of care workers has positive impact on their
professional development, work situation and
quality of patient care. Country differences are
linked to the training system of health care and
long-term care workers in the two countries.
O116
Le fardeau de la mortalité : une mesure qui
vient nuancer l'impact du vieillissement
démographique au Canada
Chloé Ronteix, Yves Carrière
Le vieillissement des cohortes du baby-boom est à
l'origine de problématiques relatives à la viabilité
des régimes de retraite et à l'augmentation des
dépenses en soins de santé à venir. Les
projections de Statistique Canada montrent que le
rapport de dépendance des personnes âgées va
augmenter de 82% entre 2015 et 2061. Mais cet
indicateur est discutable puisqu'il se base
uniquement sur l'âge sans prendre en compte
l'évolution des comportements au fil des
décennies. Nous proposons donc un indicateur qui
prend en compte l'évolution importante du cycle de
vie professionnel et de la mortalité. En le
comparant au rapport de dépendance classique
nous mettrons en évidence l'influence de
l'évolution des comportements des populations visà-vis du marché du travail pour soutenir la
population dite dépendante.
Notre indicateur du « fardeau de la mortalité »
rapporte l'effectif d'individus à qui il reste moins de
15 années à vivre à la population en emploi, pour
les hommes et les femmes, depuis 1921. Nous en
faisons des projections à l'horizon 2047. Les
résultats de ces projections montrent que si le
rapport de dépendance des personnes âgées est
multiplié par cinq entre 1921 et 1947, le fardeau de
la mortalité lui diminue d'environ 40% sur la même
période.
Le rôle de la diminution de la mortalité, de l'arrivée
massive des femmes sur le marché du travail et du
report de la retraite sera discuté pour expliquer
cette tendance.
O117
Early and involuntary retirement among
Canadian Registered Nurses and allied health
professionals: Development and validation of
conceptual models
1
2
1
Sarah Hewko , Trish Reay , Carole Estabrooks ,
1
Greta Cummings
1
2
Edmonton, AB, Canada, Alberta School of
53
Business, University of Alberta, Edmonton, AB,
Canada
Background: Registered Nurses (RNs) and allied
health professionals (AHPs) are fundamental to
elder care and population health. Trends such as
an ageing workforce and early retirement have
contributed to a shortage of these professionals.
Objective: Develop and validate conceptual
models of early retirement and involuntary
retirement among RNs and AHPs.
Method: Systematic review of literature regarding
early retirement decisions and voluntariness of
retirement (n = 22 studies). Factors reported as
predictive of early retirement or involuntary
retirement were incorporated into the appropriate
conceptual model. To validate the models, we
conducted interviews with a diverse group of
Canadian RNs and AHPs (n = 12).
Results: Interview participants reported the
models to be clear, logical and relevant. There
were eight categories (38 variables) in the final
conceptual model of early retirement: workplace
characteristics; sociodemographics;
attitudes/beliefs; broader context; organizational
factors; family; lifestyle/health, and; work-related.
There were four categories (8 variables) in the final
model of involuntary retirement: broader context;
sociodemographics; family, and; lifestyle/health.
The factor of caregiving responsibilities was added
to this model when multiple interviewees
suggested it warranted inclusion.
Conclusion: RNs and AHPs consider many
factors when contemplating early retirement; some
of these, particularly in the categories of workplace
characteristics and organizational factors, are
sensitive to intercessions by healthcare
administrators and front-line leaders. Few studies
explored reasons for involuntary retirement; thus,
fewer factors were identified as predictive of this
outcome. In future, we will test operationalized
versions of the models using quantitative data
drawn from a nationally representative data set.
1
2
Canada, York University, Toronto, Ontario,
3
Canada, Toronto Rehabilitation Institute, Toronto,
4
Ontario, Canada, University of Toronto, Toronto,
5
Ontario, Canada, Partnerships in Dementia Care
6
Alliance, Waterloo, Ontario, Canada, Bitove
Wellness Academy, Toronto, Ontario, Canada,
7
Possible Arts, Toronto, Ontario, Canada
Culture change initiatives in dementia care have
called for the adoption of a new care paradigm
informed by the principles of person-centeredness,
relationality, and embodiment. Yet translating
these humanizing and life-affirming principles into
practice has proven difficult; traditional approaches
to knowledge translation have not had sustained
impact. The arts may be a more effective means of
shifting images, understandings and actions in
healthcare. As part of a longitudinal project, this
paper explores the immediate impacts of a new
research-based drama called ‘Cracked: New Light
on Dementia’, and how it might enhance
understandings of relational caring and the
adoption of these principles into practice for staff
working in long-term care (LTC) homes. Three
data collection strategies were employed in two
LTC homes in two cities in Southern Ontario to
examine the immediate impacts: pre- and postperformance focus group/interview discussions,
evaluation questionnaires, and observations.
Immediately after engaging with the drama,
participants described an expanded understanding
of relationality including seeing family differently,
seeing the whole person with dementia in life
context, and seeing relational patterns, all which
inspired new ways of relating. Participants also
described their experience of intensified tensions
between the care principles central to the drama
and system constraints that make it challenging to
practice relational caring, which can cause great
suffering. Our results point to the effectiveness of
research-based drama in shifting individual
understandings and actions in dementia care.
However, without organizational and broader
system change, achieving sustained impact of
relational caring practices will continue to be
challenging to achieve.
O119
O118
Humanizing Dementia Care Through ResearchBased Drama
1 ,5
Sherry Dupuis , Christine Jonas-Simpson
2
3 ,4
4 ,7
Mitchell , Pia Kontos , Julia Gray
2 ,6
, Gail
Imagining and Creating Ideal Relational Caring
Experiences for All
1
2
3
Sherry Dupuis , Carrie McAiney , Susan Brown ,
4
5
6
Jennifer Carson , Lorna deWitt , Darla Fortune ,
1
1
1
Sian Lockwood , Kim Lopez , Janet McKeown ,
54
2
Jenny Ploeg
1
2
Canada, McMaster University, Hamilton, Ontario,
3
Canada, Schlegel-UW Research Institute for
4
Aging, Waterloo, Ontario, Canada, University of
5
Nevada, Reno, Nevada, USA, University of
6
Windsor, Windsor, Ontario, Canada, Concordia
University, Montreal, Quebec, Canada
Recent culture change initiatives in long-term care
(LTC) have called for the adoption of a new
humanizing paradigm informed by the principles of
person-centeredness, relationality, and
embodiment. The Partnerships in Dementia Care
(PiDC) Alliance in Canada is one of these
initiatives and has partnered with a number of LTC
organisations and homes to work towards the
creation of a culture where supporting living life to
the fullest is the priority. Using participatory action
research and appreciative inquiry,
residents/persons living with dementia, family
members, and staff work together to build strong
relationships needed to facilitate culture change
(Dawn), gather and share stories of the best of
what is (Discovery), imagine what an ideal LTC
home would look like (Dream), plan out specific
steps to make aspirations a reality (Design), and
work collectively to put the plan into action
(Destiny). Drawing on data from the Discovery and
Dream phases conducted in five long-term care
settings and a one-day workshop where we came
together to reflect on our culture change processes
using the arts, this paper describes eight
interconnected patterns that create ideal relational
caring experiences from the shared perspectives of
residents/persons living with dementia, family
members, and staff working in those settings. We
also provide examples of indicators that are
aligned with each of these patterns. Envisioning
what a new culture looks like is an important first
step in imagining and implementing new
possibilities as we work to transform the culture of
LTC.
O120
Web-administration of a ‘quantified self’
questionnaire for elderly people: a user
satisfaction survey
1
2
O Beauchet , C Vilcocq
1
McGill University, Montreal, Québec, Canada,
2
Biomathics, Paris, France
Older adults are able to evaluate their own health
and functional status with accuracy using a paper-
and-pencil format SAQ. The aims of this study
were 1) to compare the filling time, the perceived
ease of use and the quality of visual presentation
of a digitized SAQ accessible on a web platform
among adults, and 2) to examine the age-effect on
these endpoints. Based on a cross-sectional
design, 60 healthy participants (17 young adults,
17 mild-age adults and 26 older adults) were
recruited. A digitized version of the previous SAQ
was built and accessible on a web platform via a
computer connected to internet. The participants
were asked to fill the digitized SAQ. The filling
time, the perceived ease of use (i.e., global
contentment of use, items understanding and
answering, and navigation through items) and the
appreciation of quality of visual presentation (i.e.,
color, figure and calligraphy) were recorded. Older
adults took more time to fill it compared to young
(P<0.001) and mild-age adults (P<0.001). Mild-age
adults also took more time than young adults
(P<0.001). The perceived ease of use as well as
appreciation of quality of visual presentation were
very good with a high level of ease of use or of
visual quality (i.e., upper 73%) and no significant
different between age groups. Our results show
that the perceived ease of use and the
appreciation of quality of visual presentation of a
web SAQ were very good, whatever the age group
considered.
O121
Reversing the rising tide: How the Nova Scotia
Health Authority is using evidence to reduce
waitlists for long term care
1 ,2
1
Susan Stevens , Lindsay Peach
1
Nova Scotia Health Authority, Halifax, NS,
2
Canada, Mount Saint Vincent University, Halifax,
NS, Canada
One health authority, 12 months and more than
1,000 fewer people are all part of a remarkable
change that took place in 2015/16 in the health
system landscape in Nova Scotia. During its
inaugural year, the Nova Scotia Health Authority
achieved a 34% reduction in the number of people
waiting for long term care across the province
despite having the oldest population in the country,
a heavy burden of chronic disease, and a high
utilization rate of nursing home beds among its
elderly population. Utilizing both quantitative and
qualitative data from a number of sources including
data from the interRAI Home Care Assessment
tool, a qualitative research study completed by
researchers at Mount Saint Vincent University
55
commissioned by the provincial government, and
key performance indicators NSHA has effectively
employed evidence to change policy, practice and
perceptions resulting in improved access to and
utilization of long term care beds and more
effective use of home care services. This
presentation will provide an overview of the data,
the knowledge translation process undertaken and
the client and system outcomes achieved. A
discussion of lessons learned including the critical
importance of engaging frontline staff, physicians
and clients/families through meaningful
communication of the rationale for policy and
practice changes will be covered.
CI: 0.74-0.92). A reduction in LOS was observed at
3 months (MD, -1.33; 95%CI: [-2.43,-0.22]), 6
months (MD, -1.47; 95%CI: [-2.37,-0.56]) and 12
months (MD, -3.21; 95%CI: [-5.18,-1.24]). A
beneficial impact of TC on QOL was suggested by
most trials. Effect on ED visits showed mixed
results.
Conclusions: TC reduces mortality,
rehospitalisation, LOS and improve QOL.TC
represents a solution to improve the transition of
older patients with CD between hospitals and
primary care.
O123
O122
Care transition for elderly patients with chronic
diseases: A systematic review and metaanalysis
2
2
1 ,2
M Le Berre , G Maimon , V Khanassov , O
1
1 ,2
2
2
Tatar , QN Hong , M Beauchamp , M Guériton , I
1 ,2
Vedel
1
McGill University, Montréal, Québec, Canada,
2
Lady Davis Institute for Medical Research,
Montréal, Québec, Canada
Context: The healthcare system is facing the
double challenge of an aging society and an
increase in chronic diseases (CD) and has difficulty
providing the complex services required by this
population. Transitional care (TC) is widely
implemented to increase the continuity and quality
of care when patients are discharged from hospital
to primary care. We conducted a systematic review
and meta-analyses to determine the impact of TC
interventions for elderly patients with CD on
mortality, emergency department (ED) visits,
readmissions, readmission days (LOS) and quality
of life (QOL).
Methods: Medline, CINHAL, PsycInfo, EMBASE
(1995-2012) were searched for randomized
controlled studies (RCT). Statistical analysis:
relative risks (RR) or mean difference (MD) were
calculated using a random-effect model (RevMan
5.3 software).
Results: From 9772 references, 82 RCTs were
included. A reduction in mortality was observed at
6 months (RR, 0.83; 95%CI: 0.72-0.97), 12 months
(RR, 0.79; 95%CI: 0.66-0.95) and 18 months (RR,
0.77; 95%CI: 0.63-0.94). A reduction in
readmission was observed at 6 months (RR, 0.90;
95%CI: 0.82-0.99) and 12 months (RR, 0.82; 95%
Predicting clinical diagnosis of Alzheimer's
disease over 10 years in individuals with mild
cognitive impairment using regional normative
subcortical volumes
1
1 ,2
Olivier Potvin , Simon Duchesne
1
Institut universitaire en santé mentale de Québec,
2
Québec, Canada, Département de radiologie et
médecine nucléaire, Université Laval, Québec,
Canada
Objective: We recently produced normative values
for Freesurfer-extracted subcortical regional
volumes in cognitively healthy adults, taking into
account age, sex, intracranial volume, MRI magnet
strength as well as manufacturer. Using these
normative values, we compared volumes at
baseline for individuals with mild cognitive
impairment (MCI) in the ADNI study who went on
to develop clinical Alzheimer's disease or remained
stable.
Method: We used 365 participants with MCI from
ADNI1; 197 developed probable AD (age:
74.6±7.0; years to diagnosis: 2.4±1.9, range: 0.410.0) and 168 remained cognitively healthy
(75.0±7.6; maximum follow-up years: 4.0±2.9,
range: 0.5-10.3). Volume Z scores were calculated
according to our normative formulas. A Cox
proportional hazards model predicting progression
to AD was built using age, sex, hippocampi and
total subcortical volumes, and cognitive measures
(ADAS-cog, RAVLT delayed recall, MMSE) as
predictors. Backward selection was used to keep
only significant predictors.
Results: Participants who progress to AD had
significantly (p < .001) lower baseline normative Z
score for both left and right hippocampi, as well as
56
subcortical volumes respectively, compared to
those who remained stable. Age, ADAS-cog,
RAVLT, and right hippocampus Z score were
selected as significant predictors and a right
hippocampal Z score of -1 was associated with a
1.27 (1.14-1.42) increased risk of developing AD.
Conclusions: These results outline the small, but
significant, magnitude of hippocampal atrophy in
individuals with MCI that will progress to AD up to
10 years before diagnosis.
O124
Clinical Decision Tool to identify independent
injured seniors at risk of functional decline
after an emergency department visit
1 ,3
1 ,3
Marcel Émond , Marie-Josée Sirois , Jacques
2
7
5
6
Lee , Jeffrey Perry , Lauren Griffith , Eddy Lang ,
4
3
Raoul Daoust , Nadine Allain-Boule , CETI
3
Colleagues
1
2
3
Canada, Centre de recherche du CHU de
4
Québec, Quebec, Quebec, Canada, Hopital du
Sacre-Coeur de Montreal, Montreal, Quebec,
5
Canada, McMaster University, Hamilton, Toronto,
6
Canada, Alberta Health Services, Calgary,
7
Alberta, Canada, Ottawa Hospital Research
Institute, Ottawa, Ontario, Canada
Although good recovery is expected for most
independent seniors presenting to the emergency
department(ED) with minor injuries, this trauma is
associated with functional decline.
This study aims to derive and validate a clinical
decision rule(CDR) to identify independent injured
seniors at risk of functional decline over 6-months.
Two prospective longitudinal cohorts were
conducted in 7 EDs(2009 to 2015) to derive and
validate a CDR. Eligible patients were injured,
aged ≥ 65 years, independent in 7 basic activities
of daily living, visit an ED, and discharged back
home. Functional decline is as a loss ≥ 2/28 on the
OARS. Univariate and recursive partitioning
analyses were used to derive CDRs.
We recruited 3254 seniors(derivation=
1568/validation =1686). Baseline predictors of
functional decline were low-risk: age 65-74, no use
of a walking aid, <3 GP visits in the last 3 months;
high-risk: <5 outings per week, occasional use of
a walking aid; moderate-risk: not full of energy
before the injury, fall in the last three month, need
more help in the last 24 hours. Functional decline
were 38% and 18% in high and moderate risk
respectively. Sensitivity of the CDR is 85.4(80.489.6)/78.7(72.7- 83.9), specificity is 59.0(56.061.9)/64.2(61.5- 66.9). The ability of our model to
detect moderate and high-risk patients who
declined was higher than other measures
(AUC:CDR=0.72;ISAR=0.61;EP gestalt=0.62).
Even in seniors who do not seem in danger of
functional decline, at high and moderate risk
patient will experiencing a decline that is
observable over months. A CDR could help triage
and orient patient post-ED care.
O125
Post-emergency department evidence-based
interventions for the prevention of frailty and
functional decline in injured communitydwellers: Scoping review
1 ,2
1 ,2
Marcel Emond , Marie-Josee Sirois ,
2
2
Genevieve Tremblay , Nadine Allain-Boule ,
4
3
5
Katherine Berg , Debra Eagles , Jacques Lee ,
3
3
Jeffrey Perry , Laura Wilding
1
2
Centre de recherche du CHU de Quebec,
3
Quebec, Quebec, Canada, Ottawa Hospital
Research Institute, Ottawa, Ontario, Canada,
4
5
Canada
Among the 400,000 independent injured seniors
each year, around 65% will seek care in
Emergency Departments (EDs) and 70% are
discharged home. Minor injuries can trigger a
functional decline in previously independent
seniors. Specific interventions to prevent functional
decline must be tailored to at-risk independent
seniors discharged home.
The objective is to conduct a review of postemergency department interventions and
community services to help pre-frail independent
seniors to restore their autonomy following a minor
injury.
Literature published from inception to October
2015 in PubMed, EMBASE, and Grey literature
websites were searched. A single author first
screened titles of 2919 retrieved studies; two
57
independent reviewers screened 127 abstracts/fulltext for eligibility. Documents were included if their
population was 60 years+, living in the community,
had a history of minor injury, visited a primary care
setting (ED or other), and described care transition
strategies.
A total of 22 documents were included and half of
them were from grey literature. Studies were
describing ED possible interventions(n=14),
discharge plan elements as health care
professionals (HP) referrals(16), techno or care
modalities(13), multi-factorial assessment(7), and
community services were focussing of falls
preventions interventions(21). Assessed
interventions/modalities were performed in various
environment and by various HP (paramedic to the
community).
High-quality evidence on effective care transition
strategies following ED discharge are limited, but
trend favour holistic geriatric assessment and
targeted referral to community services tailored to
individual needs of injured seniors, as fallprevention programs. Improving coordination along
the continuum of care and emergency professional
teaching should be given attention.
TM
five time points. Observer video analysis was
used to compare interactions and communication.
Following AI, the staff member reduced reliance on
speech, looked more at their communication
partner and initiated physical contact more often.
The person with PD remained neutral in facial
expression, silent and did not make physical
contact. However, in the final session, the patient
moved his hand corresponding to staff initiatedphysical contact. After AI, the staff-patient dyad
were more synchronized in their behaviours, and
engaged in more eye-to-eye contact. In individuals
with PD, the behavioural repertoire may be
restricted due to facial and movement impairments
therefore staff may need to be attuned to subtle
responses. By focusing on each individual's unique
repertoire, AI provides caregivers with the
opportunity to learn to recognize, interpret and
reciprocate non-verbal communication.
O127
Multidisciplinary Consensus Approach in the
Development of a Clinically Effective Sensory
Screening Package for Residents with
Alzheimer's Disease (AD) in Long Term Care
(LTC)
1 ,2
O126
Applying Adaptive Interaction to
communication in Parkinson's Disease
1 ,2
1
Arlene Astell , Alexandra Hernandez , Sharminy
1
1
Nagulendran , Deena Ruess
1
2
Sciences, Whitby, ON, Canada, The University of
Sheffield, Sheffield, UK, UK
Adaptive Interaction (Ellis & Astell, 2008) equips
caregivers with non-verbal communication skills to
improve end of life interactions by permitting
caregivers to ‘learn the language' of people living
with dementia who can no longer speak (Astell &
Ellis, 2011). AI builds on the fundamentals of
communication including facial expressions, eye
gaze and movements. In Parkinson's disease (PD)
movement and emotional expressions are
affected. This study examined the impact on
communication between an individual with PD with
minimal speech and a communication partner
before, during and after AI training. A person with
advanced dementia with PD, and a nursing staff
member were recruited from a specialized Geriatric
Dementia Unit as part of a larger training
programme. Interactions were video-recorded at
3 ,4
Fiona Höbler , Walter Wittich , Katherine
1 ,5
McGilton
1
Department of Research, Toronto Rehabilitation
Institute-University Health Network, Toronto, ON,
2
Canada, Department of Speech-Language
Pathology, University of Toronto, Toronto, ON,
3
Canada, School of Optometry, University of
4
Montreal, Montréal, QC, Canada, CRIR/Centre de
réadaptation MAB-Mackay du CIUSSS du CentreOuest-de-l’Île-de-Montréal, Montréal, QC, Canada,
5
University of Toronto, Toronto, ON, Canada
Objectives: The aim of this study is to develop a
package of sensory screening tools that will help
identify long term care (LTC) residents with
dementia in need of referral to a vision or hearing
specialist, thereby enabling the development of
individually tailored care for vulnerable residents.
Methods: Firstly, a multidisciplinary team of
reviewers carried out a comprehensive scoping
review of the documented use of hearing and
vision tests with adults who have dementia. This
review was used to inform an expert panel of 15
hearing, vision, and technology specialists, who
selected tests and procedures for inclusion in a
sensory screening package by use of a modified
58
RAND/UCLA Appropriateness Method (RAM),
developed by the RAND Corporation and
University of California at Los Angeles (UCLA),
and a Delphi consensus approach. The combined
method of anonymous rating and subsequent
group discussion offers a structured process for
selecting elements of the package with interactive
meetings to explore areas of disagreement and in
need of review.
Results: Following this structured approach, we
offer a package of tools and a process for their
selection that considers the degree and nature of
sensory loss, with recommendations for screening
both hearing and vision in LTC residents with
dementia, along with instructions for
administration, scoring and interpretation, and
reported psychometric properties of the tools.
Conclusions: By identifying sensory impairments,
addressing them to whatever extent possible, and
adapting care plans to accommodate for such
impairments, residents with dementia are expected
to experience less agitation and improved quality
of life.
O128
Recommandations du RUSHGQ sur les
meilleures pratiques clinico-administratives au
programme Unité de courte durée gériatrique
(UCDG) des hôpitaux québécois
1
2 ,1
3
3
M-J Kergoat , J Latour , M-P Fortin , S Caron , I
2
2
1
Payot , M Lafleur , A Bolduc
1
Institut universitaire de gériatrie de Montréal,
CIUSSS du Centre-Sud-de-l’Île-de-Montréal,
2
Montréal, Canada, Centre hospitalier de
l’Université de Montréal, Montréal, Canada,
3
Centre hospitalier universitaire de QuébecUniversité Laval, Hôpital de l’Enfant-Jésus,
Québec, Canada
Contexte: Le cadre de référence des Unités de
courte durée gériatriques remonte à 1986. Notre
communauté de pratique (RUSHGQ) a entrepris
une consultation auprès des médecins et
gestionnaires des UCDG sur la mission, les
critères d'admission et les éléments d'une
planification de congé efficace et sécuritaire.
Objectifs: 1) Mettre à jour les données sur la
clientèle et des éléments de fonctionnement des
UCDG; 2) Consulter les responsables afin
d'élaborer des recommandations consensuelles.
Méthodes : Un questionnaire électronique
couvrant les informations d'intérêt a été soumis au
représentant RUSHGQ des UCDG membres
(n=50). Un processus structuré de consultation
auprès des responsables a ensuite été réalisé à
travers la province.
Résultats : Au total, 44 représentants ont fourni
les données sur leur UCDG. Quelques 42
médecins et 45 gestionnaires ont participé à un
des neuf groupes de discussion régionaux. Les
résultats ont permis au comité de pilotage de
dégager 81 propositions écrites. Ces dernières ont
été soumises aux participants pour un processus
individuel de validation. Les propositions qui n'ont
pas obtenu le degré d'accord visé (IPRAS < IPR
ou < 75 % des participants ont accordé une cote
entre 7 et 9 sur une échelle de 1 à 9) ont été
débattues lors d'une réunion des délégués des
groupes régionaux. Le rapport contenant les
recommandations finales a été complété en mars
2016.
Conclusion : Ces recommandations sont issues
d'un large consensus des acteurs du terrain. Le
MSSS pourra y puiser l'information lui facilitant la
mise à jour du cadre de référence du programme.
O129
L’apport du programme Municipalités amies
des aînés au sein des municipalités
québécoises
1
1 ,2
1
S Vallette , S Garon , C Lavoie
1
Centre de recherche sur le vieillissement,
2
Sherbrooke, Canada, Université de Sherbrooke,
Sherbrooke, Canada
Le projet Municipalités amies des aînés (MADA)
est implanté au Québec depuis 2009. En 2015 et
2016, deux questionnaires ont été créés et ont été
envoyés aux municipalités participantes au
programme MADA. Il est maintenant possible
d’obtenir statistiquement son impact et son
efficacité dans les municipalités et dans la société
québécoise en général.
Cette recherche s’intéresse à l’apport du
programme MADA au sein des municipalités
québécoises. Ainsi, l’objectif est de comprendre le
déroulement et quelques effets du programme
selon les trois étapes de ce dernier.
59
Deux questionnaire, formulés par l’équipe de
recherche du Centre de recherche sur le
vieillissement, ont été conçus afin de comprendre
la démarche du programme MADA et ont été
utilisés comme outil pour obtenir les données. Le
premier a été envoyé à 759 municipalités (N) et
362 (n) y ont répondu. Le taux de réponse est de
48% et la marge d’erreur est de 3,73%. Pour sortir
nos résultats, nous avons utilisé le logiciel de
traitement statistique R afin d’obtenir des
fréquences ainsi que des analyses bivariées, des
analyses factorielles et des analyses multivariées.
Dans cette communication nous expliqueront les
différentes fréquences indiquant la proportion
d’acteurs présents dans chacune des étapes de la
démarche, les partenaires présents, le niveau
d’appui accordé à la démarche MADA ainsi que la
relation de collaboration et de partenariat.
D’ailleurs, l’analyse des résultats nous permet de
dire que les municipalités accordent une grande
importance au travail en partenariat.
O130
"It's not just about the money": Social capital's
contribution to age-friendly communities
Elizabeth Russell
Department of Psychology, Trent University,
Peterborough, ON, Canada
Age-friendly communities funding is often a small,
one-time injection of provincial or municipal funding
to individual communities, and, program
development may overly tax local voluntary
resources in towns experiencing population aging
and outmigration. As a result, the maximum
potential of age-friendly funding may not be
achieved, and sustainable seniors' programming
may not be possible. Community social capital social cohesion, trust, volunteerism, and sense of
community - may be related to longer-term
programming success, beyond government
funding or the wealth of individual communities.
This research examined factors contributing to
age-friendly programming sustainability, beyond
short-term investment. Data were collected from
108 people and 24 communities in Newfoundland
and Labrador funded by an age-friendly
communities initiative, and included both survey
data from 45 individuals who lived, worked and/or
volunteered in 23 communities (79% of
communities funded), and focus groups or
interviews with 35 committee members and 43
seniors. Participants from communities with a high
income per capita had a significantly lower sense
of community than those living in a medium
income per capita, F(2, 35) = 3.6, p < .05, η2 = .17,
and, communities experiencing outmigration
experienced a significantly lower sense of
community, F(1, 32) = 5.75, R2 = .15, p < .05.
Furthermore, qualitative findings indicated that
communities strong in social capital were more
successful at implementing longer-term, successful
age-friendly programming, independent of internal
or external funding. Results indicate that funding
targeted at helping communities become more
age-friendly is necessary, but not sufficient, to
developing effective, sustainable age-friendly
communities.
O131
Safe Streets for Seniors and Other Valuable
Pedestrians
Peggy Edwards, Dianne Breton
Council on Aging, Ottawa, Canada
As part of the Age-Friendly Ottawa initiative, the
Council on Aging of Ottawa carried out age-friendly
walkability audits in three areas in Ottawa.
Participant volunteers aged 2 to 85 (and several
dogs) used an age-friendly checklist developed for
the audits (measuring safety, accessibility,
connectedness and comfort) in all seasons. To our
knowledge, these were the first audits to be carried
out by seniors in winter. Icy sidewalks and poor
snow removal imposes serious challenges for older
people that need to be prioritized for attention in a
winter city like Ottawa.
The analysis and final report summarizes the
findings and makes concrete recommendations to
improve pedestrian safety and walkability for older
adults and other vulnerable pedestrians. These
include the adoption of a complete streets
approach, strategies to prevent collisions and
make intersections safer for older adults and
people who use mobility aids such as walkers and
wheelchairs, procedures to improve sidewalks and
prevent falls, and the provision of a network of
safe, accessible public toilets in key public places.
This presentation will: Describe how age-friendly
walkability and safety audits were carried out in all
seasons in Ottawa; provide information on the key
factors that put older adults and other vulnerable
pedestrians at risk; provide recommendations on
how cities and communities can improve
pedestrian safety and walkability for seniors and
60
other vulnerable road users, such as people with
disabilities and young children; and provide an
age-friendly walkability checklist that other
communities can use.
professional practitioners engaged in age-friendly
work in China and internationally.
O132
Une recherche collaborative sur les
Municipalités amies des aînés (MADA) : Le
processus de coproduction au sein de quatre
études de cas au Québec
Developing a Research-based Age-Friendly
Community Strategy: A Case Study of
Guangzhou, China
1
1
Christine Walsh , Jennifer Hewson , Hongmei
1
1
2
Tong , Daniel Lai , Quin Zhang
1
University of Calgary, Calgary, Canada,
2
Guangdong Institute of Public Administration,
Guangzhou, China
Objectives Worldwide populations are aging.
According the World Health Organization (WHO)
this demographic trend is unprecedented,
pervasive, and enduring with profound
implications. Making communities more “agefriendly” has been an ongoing trend since the
WHO (2007) launched its global Age-Friendly
Cities project. China has the largest number of
older adults globally, however research on
implementing Age-Friendly Cities guidelines in
China is scant.
Methods We used a multiple-method, communitybased approach to assess and develop
recommendations for age-friendliness in
Guangzhou, China. First, we developed a
quantitative survey instrument using the WHO agefriendly framework, which was modified to be
locally and culturally relevant. The survey was
administered to adults 50 years of age and older
(N = 600) in four distinct communities in
Guangzhou by trained research assistants.
Descriptive analysis was completed across items
in the 8 domains and comparisons were made
across the four communities. Second, the results
of the analysis were presented to key stakeholders
(policy developers, service sectors and older
adults) in a series of 12 focus groups in order to
develop locally-relevant recommendations.
Results and Implications This presentation will
highlight key findings in creating local age-friendly
policy, implementation, and evaluation plans in
Guangzhou, China.
Conclusion The results of this study have
implications for policy makers, strategists, and
O133
1 ,2
1 ,2
0
M. Paris , S. Garon , A. Bureau
1
2
Sherbrooke, Québec, Canada, Université de
Le programme MADA a été mise en place en 2009
par le Secrétariat aux aînés, et ce, en collaboration
avec le Centre de recherche sur le vieillissement,
le Carrefour action municipale et famille et la
Conférence régionale des tables de concertation
des aînés du Québec. En janvier 2016, plus de
700 municipalités étaient engagées dans la
démarche MADA.
Le but de la présentation est de s'entretenir sur le
processus de coproduction en vigueur dans une
recherche collaborative financée par les IRSC et
qui comprend quatre études de cas MADA.
Cette recherche se base sur une approche
évaluative développementale (Patton, 2011). Elle a
recueilli de manière itérative 17 entrevues
individuelles, 8 groupes de discussion, 10
observations, de même que 38 questionnaires sur
la collaboration et le réseautage. Bien que MADA
promeuve une approche de développement des
communautés (Gilchrist & Taylor, 2016), les
différents acteurs engagés dans la démarche ne
partagent pas une vision commune des résultats
souhaités. La méthodologie rattachée à la
recherche met en œuvre un processus de
coproduction, et ce, afin d'instituer une base
commune entre les acteurs.
Pour la présentation, nous expliquerons d'abord
comment la recherche collaborative a permis une
coproduction des connaissances entre les
chercheurs, les décideurs, les représentants
organisationnels et les aînés eux-mêmes. Ensuite,
nous décrierons le processus de coproduction qui
a mené à la réalisation d'outils concrets pour la
démarche MADA, en particulier pour l'étape de
l'évaluation. Finalement, nous présenterons de
nouvelles avenues de recherche pour améliorer le
processus de coproduction au sein des MADA.
61
O134
O135
De la recherche au documentaire : repenser le
transfert de connaissances pour favoriser le
développement de modèles innovants
d'habitation pour aînés
BINGO! Authentic Happiness and Playfulness
of Older Adult Bingo Gamblers
1
1 ,2
1
C Lavoie , S Garon , A Veil
1
2
Sherbrooke, Québec, Canada, Université de
L'habitation pour aînés s'adapte au resserrement
des règles en matière de certification des
résidences privées pour aînés (RPA). Le nouveau
modèle de très grandes RPA ne convient pas à
tous les aînés ni à tous les milieux. Or, il est
difficile pour les acteurs locaux de développer des
modèles alternatifs aux formules traditionnelles
d'habitation pour aînés.
Ce projet poursuit 3 objectifs: 1) Rendre accessible
l'information produite en recherche aux acteurs
municipaux; 2) Susciter des changements réels
dans l'action; 3) Mesurer l'impact de cette formule
sur les connaissances et perceptions des acteurs
municipaux.
Au départ, un essai de maîtrise en service social
basé sur une recension exploratoire des écrits
visant à décrire des pratiques innovantes en
matière d'habitation pour aînés, puis un atelier
e
présenté au 27 Colloque du Carrefour action
municipal et famille (CAMF). Devant l'intérêt
suscité par ces productions et les nombreuses
questions posées, un projet de capsules
documentaires accompagnées d'un cahier
d'information est déposé pour financement au
programme QADA.
En résulte une nouvelle forme de transfert et
valorisation de la connaissance, soit deux webdocumentaires (rural/urbain) d'une durée de ±15
minutes chacun, un guide d'évaluation des besoins
en habitation, un cahier du participant.
Présentation d'un cours extrait d'une des capsules
documentaires.
Les capsules documentaires seront présentées
dans les municipalités en démarche MADA dans
l'ensemble de la province, via les formateurs du
CAMF, à l'intention des membres des comités de
pilotage MADA et/ou des membres de comités
promoteurs pour le développement d'habitations
pour aînés.
Ardith Finnamore
University of New Brunswick, Fredericton, New
Brunswick, Canada
Studies on the negative effects of gambling and
problem gambling are commonplace. In contrast,
this study investigated the relationship between
authentic happiness and measures of bingo
gambling behaviour, playfulness, and problem
gambling in adults, ages 65 and older (N=92).
Bingo has a long history as a popular gambling
game, especially among older adults in Canada.
Playfulness may be an important characteristic of
cognitive functioning and emotional growth, key
components of healthy aging, which has hardly
been investigated in the research literature of older
adults. Participants completed four hard copy
questionnaires in person at four bingo halls in New
Brunswick, Canada. The questionnaires included a
demographic questionnaire designed by the
experimenter, the Canadian Problem Gambling
Index (CPGI), the Older Adult Playfulness Scale
(OAPS), and the Authentic Happiness
Questionnaire (AHS). In the multiple regression
analysis, the linear combination of the predictor
variables of bingo gambling behaviour,
playfulness, and problem gambling was found to
significantly predict the criterion variable of
2
authentic happiness (R adjusted = .297, F(3,88) =
13.826, p < .01). Furthermore, the CPGI was found
to be a significantly negative and unique predictor
of authentic happiness (semi-partial correlation
coefficient = -.251, p < .01) while the OAPS was
found to be a significantly positive and unique
predictor of authentic happiness (semi-partial
correlation coefficient = .426, p < .01). Lastly,
participants in this sample scored higher than
average on the Authentic Happiness
Questionnaire. Results suggest that if bingo
playing develops into a gambling problem this level
of happiness may decline.
O136
Caring for the whole person through The Royal
Conservatory's ARTS-REHAB Project
Lisa Meschino, Nicole Arends
The Royal Conservatory, Toronto, Ontario, Canada
This paper examines the emergent process of
adapting a creative arts program to the unique
62
considerations of senior patients in a hospital
setting. The ARTS-REHAB Project is a
collaborative, multi-year creative arts program and
research initiative between The Royal
Conservatory and six partner hospitals across
Ontario. The research initiative examines how
meaningful engagement in a weekly creative arts
program can assist older adult rehabilitation
patients to re-enter their communities sooner and
more positively than under standard treatment
regimes. The profound physical and emotional
vulnerability of this diverse, predominantly senior
patient population and the transient nature of their
hospital stay challenge the participants' and the
Artist-Facilitators' ability to establish a consistent
community for creative expression. A
phenomenological approach using pre- and postprogram patient questionnaires and weekly artist
observation logs enables us to describe and
interpret the subjective experiences of the arts
sessions from the perspectives of the participants
and Artist-Facilitators. These perspectives shed
light on how the program's guided format and
curriculum of personal stories and new identities,
sense of purpose, and positive images of the
future continue to evolve to better meet patients'
needs for social wellness. Artist-Facilitator and
participant reflections suggest a shift in
participants' sense of vulnerability, from a
standpoint that engenders uncertainty and fear to
one that inspires independence and community.
Through analysis of these reflections, this paper
suggests what is unique about the ARTS-REHAB
creative arts program for contributing to a wholeperson model of care.
aims to improve the mental wellbeing and physical
activity levels of community dwelling older people
with unmet health needs. The program is funded
for around one hundred participants.
Method: Eleven professional artists were engaged
in 2015. Artists were trained on the role of arts in
health and ageing, occupational health and safety,
and practical strategies for developing and
managing programs for older participants.
Programs were delivered to small groups of around
six participants. Program evaluation used mixed
methods (questionnaires and focus
group/interviews).
Results: Older people were referred from general
practitioners, nurses and allied health
professionals. Participants were matched to an art
form of their preference (dance and creative
movement, visual arts, and music). In postprogram evaluations, participants indicated the
program had benefitted then by providing a
challenge, something to look forward to, a sense of
achievement, and friendship. These reports were
supported by improvements on the WarwickEdinburgh Mental Well-being Scale (WEMWBS).
Improvements in physical function were less
obvious.
Conclusions: The program suggests positive
benefits on wellness for older people. Difficulties
with sustainability outside of specific funding exist.
A volunteer supported model is now being trialled
to address this.
O138
O137
‘Arts on Prescription' - participatory arts to
improve the health and wellbeing of older
people
1
2 ,1
Roslyn Poulos , Christopher Poulos
1
The University of NSW, Sydney, NSW, Australia,
2
HammondCare, Sydney, NSW, Australia
Background & Objectives: The evidence base for
the positive role of participatory arts programs on a
number of wellness domains is growing. However,
evidence remains limited in respect of programs for
older people with conditions and circumstances
associated with ageing, such as frailty and
cognitive impairment, social isolation, bereavement
and carer burden.
The HammondCare "Arts on Prescription" project
Opening Doors: Elder Circles as a Tool to
Address Social Isolation
Trudy Medcalf
Council on Aging of Ottawa, Ottawa, Canada
Along with age, poor health, and other factors,
living with low income can place older adults at
significant risk of social isolation. In 2011 the City
of Ottawa’s Older Adult Plan consultation identified
older adults living with limited resources, including
low income, as being at risk. The Opening Doors
project, federally funded and supported by the
Council on Aging of Ottawa, conducted between
June 2014 and May 2016, was designed to
address social isolation among low-income older
adults, specifically those living in Ottawa
Community Housing (OCH) for seniors. The
Opening Doors project trained a cohort of 10
63
retired older adults as volunteer co-facilitators of
elder circles – a form of learning circle – engaging
small groups of older adult tenants of OCH
communities, through one-hour sessions held
weekly for a period of six weeks, in collaborative
exploration of their experience of growing older.
Discussions were elder-centred, and topics built
each week on comments introduced by
participants. Elder circles provided a learning
opportunity respectful of the contributions of all
participants. The elder circle process gave
participants opportunities for purposeful social
connection. Participants reported feeling validated
by the group, meeting new friends in their OCH
communities, and sharing stories and strategies for
living as older adults, all in a positive environment
where they felt safe. Elder circles are being shown
to foster peer relationship-building for older adults
at risk of social isolation in ways that have high
impact at low cost.
O139
Agent virtuel et personnes âgées font-ils bon
ménage?
1
1
1 ,2
W. B. L. Loued , L. L. Lieb , A. P. Porcher , D. L.
1
2
2
Lorrain , C. G. Guérin , C. C. Chauvin , H. P.
1
Pigot
1
Université de Sherbrooke, Sherbrooke/Québec,
2
Canada, Université de Bretagne Sud,
Lorient/Morbihan, France
Grâce aux nouvelles technologies l'organisation de
la vie quotidienne des ainés sera facilitée et le
maintien à domicile prolongé. Mais le risque de
fracture numérique chez les personnes âgées
incite à trouver des solutions alternatives pour
faciliter l'usage des nouvelles technologies.
L'objectif de cette étude est de concevoir avec les
personnes âgées un agent virtuel pour interagir
avec un calendrier électronique. La méthodologie
retenue est la conception participative avec les
personnes âgées et la construction d'un agent
virtuel basé sur un modèle des émotions. Trois
ateliers ont été réalisés avec 35 personnes âgées
du Québec et de la France habitant dans une
résidence semi autonome. Le premier atelier
concernait les fonctions retenues pour le
calendrier, le deuxième les modes d'interaction
privilégiés et le troisième l'aspect visuel et la
personnalité de l'agent virtuel. A l'issue de ces
ateliers un modèle émotionnel de l'agent virtuel a
été construit pour rendre les interactions plus
naturelles. Les résultats montrent que les
personnes âgées souhaitent avoir un calendrier
électronique à domicile incluant entre autres, la
consultation de la météo, un album des photos
personnelles et l'écoute de radio ou de musique.
Elles apprécient l'usage de l'agent virtuel s'il ne
remplace pas leurs relations sociales et s'il est
accepté par leur entourage. Elles s'attendent à ce
que l'agent virtuel soit fiable et responsable et qu'il
reste discret. En conclusion, les personnes âgées
sont prêtes à innover dans les interactions avec
les nouvelles technologies en autant que l'agent
virtuel soit utile, et agréable.
O140
A mixed methods study of student perceptions
about gerontology
Michelle Silver
Objective: To examine whether and how
expectations about aging changed for students
enrolled in an undergraduate health studies course
in gerontology course at a Canadian research
university.
Methods: At the beginning and end of the course,
a survey questionnaire that included the
Expectations Regarding Aging (ERA-12) survey
was collected among a sample of diverse
university students (n=41) and later analyzed along
with information from three focus groups sessions.
Results: Findings indicate that student perceptions
about aging and gerontology are influenced by
household composition, including the presence of
grandparents, community engagement with
seniors, and cultural orientations toward later life
developmental stages.
Conclusion: As the increasing proportion of older
adults translates to increased demand for health
services, gerontology student perceptions about
aging are gaining importance. Findings have
implications for geriatric health competencies of
students in the health professions.
O141
Aging Content in Health Discipline University
Curriculums
Suzanne Dupuis-Blanchard, Danielle Thériault
Université de Moncton, Moncton, NB, Canada
64
Older adults want to age at home for as long as
possible and prefer to receive care and services in
the community. Our research on human resources
for aging in place has revealed a worrisome trend,
that of few young adults selecting a career in
aging. In fact, most services in the home setting
are provided by women aged 50 and over. One
hypothesis for the lack of interest in a career in
aging could be the lack of content on aging in
university courses. Therefore, the goal of this
quantitative descriptive case study was to identify
the aging related content in university level
courses, specifically in the disciplines of nursing,
nutrition, kinesiology, psychology and social work.
Teaching staff (professors, instructors) in one
university were sent an email invitation to complete
an on-line survey. Descriptive analyses indicates
many variations from one discipline to another from
optional courses related to aging to scarce content
on aging. This case study provides data confirming
the lack of content on aging in disciplines related to
health. Recommendations include repeating this
study in other universities along with community
colleges offering health related programs in order
to better understand the amount of content
students are receiving in their curriculum. With an
aging population, professions may want to
consider minimum competencies in aging for future
students in order to produce health professionals
aware of the needs of seniors.
O142
Everybody Present – How mindfulness and
meditation ‘works’ to educate and inspire the
next generation of gerontologists
Paula Gardner
A growing body of research illustrates mindfulness
– a state of active open attention to the present
moment – can assist students and faculty become
more resilient in responding to the day-to-day
pressures of academia. Among students,
mindfulness enhances academic performance by
increasing attention, memory, problem solving
skills and concentration. For educators,
mindfulness practices positively impact their
mental health and improve the quality of teaching
and learning.
The Mindfulness Experiment is an ongoing
research project examining the integration of
mindfulness practices into university classrooms
and the impact on students, faculty and the
learning environment. In Phase I, undergraduate
Health Sciences students participated in a group
meditation at the beginning of every class (11
weeks). Self-reported surveys (n=356) consisting
of both rating scale and open-ended questions
were administered at the end of the semester to
evaluate the practice and its impact.
Findings suggest mindfulness meditation positively
influences student learning and fosters a calm and
supportive classroom environment. Analysis further
suggests the practice promotes deeper
connections with the course material and cultivates
compassion within participants.
Discussion will include how findings relate to
gerontological education specifically as well as
‘how-to’ strategies for integrating mindfulness and
meditation into post-secondary classrooms.
O143
Introducing the Comic Manifesto as a
Reflection Strategy for Fourth Year Nursing
Students Placed in Long-Term Care
Lori Schindel Martin
Ryerson University, Toronto, Canada
The purpose of this paper is to discuss creative
strategies that support nursing students to practice
family-centered dementia care. The presentation
will outline the process through which students
created individual Comic Manifestos (CMs) for their
final assignment (Al-Jawad & Frost, 2014). The
CMs created visual, emotive and symbolic
representations of the beliefs and values needed
to provide family-centered dementia care. Students
first synthesized key theoretical literature, then
developed CMs that could guide their future
practice. The CMs were powerful, ranging from
drawings to collages. The final class included a
Viewing Gallery during which students discussed
the capacity of CMs to communicate the theoretical
principles of family-centered dementia care.
Analysis revealed the shared belief that family
members should be acknowledged as care experts
and thus be placed together with the person with
dementia at the center of relational care. Students
believed family conversations are entry-to-practice
competencies, but that ultimately novices should
be aware of and accommodate for barriers that
exist in the field. Students observed that the
predominant discourse leads to labeling and
avoiding families considered to be ‘difficult’.
However, it was observed that family-centered
65
approaches were embraced with enthusiasm by
small pockets of professional caregivers. Students
believed that staff co-creation of a unit-based CM
might increase overall application of familycentered care principles and enhance commitment
to involve family members as expert partners in
care. This paper will present an overview of the
assignment expectations, an analysis of the CMs
and how the Viewing Gallery contributed to the
students’ shared understanding.
and Education" described the program's impact on
staff, mentors, visitees, and the homes as a whole.
Conclusions. The preliminary qualitative findings
are encouraging and will help to inform a future
experiential study that will examine the efficacy of
this intervention, which we hope will decrease
depression and loneliness and enhance purpose in
life among those living in residential care.
O145
O144
"It's given me a new life": Experiences of peer
mentoring in residential care
1
1
2
Kristine Theurer , Ben Mortenson , Robyn Stone ,
1
3
4
Melinda Suto , Virpi Timonen , Susan Brown
1
2
Canada, LeadingAge, Washington, DC, Canada,
3
Trinity College Dublin, Dublin 2, Ireland,
4
Schlegel-UW Research Institute for Aging,
Waterloo, ON, Canada
Objectives. Loneliness and depression have been
linked with lack of purpose and are serious mental
health concerns within residential care, including
long-term care homes, assisted living and
retirement homes. Research indicates that
individuals engaged in peer support groups
experience significant benefits, but these types of
programs are rare within residential care settings.
A study was conducted to explore participant's
experiences with an innovative peer support
intervention called the Java Mentorship Program.
In this program volunteers, family members and
residents (mentors) form a supportive team,
receive education and provide mentorship and
visitation in pairs to residents (visitees) that are
lonely or socially isolated.
Method. As part of a larger mixed-methods study
exploring the outcomes associated with the
introduction of the Java Mentorship Program,
qualitative data were collected using a combination
of observations, individual interviews and staff
focus groups over six months among 104 mentors,
70 visitees and 22 staff in 10 residential care
settings.
Results. Our preliminary analysis of the data
identified three themes: 1) "Mutually Beneficial"
described how both mentors and visitees
benefitted from the visits; 2) "Recruitment and
Pairing Matters" described challenges encountered
by staff; and, 3) "Transformative Team Meetings
Educational priorities for hospice palliative
care among healthcare providers across
southwestern Ontario
1
1
Marie Savundranayagam , Allison Gallant , Nicole
1
2
Atkins , Lisa Gardner
1
Western University, London, Ontario, Canada,
2
South West Local Health Integration Network,
London, Ontario, Canada
The absence of minimum education requirements
for healthcare providers in Ontario results in
inconsistent delivery of hospice palliative care. The
purpose of this study was to identify the
educational priorities of healthcare providers who
deliver hospice palliative care in primary care,
acute care, long-term care, and residential
hospices in the South West Local Health
Integration Network in Ontario. Participants
(N=226) included registered nurses/registered
practical nurses, managers, allied health
professionals, medical professionals, personal
support workers, and volunteers. They completed
questionnaires on the current state of education
and training in hospice palliative care. The
questionnaires included two open-ended questions
on educational priorities and unique regional
educational needs, with response rates of 56%
and 46% respectively. The highest proportion of
responses for educational priorities came from
registered nurses/registered practical nurses (60%)
whereas the lowest proportion of responses came
from personal support workers (7%). A content
analysis of responses to the two open-ended
questions yielded the common themes of care
processes, resource availability, interprofessional
educational strategies, and psychosocial support.
Sociocultural care was a theme unique to the
question regarding educational priorities.
Addressing ethical issues at end of life was a
theme identified as a unique regional need.
Implications of the findings are discussed in terms
the educational priorities identified by specific
professional roles and geographic regions.
66
1
O146
Rapport au corps et vieillissement: une étude
exploratoire au croisement des approches
théoriques du parcours de vie et de
l’intersectionnalité
1 ,2
2 ,3
1
I Wallach , I Van Pevenage , L Després , M
1
Lepage
1
Université du Québec à MontréalAM, Montréal,
2
Québec, Canada, CREGÉS- Centre de recherche
et d'expertise en gérontologie sociale, Montréal,
3
Québec, Canada, Université de Montréal,
Montréal, Québec, Canada
En dépit d’une association de la vieillesse à
l’asexualité, la vie intime des personnes âgées
tend à se prolonger et il existe désormais une
pression sociale à maintenir une apparence jeune
et désirable. Loin d’être sans effet, la
dévalorisation des corps âgés dans notre société
peut nuire à l’image corporelle et plus
généralement à la vie intime des personnes âgées.
L’originalité de notre recherche réside dans le fait
que nous souhaitons à la fois documenter
l’influence du vieillissement et celle du parcours de
vie sur la perception du corps des personnes
âgées, tout en tenant compte de leur genre et de
leur orientation sexuelle.
Notre recherche s’inscrit dans le double cadre
théorique de l’intersectionalité et du parcours de
vie. À cet effet, elle s’appuie sur une méthodologie
qualitative qui compare les expériences de quatre
sous-populations âgées, les femmes
hétérosexuelles, les femmes lesbiennes, les
hommes hétérosexuels et les hommes gais. Seize
personnes âgées de 64 à 74 ans ont été
interviewées individuellement à propos de leur vie
intime et de leur perception du corps durant leur
jeunesse, leur vie d’adulte d’âge moyen et à partir
de la soixantaine.
Les résultats préliminaires montrent l’influence du
vieillissement sur la perception subjective du corps
et de la désirabilité pour l’ensemble des
participants, bien qu’elle varie en fonction du genre
et de l’orientation sexuelle. Par ailleurs, les
parcours de vie se révèlent également jouer un
rôle important, mettant en lumière l’influence des
étapes de vie précédentes sur la perception du
corps à un âge avancé.
O147
The Impact of Socialization, RelAte
1
Sabina Brennan , Brian Lawlor , Phyllis Hegstrom
1
2
Trinity College Dublin, Dublin, Ireland, Home
Instead Senior Care, Omaha, USA
2
Research has shown that social isolation amongst
seniors is a precursor to admission to institutional
based care. Increased social isolation is often a
result of illness, frailty, bereavement and
dispersement of family. The Home Instead
approach to providing non-medical personalized
person centred care around the world is based on
the belief that health and ability can improve with
greater socialization. Home Instead Senior Care
partnered to research this hypothesis with
researchers at NEIL (Neuro-Enhancement for
Independent Lives) in the Trinity College Dublin
(TCD) Institute of Neuroscience.
The TCD research team led a project entitled
RelAte, which delivered and evaluated mealtime
interventions over a two-year period. As part of a
randomized controlled trial for RelAte, 100 older
adults living alone at risk of social isolation were
identified, and community volunteers were trained
to deliver the intervention.
All participants were assessed at baseline and
again post-intervention at eight, 12 and 26 weeks.
The research team evaluated the impact of
relationship-based care on: Quality of Life,
Cognitive Function, Social Connection,
Psychological Measures, Behavioral Measures,
Health Utilities Index, and Biological Measures.
The results showed that the people in the
intervention group increased their food enjoyment;
had greater improved self-efficacy; and,
improvement in executive functions over the
course of the study period when compared to the
people who did not receive these meal time visits.
The findings demonstrate the value of
socialization in care of the elderly.
O148
Representations of Sexuality and Dementia in
the Media
1 ,2
Alisa Grigorovich
1
University of Toronto, Toronto, ON, Canada,
2
Toronto Rehabilitation Institute - University Health
Network, Toronto, ON, Canada
Objectives: Dominant socio-cultural discourse
represents persons living with dementia in
67
catastrophic and stereotypical ways, as either
victims of their disease or as victims of healthcare
services. These representations have material and
symbolic repercussions for the social treatment of
persons living with dementia and their
experiences. Recently, media coverage on
dementia has focused on sexuality.
Methods: Drawing on feminist disability, critical
sexuality and dementia scholarship, this paper
presents a discursive analysis of how dementia
and sexuality are portrayed in online media texts
and accompanying visuals. In particular, the
analysis interrogates the dominant discourses
within which sexuality and dementia are described
and interpreted in media reports.
Results: Representations of dementia and
sexuality are predominantly negative, consisting of
descriptions of sexual violence/sexual harassment
committed by and against persons with dementia.
Examples of this type of coverage include reports
of spouses of persons with dementia charged with
sexual assault, reports of sexual assaults
committed by men with dementia, and reports
about men with dementia exhibiting "inappropriate
sexual behaviors" in public. These representations
rarely feature the voicers or perspectives of
persons with dementia, and reflect dominant
ideologies about dementia and gender, and sociocultural anxieties about older and disabled
sexualities.
Conclusions: Media representations construct the
sexuality of persons with dementia as revolting and
dangerous, or the abject. In doing so, they justify
the ongoing stigmatization of persons with
dementia and the suppression of their sexual
rights. This suggests the critical need for
alternative representations that challenge the
exclusion of persons with dementia from the
sexual imaginary.
gaps inherent in both person- and relationshipcentred approaches to care. However it has not
engaged with disability and critical sexuality
scholarship on sexual rights. As a consequence, it
has inadvertently served to prevent consideration
of this fundamental aspect of embodiment in
policy, legislation, and clinical guidelines for
dementia care. We advance a new model of
relational citizenship that recognizes sexuality as
integral to embodied self-expression.
Methods: We draw on scholarship on citizenship,
sexual ethics, embodiment, and relationality to
conceptualize the principles of an ethic of
embodied relational sexuality.
Results: An ethic of embodied relational sexuality
importantly broadens the exclusive goal of
biomedical sexual ethics from only the duty to
protect individuals from harm, to also the duty to
uphold and support their sexual rights in long-term
care settings. This encompasses both the removal
of barriers and the implementation of facilitators
using a multiscalar approach (micro-, meso-, and
macro-level) to cultivate residents' sexual
expression. These include: public health and policy
initiatives to raise awareness and to counteract
deeply seated perceptions of sexuality and
dementia that foster discriminatory and
marginalizing practices; the identification and
correction of current oppressive organizational
practices; and facilitation of residents' sexuality
through the provision of opportunities for sexual
activities and sexual expression.
Conclusions: An embodied relational ethic would
more inclusively and unconditionally support the
sexual rights of persons living with dementia in
long-term care settings by guiding multiscalar
interventions, policies and practices.
O150
Protecting the Rights of Older Persons
Through a New UN Treaty
O149
Relational citizenship, sexual rights, and a new
ethic for dementia care
1 ,2
1 ,2
Pia Kontos , Alisa Grigorovich
1
Toronto Rehabilitation Institute - University of
2
Toronto, Toronto , Canada, University of Toronto ,
Toronto, Canada
Gordon DiGiacomo, Martine Lagacé, Caroline
Andrew
University of Ottawa, Ottawa, Ontario, Canada
The population of the world is ageing rapidly. By
2050, the proportion of the population aged 60 and
over is expected to be twice what it was in 2015.
Objectives: Citizenship is an important movement
in the dementia field that is redressing some of the
68
This demographic transformation is exposing a
major deficiency in the international human rights
regime. As the Secretary-General of the United
Nations, Ban-Ki Moon, has written, "At the
international level, there is still no dedicated
international protection regime for the human rights
of older persons." While women, children, persons
with disabilities, migrant workers, and racial
minorities are rightly the beneficiaries of legally
binding human rights treaties, older people are
not. This has left them without an effective device
to deal with ageism, defined by Robert Butler as
negative beliefs and prejudicial attitudes toward
older persons as well as the ageing process.
After taking note of the global situation of older
persons and providing a short history of previous
efforts to secure a dedicated rights treaty, the
paper seeks to make the case for a global
convention to protect older persons' rights,
showing why it is necessary and why arguments
against a convention are unconvincing.
The paper's basic conclusion is that the reasons
for a rights treaty that is designed with the
particular needs and circumstances of older people
in mind are compelling. Acknowledging that a
treaty is not a panacea, the paper nevertheless
believes that it can be a valuable tool to combat
ageism.
O151
Development and Implementation of a User-led
Neighbourhood Built Environmental Audit Tool
for People with Disability-"Stakeholder
Walkability/Wheelability Audit in
Neighbourhoods" for People with Disability
(SWAN-PWD)
1
1
Atiya Mahmood , Catherine Bigonnesse , Tanveer
1
1
2
Mahal , Habib Chaudhury , Michael Prescott , W.
2
3
Ben Mortenson , Kathleen Martin Ginis
1
2
3
Canada, McMaster University, Hamilton, ON,
Canada
Context: Research indicates that the physical
environment of the neighbourhood influences the
mobility of people using assistive devices many of
whom are older adults. Mobility is linked to
independence, health and quality of life among
people with mobility disability. Documentation of
barriers and facilitators in their neighbourhood built
environment by assistive device users themselves
can enable them to vocalize and advocate their
needs for appropriate neighbourhood design to
support mobility and social participation.
Methods: In this study, 24 participants with
mobility disability collected data in their
neighbourhoods using a user-led neighbourhood
environmental audit tool, "Stakeholder
Walkability/Wheelability Audit in NeighbourhoodsPeople with Disability" (SWAN-PWD). The tool of
89 items was developed to collect objective built
environmental data across five domains:
functionality, safety, destinations, aesthetics and
social aspects keeping accessibility as an
important factor in mind. The participants were
purposefully recruited based on their assistive
device use (i.e., manual wheelchairs, power
wheelchairs, scooters, canes, crutches, walkers).
Data were collected across three neighbourhoods
in Greater Vancouver area on urban design
features (e.g., sidewalk quality, crosswalks and
supportive destinations).
Results: Preliminary results from this study will be
presented on physical environmental features that
facilitate or deter mobility of the study participants
highlighting similarities and difference between 65+
and younger participants with mobility disability.
Conclusion: This audit tool is a resource for
people using assistive device and community
stakeholders to systematically document their
neighbourhood built environment to initiate
environmental change in their communities and
become informed partners in neighbourhood
physical planning and decision-making processes.
O152
The applicability of community-based
participatory research approaches to health
promotion programs for Aboriginal older adults
Lauren Brooks-Cleator
University of Ottawa, Ottawa, Ontario, Canada
Physical activity (PA) programs organized at the
community level are relatively low cost and have
numerous physical, mental, and social benefits for
older adults. In many PA programs, however, there
is an overemphasis on the medical model
perspective of PA that emphasizes the personal
responsibility to maintain a healthy active lifestyle.
Such a model fails to recognize the social and
environmental circumstances for PA participation
69
and the community-based context of PA,
especially for Aboriginal older adults who continue
to be subject to colonial Eurocentric programs. PA
programs are typically developed or evaluated by
“experts” and then implemented on older adults.
As such, we examine how community-based
participatory research (CBPR) approaches can be
used to further program development with
Aboriginal older adults to encourage them to lead
healthy active lives. Programs should be reflective
of participants’ cultures and values, which can be
accomplished by including Aboriginal older adults
and their knowledge in PA programs. To
demonstrate why this approach is needed in PA
programs, we will provide a review of the use of
more traditional, top-down approaches to program
development that typically neglect input from those
who are most actively engaged in the program. We
will then discuss how CBPR approaches to
program development can be useful for addressing
the health of Aboriginal older adults, a significantly
marginalized group in Canada, with examples from
our own research with this population.
O153
New physical activity participation in later life:
Aging actively via bodily enculturation
Meridith Griffin
A disconnect exists between discursive
imperatives to age ‘well' by way of engagement in
physical activity, and the lived experience of the
majority of older adults. This disconnect prompted
an investigation of the experiences of those who
had made the choice to engage in physical activity
in later life. In this scoping study, in-depth
interviews were done with ten adult newcomers to
different physical activity/sport settings
(recreational team, individual lifestyle, group, and
competitive). The objectives were to: (1) explore
the perspectives and experiences of individuals
beginning or returning to physical activity
participation in later life; (2) trace the pathways to
this participation in terms of social, emotional,
psychological, and environmental resources for
(and facilitators of) participation; (3) better
understand the settings and environments that
provide inclusive opportunities for later life
participation (and/or older adults as ‘beginners'
rather than ‘veterans' or ‘continuers'). Here, the
focus is on the first question - specifically, on the
ways in which participants talked about becoming
absorbed in their new chosen activity. Drawing
from contemporary anthropological theory focusing
on the enculturation of bodily practice, findings
reveal the ways in which new styles of moving
were taken on by participants - as they confront
unconscious patterning, unexamined inhibition,
and corporeal reservations that emerged when
challenged by new kinaesthetics. These findings
are linked back to potential avenues and/or
strategies through which more older adults may be
encouraged to view new physical activities as
desirable, accessible, and achievable - even when
a true beginner.
O154
A portrait of the socioecological milieu of
physical activity in low-income older adults
K Saint-Onge
Université du Québec à Montréal, Montréal,
Québec, Canada
This study’s goal is to outline the known
determinants of participation in physical activity by
low-income older adults, focusing on multi-level
factors that may contribute to social disparities in
participation. Physical activity promotion is widely
recognized as a public health practice aimed
toward bettering physical and mental health as well
as life expectancy, autonomy and quality of life in
older adults (Comité scientifique Kino-Québec,
2002 & 2004). Despite numerous studies and
interventions aspiring to increase physical activity
participation, their effects are short-winded and
levels of participation remain low (Taylor et al.,
2004, INSPQ, 2014). This is especially true of
older adults in low-income settings (Blanchet et al.,
2013) where indexes of physical activity, quality of
life and general health are lesser (Le Blanc et al.,
2011). Yet older adults and low-income settings
are insufficiently reached by physical activity
promotion efforts (Yancey et al., 2006). To battle
growing social health disparities in Canadian older
adults and to promote the overall well-being of
those in low-income settings, we must better map
out modifiable intra- and extra-individual factors
allowing to facilitate participation in physical
activity. Pertinent scientific literature is reviewed to
draw multi-level factors within Spence & Lee’s
(2002) Ecological Model of Physical Activity. They
are presented so as to place a greater focus on
community and social determinants that influence
individual characteristics, perceptions and
behaviours. They will be discussed as a means to
consider social equity in the promotion of physical
70
activity to older Canadian adults using a
community psychology approach.
O155
SHIFT — Senior Housing in India, a Future in
Transition.Independent Living Communities at
Glance
M Plard
CNRS, Nantes, France
En Inde, de multiples facteurs structurels,
économiques, culturels et sociaux poussent les
familles et les individus à trouver de nouveaux
arrangements pour prendre en charge les seniors.
En 2014, le pays a franchi la barre des 115
millions de personnes âgées d’au moins 60 ans et
en comptera plus de 350 millions d’ici 2050
(presque 20% de la population totale). Issue de la
middle class, une nouvelle catégorie minoritaire vit
sur un autre modèle que celui de la Indian Joint
Family usuelle. Ils sont financièrement
indépendants, autonomes, ils aiment voyager,
leurs enfants sont parfois installés à l’étranger. À
l’heure de la retraite ils souhaitent poursuivre une
vie confortable et considèrent les différentes
options proposées dans leur pays. En passe de
devenir le plus grand marché mondial de la Silver
Economy en terme de clientèle potentielle, on ne
sait que très peu de choses de cette « industrie
indienne du vieillissement ». Le projet SHIFT
explore un nouvel objet d’étude à la croisée de la
gérontologie sociale, de la géographie des
pratiques immobilières et de la socio.anthropologie. SHIFT regarde précisément
l’impact du vieillissement de la population sur les
modalités de care dédiées aux seniors en Inde et
sur l’organisation territoriale de cette offre. À
travers l’analyse des pratiques et des stratégies
des développeurs immobiliers, la phase
exploratoire consiste ici à proposer un état des
lieux de l’offre « senior living sector in India ».
O156
A Case Study Exploring the Implementation
and Lived Experience of Person-Centred
Dementia Care
Kyle Plumb
Queens university, Kingston, Ontario, Canada
Person-centred dementia care is an approach and
philosophy that has emerged as one that is
synonymous with ‘good’ care. Its core goal of
maintaining and enhancing the remaining
capabilities and personhood of individuals living
with dementia is widely proclaimed as the ultimate
goal of dementia care. Although it is clear why this
approach should be implemented, it is much less
clear how it can be operationalized at a facility
level. A project was carried out in Victoria, British
Columbia in 2013 to analyse person-centred care.
The project applied a layered environment
perspective to capture the contributions of the
physical and social environment in the
operationalization of person-centred care.
Interviews and focus groups were conducted with
managers and staff in a facility dedicated to
providing care for persons with dementia, followed
by a thematic analysis to synthesize the findings.
These approaches were informed by an extended
obsrvational, volunteer period to construct a
personal perspective of the facility and the people
in it. The three major themes that emerged as the
most important influences the care environment
can have in an explicitly person-centred facility
were forming relationships, aligning values, and
maintaining a sense of identity. This spatial
orientation to person-centred care is a contribution
to geographical gerontology and elicits new
understandings of what the approach looks like
and how it is put into practice.
O157
The Aging, Community and Health Research
Unit (ACHRU) - Community Partnership
Program for Diabetes Improves Quality of Life
in Older Adults with Multimorbidity: A
Pragmatic Randomized Controlled Trial in
Ontario
1
1
2
Maureen Markle-Reid , Jenny Ploeg , Kim Fraser ,
1
1
Amy Bartholomew , Noori Akhtar-Danesh ,
1
2
3
Amiram Gafni , Andrea Gruneir , Sandra Hirst ,
1
4
Sharon Kaasalainen , Carlos Rojas-Fernandez ,
2
1
Cheryl Sadowski , Lehana Thabane , Jean
2
5
Triscott , Ross Upshur
1
McMaster University , Hamilton, Ontario , Canada,
2
3
University of Calgary , Calgary, Alberta, Canada,
4
University of Waterloo, Waterloo, Ontario ,
5
Canada, University of Toronto, Toronto, Ontario ,
Canada
Objectives: To examine the effects and costs of
the ACHRU - Community Partnership Program for
Diabetes, compared with usual diabetes care for
older adults (> 65 years) with Type 2 Diabetes
Mellitus (T2DM) and multimorbidity.
71
Methods: A pragmatic randomized controlled trial
was used. Study participants were randomized to
intervention (n=80) or control (n= 79) groups. The
intervention was a 6-month interprofessional
nurse-led program that was delivered by
Registered Nurses and Registered Dietitians from
a Diabetes Education Centre in partnership with
the YMCA or a community centre. Of the 159
eligible consenting participants, 144 (91%)
completed the 6-month follow-up. The 6-month
analyses were based on complete baseline and 6month follow-up data. Outcomes included the
change in health-related quality of life (HRQoL),
depressive symptoms, anxiety, self-efficacy, selfmanagement behaviours, and the costs of use of
health services, from baseline to 6-months.
Results: The 159 older adult participants had an
average of eight chronic conditions, and took an
average of nine prescription medications daily.
Compared with the usual care group, older adults
in the intervention group showed greater
improvements in the mean SF-12 mental health
composite, vitality and general health scores.
These benefits were achieved at no additional cost
than that of usual home care. Significant
reductions were observed in the use of physician
specialists over the study period among
participants in the intervention group.
Conclusions: The findings support the
effectiveness of the intervention in improving
HRQoL, and reducing the use of expensive health
services in older adults with multimorbidity in
community settings.
O158
Examining Aged Care Transitions (EXACT):
Decisions to Transfer from Long-Term Care to
Emergency
1
1
Greta Cummings , Jude Spiers , Carole
2
1
1
Robinson , Rowan El-Bialy , Kaitlyn Tate , Patrick
1
McLane
1
2
University of British Columbia, Kelowna, British
Columbia, Canada
The Examining Aged Care Transitions (EXACT)
study is a two-phase, mixed-methods study that
explores decision-making regarding transitions of
residents from long term care (LTC) facilities to the
emergency department (ED). LTC residents are
typically frail elderly, who can suffer from iatrogenic
effects of unnecessary or avoidable transitions.
The purpose of the study is to: define avoidable
transitions, identify factors that influence decisions
to transfer or not, and identify modifiable attributes
of avoidable transitions. Phase 1 involved in-depth
individual and focus group interviews in 6 LTC
facilities in Alberta, Canada. The sample consisted
of 71 Registered Nurses (RNs), Licensed Practical
Nurses (LPNs), Healthcare Aides, managers, and
family members of LTC residents, in addition to 9
regional Emergency Medical Services (EMS)
Personnel. In Phase 2, an online survey was
distributed among staff and physicians in 18 LTC
facilities, in addition to regional EMS Personnel.
This paper draws on Phase 1 results and Phase 2
preliminary findings. Primary factors contributing to
avoidable LTC-ED transfer decisions include:
healthcare providers’ lack of familiarity with
residents, a shortage of diagnostic and treatment
resources in LTCs, limitations in the staff-family
relationship, and varied interpretations of the
Advance Care Planning policy. We also present a
conceptual definition of avoidable transitions
created based on Phase 1 results and validated in
Phase 2. The implications of these findings lead to
recommendations for changes to policies and
decision-making regarding LTC-ED transitions.
O159
Improving Communications During Aged Care
Transitions: Piloting an Inter-Facility
Communication Form
1
1
Greta Cummings , Sarah Cooper , Garnet
1
1
2
Cummings , Carole Estabrooks , Karen Latoszek ,
3
1
1
Colin Reid , Brian Rowe , IMPACT Team
1
University of Alberta, Edmonton, AB, Canada,
2
Alberta Health Services, Edmonton, AB, Canada,
3
University of British Columbia, Kelowna, BC,
Canada
Communication during long term care (LTC) to
emergency department (ED) transitions is
frequently reported as lacking or deficient. In
association with Alberta Health Services, we pilot
tested a 2 page communication form to facilitate
transmission of handover information between
LTCs, emergency medical services (EMS), and
EDs. We provided tailored, setting specific, training
(LTC, EMS, ED) and a user guide. 90 completed
inter-facility transfer forms were collected from 11
participating LTCs and 1 ED between February 25
and October 30, 2015. In addition, 266 LTC, EMS
and ED staff responded to a post- implementation
survey about the communication form. The
72
communication forms were often only completed
by staff in one healthcare setting (usually the LTC)
and many elements of the form were completed
only occasionally. Based upon form completion,
surveys and research staff study notes, we argue
that the following facilitators and barriers influence
introducing the new interfacility patient transfer
form. Facilitators include healthcare providers’
desire for better communications, and
accompanying improvements in patient care, and
strong recommendations by practitioners in each
setting to develop a consistent detailed checklist to
send to ED with LTC residents. Barriers include
resistance to new processes, staff turnover,
difficulty spreading awareness of the new form
among healthcare providers, and mistrust between
healthcare providers who work in different settings.
O160
Advance Care Planning for the Intensive Care
Unit - Mapping the Gap
1 ,2
2
3
Kristina Miller , Lisa Faden , Lorelei Lingard ,
4
4
1
Valerie Shulz , Asha Rawal , Kristen Bishop , Ravi
4
Taneja
1
Health and Rehabilitation Sciences, Western
2
University, London, ON, Canada, Centre for
Education Research & Innovation, Schulich School
of Medicine & Dentistry, London, ON, Canada,
3
Centre for Education Research & Innovation and
Department of Medicine, Schulich School of
Medicine & Dentistry, London, ON, Canada,
4
London Health Sciences Center, London, ON,
Canada
Introduction: One in five patients die in the
Intensive Care Unit (ICU) in North America, yet it is
unclear whether the average layperson knows
enough about life sustaining options in the ICU to
make decisions about medical care. Hence, we
conducted a qualitative study to ascertain: 1) What
is the state of knowledge about ICU interventions
among healthy elderly laypersons in London, ON?
2) How do healthy elders use their knowledge to
engage in Advance Care Planning (ACP)?
Methods: Using a qualitative research design
informed by constructivist grounded theory, we
conducted 20 semi-structured interviews with
community-dwelling seniors in London, ON.
Participants were were 55 years or older, not
housebound, in apparent good health and had the
ability to make independent decisions about their
health care. Data has been analyzed using the
constant comparative method.
Results: Participants had not factored in the ICU
into their ACP and had limited knowledge of ICU
interventions, characterized by misconceptions
and unrealistic expectations for likelihood of
recovery post-resuscitation. Participants'
preferences for end-of-life (EOL) care were
informed primarily by their conceptions about
quality of life and were adaptable to different
contexts.
Conclusions: The participants in this study
demonstrated limited knowledge of ICU and acutecare interventions. Many expressed a desire to
learn more to improve their ACP. Even among
healthy elders who have engaged in ACP, there is
still a need for more knowledge and explicit
conversations about EOL care options. Typical
discussions with family members about EOL care
may be too vague to offer effective guidance.
O161
Predictors of Family Satisfaction with Nursing
Home Care
1 ,2
3
Amy Restorick Roberts , Yeonjung Lee
1
2
Miami University, Oxford, Ohio, USA, Scripps
Gerontology Center, Oxford, Ohio, USA,
3
University of Calgary, Calgary, AB, Canada
Families are important consumers of long-term
care services. They often remain involved in the
care of their resident loved one after placement
and offer a unique perspective regarding the
quality of services provided. Using a combined
dataset of the 2012 survey state-wide data from
Ohio, USA (27,008 family members from 947
nursing homes) and state inspection reports from
the national Certification and Survey Provider
Enhanced Reporting 4th Quarter Survey in 2011,
we examine the predictors of higher family
satisfaction with nursing home care, taking into
account the characteristics of residents, family
members, and facilities. Ordinary least squares
regression revealed that family satisfaction was
higher when residents had better physical health
and high cognitive functioning and were older than
the average age of 82, and when a longer-term (3+
months) stay was expected. For family members,
satisfaction increases as the frequency of
communication with nursing home staff increases.
However, visiting resident loved ones often and
providing them with personal care decreases
family satisfaction. Spouses were also less
satisfied than adult children or other family. At the
facility level, family satisfaction increases with
73
higher staff retention, higher occupancy rate, a
lower number of nursing home deficiencies,
smaller facility size, non-profit or governmental
ownership status, and lower percentage of
residents relying on welfare (Medicaid).
Recommendations to enhance family satisfaction
in nursing homes include increasing meaningful
family involvement in resident care, increasing
family-to-staff communication, and investing in
efforts to provide high quality care within facilities
such as increasing staff retention and quality
improvement initiatives.
O162
Exploring Intersubjectivity between the person
with dementia and their intimately involved
other
Barbara Tallman
University of Manitoba, Winnipeg, Canada
Objective: This presentation describes a research
study that explores the intersubjectivity between
the person with dementia and their intimately
involved other (couple). Exploration of
intersubjectivity focuses on how self and other are
constructed within the couples’ every day activities
and within the description of their relational life
story.
Methods: Symbolic interactionism defines
intersubjectivity as the effort people make to come
to a mutuality of understanding. This theory directs
attention to, and guides the interpretation of how
self is constructed in day to day interaction as a
reflection of these efforts. A focused ethnographic
approach captures the “emic” or the insider’s
perspective of the participants by using individual
and joint interviews, participant observation and
photo-elicitation.
Results: Thematic analysis and the listening
guide are two analytical approaches that describe
how the intersubjectivity of the couple is being
revealed and shaped within the everyday
experience. Preliminary analysis suggests that the
individuals can experience isolation even within
close interaction. Analysis suggests that couples
do make efforts to overcome their sense of
isolation through their interaction and through their
everyday activities with each other.
Conclusion: Policy and clinical implications of the
results of this research will be discussed. The
knowledge gained from this study can be used to
broaden our understanding of what the couple can
expect through the course of the dementia
experience. Knowledge on what to look for and
how to respond to the relationship will build
capacity to support the couple living in the
community with dementia.
O163
Frailty, neuropathologic markers, and
neuropsychological outcomes in older adults
with dementia
1
2
Joshua Armstrong , Judith Godin , Lindsay
1
1
1
Wallace , Melissa Andrew , Kenneth Rockwood
1
2
Dalhousie University, Halifax, Canada, Nova
Scotia Health Authority, Halifax, Canada
Introduction: Although a number of studies have
linked frailty with cognitive impairment, fewer
studies have examined these constructs together
in relation to brain health. Probing the relationships
between neuropathological lesions, frailty and latelife cognitive function may provide insight into why
some individuals can tolerate more
neuropathological lesions than others. Here, we
examine the National Alzheimer's Coordinating
Center (NACC) database to evaluate the variance
in clinical outcomes explained by frailty, after
accounting for neuropathologic markers.
Methods: Health assessment data from the last
visit prior to death was linked to neuropathology
information collected at autopsy in the NACC. An
accumulation of health deficits frailty index (FI) was
developed using 30 assessment variables.
Hierarchical multiple regression models were
developed to evaluate the separate influence of
control variables (age, sex, education, APOE ε4),
neuropathological markers, and frailty on
explaining variances in two clinical outcome
measures.
Results: After accounting for the control variables,
seven neuropathologic markers accounted for a
significant amount of variation in both the MiniMental State Exam (MMSE; R2 change = 0.170)
and Clinical Dementia rating (CDR; R2 change =
0.168) scores. When the FI was added to these
models, the FI accounted for a significant amount
of additional variation in both the MMSE (R2
change = 0.113) and CDR (R2 change = 0.207)
scores.
74
Conclusions: Consideration of frailty reduced the
explanatory power of neuropathology on clinical
outcomes, suggesting that overall health may play
an important role in the relationship between
neuropathologic lesions and dementia disease
expression in late-onset Alzheimer's disease.
Future work includes a pretest-posttest study at
three LTC facilities in Ontario that will evaluate the
impact of AAA on well-being related outcomes in
residents (e.g., quality of life), as well as in staff
and family members (e.g., satisfaction).
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O164
The Iterative Design of Ambient Augmenting
Activities for People Living with Dementia
1
1
Andrea Wilkinson , Mark Chignell , Judy O'Neill
1
2
Grandview Lodge, Dunnville, Canada
2
Caring for individuals with dementia in long-term
care (LTC) requires the management of responsive
behaviours (e.g., screaming), which affect 60-80%
of residents with dementia, are commonly treated
with anti-psychotic medications, and compromise
well-being of residents and staff.
As part of AGE-WELL WP 6.1, our objective is to
create a wall-mounted interface, called Ambient
Augmenting Activities (AAA) that reduces distress
in residents by providing opportunities to selfinitiate to engage with personalized, meaningful
content.
In this presentation, the user centered design
framework implemented during AAA development
will be described, including design, development,
and evaluation phases.
End user evaluations were conducted with
residents and staff at Grandview Lodge LTC, which
highlighted several key design recommendations –
e.g., minimize physical strength requirements, do
not include present day photographs, and occlude
electrical components from residents’ view.
In addition, we are holding workshops with key
stakeholders to incorporate user input into the AAA
design. At our “Living with Dementia” workshop,
input was gathered from older adults and
caregivers by collecting “Getting to Know Me”
surveys, and asking attendees to complete a
design thinking exercise to learn about ideal
personalized content and reminiscent
needs/interests, and creative designs for dementia
specific activities. More information will be
collected from caregivers of elderly informants at
an upcoming workshop in Simcoe County.
Ageing with disability. A lifecourse perspective
Eva Jeppsson Grassman
Linkoping University, National Institute for the
Study of Ageing and Later Life, Norrkoping,
Sweden
The aim is to discuss what it means to live a long
life, to age, and to become old for people who
have disabilities acquired early in life. This
question was explored from a lifecourse
perspective by means of prospective and
retrospective, qualitative methods, in a broad
research program.
Extensive and varying results emanated from the
seven studies, yet when the results were
compared, common themes also emerged.
Multidimensional patterns of time, along with age,
and the severity of the illness trajectory are
conditions that impacted on the lifecourse of
disabled people, not least on later life. In old age,
life seemed to become more like that of other
people and "third-age lives" were possible in some
cases. But the unique experience of having lived a
long life with disability continued to shape life in old
age. In the center was the failing body: disability is
seldom connected with stable properties, it is more
adequate to see it as a transitional process. A
common theme concerned worries about the
future. They seemed to increase with age and with
additional illness complications. The worries
concerned the unpredictable body, the fear of
losing the rights to assistance and support from
family members. Another concern had to do with
the fear of having a short life and with premature
death.
The intersection between age and disability brings
to the fore new insights concerning the meaning of
growing old, and about what it means to live and
age with early onset disabilities.
O167
Design and Evaluation of an Interactive Frailty
Test Battery for Older Adults
75
1
1
2
Tiffany Tong , Mark Chignell , Mary Tierney ,
3
4
Marie-Joseé Sirois , Judah Goldstein , Marcel
5
6
2
Edmond , Kenneth Rockwood , Jacques Lee
1
2
3
Canada, Centre Hospitalier Universitaire de
4
Québec, Ville de Québec, Québec, Canada, Nova
Scotia Health Authority, Nova Scotia, Canada,
5
Université Laval, Lavel, Québec, Canada,
6
Canada
Older adults have a higher risk of functional
decline and becoming frail, which can impact their
ability to live independently, increase their
vulnerability to disease, and impact their ability to
carryout daily tasks (Rockwood 1994, Speechley
1991). As many as 21% of older adults in Canada
meet at least one criterion for frailty (McDowell
1994; Hogan 1990). Frail adults must frequently
rely on emergency services for their frailty-related
health care. Thus, the emergency department is a
prime location for assessing an individual's frailty
status, in order to prevent further deterioration.
Existing functional screening methods in
emergency care settings are often inadequate due
to low sensitivity, and lack of empirical support
(Laupacis 1997) or validation (Shah 2004). We
designed a digital tool that can identify high at-risk
patients for frailty, and that can be used by patients
and caregivers as well as physicians and
paramedics. Our presentation will discuss the
design and usability findings associated with this
tablet-based interactive battery of frailty measures.
Functional states of elderly adults were assessed
during their admission to emergency care. We will
present our findings on the concurrent validity of
the digital frailty and functional assessments. This
study was carried out in both French and English
across three different Canadian provinces with
over 200 patients. The Clinical Frailty Scale (CFS)
(Rockwood 2005) had strong correlations with
(instrumental) activities of daily living and other
functional measures. In addition, CFS ratings by
research personnel correlated more strongly with
patient and caregiver ratings than did the physician
ratings.
O168
2
Canada, University of Waterloo, Waterloo,
3
Ontario, Canada, McMaster University , Hamilton,
Ontario, Canada
Background: Early frailty measures included
cognitive impairment, but more recent frailty
measures have not considered cognitive loss.
Objectives: To determine if cognitive impairment
is associated with five year mortality after
accounting for the effect of frailty, and to determine
if there is an interaction between frailty and
cognitive impairment.
Methods: We conducted a secondary analysis of a
prospective cohort study of 1751 older adults
followed over a five year period. Frailty was
defined as a score of greater than 0.25 on the
frailty index (FI) and cognitive impairment was
defined as a score of less than 26 on the Minimental State Examination (MMSE). The outcome
was time to death. Cox proportional hazards
models were constructed and adjusted for age,
gender and education. Interaction terms between
the FI and MMSE were included in the models.
Results: Both the FI and MMSE were strong
independent predictors of mortality, and there was
no interaction. The unadjusted Hazard Ratio (HR)
(95%Confidence Interval (CI)) for mortality was
2.17 (1.69, 2.80) for those who were only
cognitively impaired; 2.02 (1.53, 2.68) for those
who were only frail; and 3.57 (2.75, 4.62) for those
who were both frail and cognitively impaired.
Adjusted for age, gender and education, the HR
(95%CI) was 1.49 (1.13. 1.95) for those who were
only cognitively impaired; 1.81 (1.35, 2.41) for
those who were only frail; and 2.28 (1.69, 3.09) for
those who were both frail and cognitively impaired.
Conclusion: There is a strong cumulative effect of
frailty and cognitive impairment on mortality.
O169
The psychometric properties of a modified sitto-stand test with use of the upper extremities
in institutionalized older adults
1 ,3
The Cumulative Effect of Frailty and Cognition
on Mortality - A Prospective Cohort Study
1
2
3
Philip St John , Suzanne Tyas , Lauren Griffith ,
1
Verena Menec
1
1
1
Mélanie Le Berre , David Apap , Sarah Bray ,
1
2
Jade Babcock , Esther Gareau , Kathleen
2
2
1 ,4
Chassé , Nicole Lévesque , Shawn Robbins
1
McGill University, Montreal, Quebec, Canada,
2
Ste. Anne’s Veterans Hospital, Montreal, Quebec,
3
Canada, Lady Davis Institute for Medical
4
Research, Montreal, Quebec, Canada, Constance
76
Lethbridge Rehabilitation Centre, Montreal,
Quebec, Canada
Objectives: Current sit-to-stand (STS) protocols
do not permit use of upper extremities, limiting the
protocols' utility for institutionalized older adults.
The objective of this study was to modify a 30second STS (30STS) protocol to reflect a more
realistic method of standing for older adults by
allowing for arm use and to examine test-retest
reliability and convergent validity with the Timed
Up and Go Test (TUG).
Methods: A previous version of the 30STS
protocol was modified by permitting upper
extremity use. Fifty-four institutionalized older adult
men (age=91±3 years) residing in a long-term care
hospital performed the 30STS and the TUG twice
within a span of 3-7 days. Test-retest reliability
between the two test sessions was determined
using ICC model 2,1 with 95% confidence
intervals, standard errors of measurement (SEM)
with 95% confidence intervals, minimal detectable
change scores at 90% confidence (MDC90) and
Bland-Altman plots. Convergent validity between
the 30STS and TUG was examined using Pearson
correlation coefficients with 95% confidence
intervals.
Results: Results suggest good test-retest reliability
(intraclass correlation coefficient=0.84) and
convergent validity with the Timed Up and Go Test
(r= -0.62).
Conclusions: This modified 30STS can be used to
assess physical function performance in
institutionalized older adults, and will ensure that
individuals with lower physical function capacity
can complete the test, thus eliminating the floor
effect demonstrated with other STS protocols.
O170
Too Frail for Surgery? FACT Screening in the
Pre-Operative Setting
1 ,2
1 ,2
Paige Moorhouse , Laurie Mallery , Heather
1 ,2
1 ,2
Moffatt , Ruth Ellen
1
2
Canada, Division of Geriatrics, Halifax, Nova
Scotia, Canada
Objective: Frailty has recently been acknowledged
as an independent predictor of poor surgical
outcomes [1] and as such, has challenged
traditional surgical decision making processes in
regards to high-risk patients [2]. Using the Frailty
Assessment for Care Planning Tool (FACT) to
identify and stage frailty in the pre-operative
setting, this study aims to describe the complex
presentation and drivers of frailty as well as the
subsequent decision-making observed amongst
this population.
Methods: Patients that are ≥75years complete the
FACT with the pre-operative nurse and their
caregiver through the scoring of a chart that
outlines the patient's baseline function, cognition,
social, and mobility. The nurse evaluates the
patient's cognition using a brief test and tabulates
the score, which correlates with a frailty staging
level (1-9). Depending on the FACT derived
severity of frailty, the patient will be referred on for
further consultation before their scheduled
procedure.
Results: 55 patients from the pre-operative clinic
have been screened for frailty over 9 months. Data
analysis showed that 50% of the population was at
least mildly frail. Cognitive assessment found that
38% of the patients failed the MiniCog
assessment. 14 patients were referred on for
further assessment, after which 86% decided to
postpone or decline their pending surgery.
Conclusions: Our results found that overall there
is a high degree of frailty amongst the preoperative population ≥75years old facing imminent
surgical intervention, and that identification and
assessment of frailty has an impact on the
decisions made about whether to proceed with the
scheduled procedure.
O171
Key Stakeholders' Views on the Quality of Care
and Services Available to Frail Seniors in
Canada
1 ,2
1
Anik Giguère , Valérie Carnovale , Jayna
3
4
Holroyd-Leduc , Arminee Kanzanjian , Sharon
5
6
1
Straus , Robin Urquhart , Erik Breton , Mohamed1
3
7
Amine Choukou , Selynne Guo , Serge Dumont ,
8 ,2
1
Pierre Durand , France Légaré , André
8
9 ,10
1
Tourigny , Alexis Turgeon , Michèle Aubin ,
8
René Verreault
1
Department of Family Medicine and Emergency
Medicine, Laval University, Quebec, Quebec,
2
Canada, Center for Excellence on Aging, SaintSacrement Hospital, Quebec, Quebec, Canada,
3
Division of Geriatrics Departments of Medicine
77
4
and CHS, Calgary, Alberta, Canada, School of
Population and Public Health, University of British
Columbia, Vancouver, British Colombia, Canada,
5
Department of Medicine, University of Toronto,
6
Toronto, Ontario, Canada, Department of Surgery,
7
Canada, Faculty of Social Sciences, Laval
8
University, Quebec, Quebec, Canada, Department
of Social and Preventive Medicine, Laval
9
University, Quebec, Quebec, Canada, Division of
Critical Care Medicine, Laval University, Quebec,
10
Quebec, Canada, l'Enfant-Jésus Hospital,
Quebec, Quebec, Canada
Introduction: To improve outcomes important for
frail seniors (FS), health care should match the
values of patients, caregivers, and clinicians. Thus,
we explored their views of the barriers and
facilitators to the quality of care and services
available to FS.
Methods: This mixed methods study comprises a
survey and semi-structured individual interviews.
We purposefully sampled FS, caregivers,
clinicians, and managers/policy-makers - involved
in FS care- from Nova Scotia, Quebec, Ontario,
Alberta and British Colombia (n=42). In the survey,
the participants prioritized 36 indicators of the
quality of care (IQC) provided to FS. Interviews
explored participants' views on the quality of care
and services available to FS which were grouped
into barriers and facilitators using a thematic
qualitative data analysis (NVivo).
Main Findings: Increasing quality of life (QoL) was
the most valued IQC; as it ensures meeting
patients' goals, and is more important than
prolonging their life. Increasing clinician skills came
next; because this indicated gaps in providers'
skills which are important for care delivery and
QoL. The four other IQC prioritized were:
increasing patient satisfaction and family doctor
continuity of care over the last year of life, and
decreasing patient symptoms and caregiver
burden. Several barriers were discussed on the
current organisation of care in Canada which lacks
a holistic approach to assess FS needs, and is not
adapted to incurable conditions. Patient-centered
care with an emphasis on continuity was valued by
participants.
Conclusion: Study findings can lead to meeting
stakeholders 'values leading to the proper
utilization of healthcare resources.
O172
Réflexions tirées d’une évaluation pilote d’un
programme visant à aider les aînés à « Rester à
l’écoute »
1
1
Kadia Saint-Onge , Luc Dargis-Damphousse ,
2 ,3
2 ,3
Jean-Pierre Gagné , Tony Leroux , Martine
4
3
3
Lagacé , Martine Gendron , Sylvie Belzile ,
3
Micheline Petit
1
Université du Québec à Montréal, Montreal,
2
Québec, Canada, École d’orthophonie et
d’audiologie, Université de Montréal-CRIR,
3
Montreal, Québec, Canada, CIUSSS-CSMTLRaymond-Dewar , Montreal, Québec, Canada,
4
Université d’Ottawa, Ottawa, Ontario, Canada
Le tiers des personnes âgées de 65 ans et plus
aurait une perte auditive assez importante pour
entraîner des problèmes de communication
(Statistique Canada, 2002). Cette proportion
augmente considérablement avec l’âge. Or, les
aînés consultent peu les professionnels de santé
pour leurs difficultés auditives (Kochkin et al., 1993
et 2007). L’autostigmatisation associée à la perte
auditive et au vieillissement semble représenter un
obstacle important à la demande d'aide et de
services. Le programme d'intervention par les
proches « Rester à l'écoute » a été conçu pour
tenter de contrer l’autostigmatisation liée à la perte
auditive et au vieillissement respectivement. Cette
présentation a pour but de présenter les détails de
l’évaluation de l’implantation du programme et de
suggérer des pistes pour son amélioration.
L’évaluation a été effectuée en 2 temps. D’abord, 4
intervenantes ont été formées à animer les deux
volets du programme d’intervention (vieillissement
et difficultés auditives). Ensuite, le volet difficultés
auditives a été implanté auprès de 4 dyades
(proche - aîné). L’implantation du programme s’est
avéré réaliste et faisable dans les délais prévus.
Les animatrices et les participants ont rapporté une
bonne appréciation des activités et du déroulement
du programme. Des analyses descriptives
exploratoires suggèrent qu’un plus grand
échantillon de participants permettrait d’observer
des changements dans les niveaux
d’autostigmatisation des aînés. Cependant, le
recrutement de participants s’est avéré un défi de
taille. Des leçons tirées du processus de
recrutement pour ce programme innovateur seront
exposées.
78
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O174
« J’utilise ce que l’approche met à ma
disposition et je peux me dire que j’ai fait tout
ce que je pouvais pour aider mon client »
Volunteering and social capital: A case study
of older hospital volunteers in Southern
Ontario
Pierre-Yves Therriault, Ginette Aubin, Lyne
Desrosiers, Marie-Michèle Lord
Université du Québec à Trois-Rivières, TroisRivières, Québec, Canada
Saranjah Subramaniam, Miya Narushima
Brock University, St. Catharines, Ontario, Canada
Problématique Préoccupés par la qualité de vie
des personnes vivant avec la maladie d’Alzheimer
et de leurs proches, quatre organismes de la
région de Brome-Missisquoi se sont mobilisés pour
développer un continuum de services centré sur
l’Approche de rehaussement de la qualité de vie
des aidants et de leur proche atteint de troubles de
mémoire (ARQVAP). À l’hiver 2014, une étude
pilote a été réalisée avec des auxiliaires familiaux
en soutien à domicile (AFSD) et a mis en lumière
les impacts positifs de cette approche tant pour les
aidés, leurs aidants que pour les intervenants
impliqués. En 2015-2016, un nouveau projet qui
poursuivait, entre autres, l’objectif d’apprécier les
impacts de cette implantation sur les acteurs
concernés a été réalisé.
Objectif/Méthode L’objectif de la communication
est de discuter des résultats d’une enquête en
psychodynamique du travail menée auprès
d’AFSD œuvrant dans une coopérative de
services.
Résultats Il a été montré qu’un manque de
communication, tant sur le plan vertical (avec
l’organisation du travail ou le(s) aidant(s))
qu’horizontal (entre pairs) constituait un frein
certain à l’établissement de rapports sociaux dans
le travail signifiant.
Discussion/Conclusion Ainsi, même si
l’ARQVAP est basée sur l’établissement de tels
rapports, dans le contexte organisationnel, les
outils de régulation ne peuvent être partagés,
l’expertise particulière des uns ne peut être
transmise aux autres et les règles de métier ne
sont pas remises collectivement en débat, puisque
les travailleurs ne se retrouvent presque jamais
ensemble. Cependant, l’ARQVAP offre des
mécanismes de communication efficaces avec la
clientèle.
Volunteering as a form of social participation can
facilitate older adults’ active aging through
community engagement. The purpose of this
qualitative case study was to understand the views
on older adults’ volunteerism in a community
hospital network in Southern Ontario. Utilizing indepth interviews with 10 older volunteers (over the
age of 65), document analysis, and a key
informant interview, the study explored their
experiences of volunteering and social capital
development at six hospitals in the network. Data
analyses included open and axial coding, as well
as conceptualization of the themes. Four major
themes emerged: reasons to volunteer,
management’s influence, negative experiences of
volunteering, and connections with others. The
findings emphasized older volunteers’ strong
commitment and enthusiasm to support their
hospitals, the power of volunteering to enhance the
development of bonding, bridging, and linking
social capital, and the influence of two major
contextual factors, the Auxiliary Factor and the
Change Factor, to facilitate or hinder older
volunteers’ social capital development. Future
research should focus on further unpacking the
different degrees to which each type of social
capital is developed, placing emphasis on the
benefits of its development for volunteers in
healthcare settings. Practical implications include
the targeted recruitment of older adults as
healthcare volunteers, as well as sustaining
hospitals’ existing long-term volunteers by
enhancing facilitating factors for social capital
development, and mitigating the negative effects of
the Change Factor. By developing social capital
through hospital volunteering, older adults can
engage in active aging, while participating in
developing an age-friendly community.
O175
L'apport de bénévoles universitaires pour
faciliter la communication des résidents vivant
en CSLD
79
1
1 ,2
Mélina MacLean , Linda Garcia , Annie
1
3
1 ,2
Robitaille , Lynn McCleary , Martin Bilodeau ,
1
1
1
Geneviève Lemay , Jacinthe Savard , Mary Egan ,
1
1
Christine Lacelle , Marie Agapitos
1
University of Ottawa, Ottawa, ON, Canada,
2
Bruyère Research Institute, Ottawa, ON, Canada,
3
Brock University, St Catharines, ON, Canada
Objectif: La communication est essentielle à la
prestation des services de santé, et les
communautés de langue officielle minoritaire sont
particulièrement désavantagées lorsqu'elles
reçoivent des services dans la langue majoritaire.
L'objectif de ce projet est de décrire si la langue
utilisée pour communiquer avec les résidents
facilite ou nuit au bien-être des résidents et
d'identifier les changements à cet égard.
Méthodes: Des résidents en Centre de soins de
longue durée (CSLD) sont jumelés avec des
bénévoles universitaires avec qui ils passent six
heures par semaine, pendant 18 mois. Les
bénévoles parlent tous la langue de préférence
des résidents avec qui ils sont jumelés. Ces
derniers remplissent des fiches d'observation
après chaque visite qui leur permettent de réfléchir
sur leurs expériences. Un des thèmes de ce
questionnement est celui du langage et de la
communication. Les réflexions des bénévoles sont
analysées qualitativement en utilisant des
techniques d'analyse de contenu.
Résultats: La participation sociale des résidents
repose sur la langue et la culture; deux éléments
fondamentalement intégrés en CSLD. Les
résidents en milieux de minorité linguistique
(francophones en CSLD anglophone ou vice
versa) vivent des difficultés de communication
avec le personnel et leurs pairs. Par contre, la
présence d'un bénévole parlant leur langue de
préférence semble améliorer la communication et
la participation sociale puisqu'ils agissent comme
porte-paroles ou traducteurs pour leurs résidents.
Conclusion: La présence de bénévoles semble
améliorer la qualité de vie des résidents et le fait
qu'ils parlent la même langue que le résident
contribue grandement à cette fin.
O176
Public Guardians: An Overlooked Abuser of
Seniors
1 ,4
1
Ura Greenbaum , Rebecca Nussenbaum
1
Association for the Defense of People and
Property under Public Curatorship, Montreal,
2
Canada, Association for the Defense of People
and Property under Public Curatorship, Montreal,
3
Canada, NDG Community Committee Against
4
Elder Abuse, Montreal, Canada, Table de
concertation des aînes de Montréal, Montreal,
Canada
Canadians at age 65 can on average expect to live
another 20 years and projections predict unabated
growth in the number of seniors every year until
2050. The incidence of chronic disability increasing
sharply with advancing age, a large number of
decisionally-impaired people are elderly.
Guardianship is the substitute decision-making
mechanism for people who for causes beyond their
control are unable to exercise reasoned decisions.
Nuclear families and mobility dispersing relatives
leave less candidates as guardians. When there is
no one available, public guardian offices have
been created to fill the void. Public guardianship
has become a mainly elders' issue, yet the
relationship between public guardians and elder
abuse has received scant attention. Our research
derives from reports by external investigators that
examined the performance of public guardians in
the three most populous provinces - Quebec,
Ontario and British Columbia - and on the federal
level over the past quarter century. Vertical and
horizontal reviews reveal that while elders are
becoming the principal clients, abuse by public
guardians has been persistent and widespread,
repeatedly inviting intervention by public
authorities. Devised for the purpose of
protecting those who have no one else to help
them, public guardianship, paradoxically, has
added to the fold a heretofore unsuspected
abuser. The results invite questions on why public
guardianship in Canada fails so often and whether
as currently structured it is an appropriate model
for substitute decision-making. Public guardians
must be closely supervized internally and
intensively scrutinized from outside. More research
and critical thought should also be directed to this
venerable but still obscure institution.
O177
L'évolution de l'âge effectif de la retraite et de
son effet sur le taux d'emploi global au Canada
1
1
Yves Carrière , Diane Galarneau , Jacques
1
2
Légaré , Janice Keefe
80
1
2
Université de Montréal, Montréal, Canada, Mount
Saint Vincent University, Halifax, Canada
Les baby-boomers ont été à l'origine de
nombreuses transformations des cycles de vie
familiale et professionnelle lors de leur entrée dans
la vie adulte. Ces transformations semblent vouloir
se poursuivre alors que ces cohortes sont à
l'origine d'une hausse des taux d'emploi chez les
55 ans et plus, accompagné d'un report de la
retraite. Cette présentation examine :
1. L'évolution récente et future de l'âge effectif de
la retraite et de la durée de la retraite chez les
cohortes nées entre 1921 et 1966.
2. L'effet de la poursuite du report de la retraite sur
le taux d'emploi global.
3. L'âge effectif de la retraite requis pour maintenir
constant la proportion de l'espérance de vie à 50
ans passée à la retraite et son impact éventuel sur
le taux d'emploi global.
L'âge effectif de la retraite des cohortes nées entre
1921 et 1966 sera estimé à partir des données de
l'Enquête sur la population active et de projections
basées sur divers scénarios de variation des taux
de retraite volontaire et involontaire (pour raison de
mises à pied, maladie ou pour s'occuper d'un
proche).
L'âge effectif de la retraite devrait continuer sa
progression au cours des prochaines années,
entraînant une hausse des taux d'emploi chez les
55 ans et plus. Il est fort probable que le poids des
années de retraite par rapport à l'espérance de vie
à 50 ans ne soit pas plus important chez les
futures cohortes de retraités qu'il ne l'est
aujourd'hui.
O178
Fears about growing old, age, and gender:
Which fears should be overcome for
postretirement satisfaction?
Satoko Nguyen
Sundai Michigan International Academy, Novi,
Michigan, USA
Laslett predicted that the Third Age launched at
retirement. Yet, it is little known that Laslett also
mentioned that the Third Age accompanied fears
about growing old. By surveys conducted at senior
centers in Ontario, Canada, with an instrument
Fears About Growing Old (FAGO) that we created
from Laslett's 14 exemplifications (Nguyen, Tirrito,
& Barkley, 2014), social-participation related
measures, and gender, Laslett theory was verified
first in the world as far as we knew. That is, the
Third Age could be a crown of a life through social
participation, but accompanied the fears. To find
structure of the fears, this time, I conducted a
factor analysis for the instrument FAGO. FAGO
comprises three fear factors: loss of competency,
loss of sociability, and end of life. Moreover, to
examine what specific fears correlated with
postretirement life satisfaction or retirement
satisfaction by age and gender, I conducted
multiple regression analyses (level of significance:
0.05). For males aged 50 and 65 years or older,
fears related to loss of sociability (i.e., loss of
earning power and funeral planning) negatively
correlated with only their retirement satisfaction.
For females aged 50, 65, and 75 or older,
meanwhile, fears related to end of life (i.e., loss of
beauty) and/or loss of competency (e.g., inability to
recall, loss of keenness, and loss of mobility)
negatively or positively correlated with mostly their
life satisfaction. Thus, males showed needs for
postretirement sociability, whereas females
required overcoming fears about end of life and
loss of competency to have life satisfaction.
O179
Challenging Identities: Women's attempts to
construct their identities through the rejection
of traditional discourse around late-life
transition
Deborah K. van den Hoonaard
St Thomas University, Fredericton, NB, Canada
This paper examines the dissatisfaction older
women express with identity discourse around the
transitions of retirement and widowhood. The data
on which it is based come from two in-depth
interview studies. The first looked at the
experiences of baby-boomer women who had
retired within the previous five years while the
second involved conversations with women over
60 whose husbands had died within the previous
10 years. Using a symbolic-interactionist
theoretical perspective, both studies interrogated
participants' negotiation of their new status and
how it affected their social identity. Both studies
found that participants tended to reject the
traditional discourse that names them as "retirees"
and/or "widows." They articulated negative images
81
and stereotypes associated with those terms and
distanced themselves from those images. Several
participants argued that there ought to be another
word to describe themselves that would not carry
with it the negative connotations implicit in the
discourse. The paper concludes that increasing
individualism within society provides a social
context that allows women to challenges taken-forgranted discourse in new and unexpected ways.
O180
A capabilities approach to ageing well: Shifting
the lens to include all older people
Christine Stephens, Mary Breheny, Fiona Alpass
Massey University, Palmerston North, New
Zealand
The ‘successful ageing' model has been an
important influence on research, intervention, and
public policy for three decades. This paper
summarises the widespread critiques of this model
and empirical support for their unintended negative
effects on the wellbeing of older people through
oppressive policies, a focus on individual
responsibility, and denial of death. The paper then
turns to discuss how a ‘capability approach' (Sen,
1987) to the wellbeing of older people can address
each of these problems and provide a new socially
oriented framework for research, policy, and
intervention. The capability approach takes into
account the influence of the social and material
environment and the values of older people
themselves. From this perspective, understanding
the nature of wellbeing shifts to understanding the
freedom people have to pursue the life they value.
A capabilities approach recognises differences in
health, education, and social connections that
influence this freedom, and additionally accounts
for social and cultural diversity in preferences.
Sen's capability approach provides a framework to
support new theoretical approaches to research
and social change such as that suggested by the
World Health Organisation's 2015 report on
Healthy Ageing built around the new concept of
functional ability. The paper will discuss how the
adoption of a capabilities approach to frame
research, practice, and social policy could
influence the way in which ageing is constructed
by all, including older people themselves.
O181
Older Adults’ Perceptions of their Ability to
Remain Active: A Qualitative Study Using
Structuration Theory
Emmanuelle Bélanger, Johanne Filiatrault,
Katherine Frohlich
Université de Montréal, Montréal, Québec, Canada
Objectives: The World Health Organization
defines active aging as “the process of optimizing
opportunities for health, participation and security
in order to enhance quality of life as people age”
(2002). Active aging represents a promising public
health model that emphasizes both older adults’
resources and contributions, as well as the
structural limitations that exist in their environment.
The research question guiding this study was:
What are older adults’ perceptions of their ability to
remain active as they age in the context of their
social and physical environment?
Methods: This descriptive qualitative study
consisted of deductive content analysis inspired by
structuration theory, which recognizes the
relationship between structure (rules and
resources of society) and agency (ability to deploy
a range of causal powers). We conducted semistructured interviews with 15 independent
community-dwelling adults living in Montreal
(Canada), aged over 65.
Results: Provided that they were free of major
health issues and cognitive impairment,
participants described Montreal as a city where
there were few barriers to active aging, with
affordable social activities, available transportation,
adequate health services (with some accessibility
issues), and limited threats to safety. In terms of
agency, participants emphasized their ability to
adapt to worsening health and disability, to seek
help and health services, and to pursue activities
that made their lives meaningful.
Conclusions: Although participants acknowledged
certain physical barriers when structure interacted
with poor physical health, they emphasized their
agency in remaining active as they age.
O182
The association between a mentally stimulating
lifestyle and better cognitive function in older
adults persists after adjustment for diet quality
and health behaviours: the Nutrition and
Cognition (NutCog) study
82
1
3
Matthew Parrott , Alexandra Fiocco , Pierre4
5 ,6
Hugues Carmichael , Guylaine Ferland , Carol
1 ,2
4 ,7
Greenwood , Danielle Laurin , Bryna
5 ,6
8
Shatenstein , Pierrette Gaudreau , Sylvie
5 ,9
10
11
Belleville , José Morais , Hélène Payette ,
5
Marie-Jeanne Kergoat
1
Rotman Research Institute, Baycrest Health
2
Sciences, Toronto, ON, Canada, Department of
Nutritional Sciences, University of Toronto,
3
Toronto, ON, Canada, Department of Psychology,
4
Ryerson University, Toronto, ON, Canada, Centre
d’excellence sur le vieillissement de Québec,
5
Québec, QC, Canada, Centre de recherche,
6
Montréal, QC, Canada, Département de nutrition,
Université de Montréal, Montréal, QC, Canada,
7
Faculté de pharmacie, Université Laval, Québec,
8
QC, Canada, Centre de recherche du Centre
hospitalier de l’Université de Montréal, Montréal,
9
QC, Canada, Département de psychologie,
10
Division of Geriatric Medicine, McGill University,
11
Montréal, QC, Canada, Centre de recherche sur
le vieillissement, Institut universitaire de gériatrie
de Sherbrooke, Sherbrooke, QC, Canada
Background: A mentally stimulating lifestyle
(MSL) is associated with better cognitive function
in older adults, but few studies comprehensively
control for diet or other health behaviours. Our
objective was to prospectively examine the
association of MSL with tests of global cognition
(GC), episodic memory (EM), and executive
function (EF) in community-dwelling older adults
after controlling for often unexplored confounders
like diet quality.
Methods: A binary MSL indicator was calculated
based on self-reported education, occupational
complexity, and social engagement for participants
of the NutCog study (n=351, mean age=74 y), a
sub-study of the Québec Longitudinal Study on
Nutrition and Aging. GC, EM and EF were
assessed using the Modified-Mini Mental State
Examination, RL/RI-16 free and cued recall task,
and the Stroop test respectively. Diet quality was
defined as adherence to empirically derived eating
patterns. Associations between the MSL indicator
and cognitive test performance were assessed
over two years of follow-up using multiple-adjusted
mixed models.
Results: At baseline, MSL was positively
associated with a high quality ‘prudent' eating
pattern (P=0.003) and inversely associated with a
low quality ‘Western' eating pattern (P=0.051).
MSL was associated with better GC (P<0.001) and
EF (P=0.001) at baseline after adjustment for sex,
age, diet quality, physical activity, and smoking.
MSL was not associated with EM, or decline on
any cognitive test in fully-adjusted models.
Conclusions: MSL was associated with better
cognitive function after comprehensively adjusting
for diet quality and other health behaviours. MSL
appeared to especially benefit EF.
Supported by Canadian Consortium on
Neurodegeneration in Aging.
O183
Individual and environmental factors
contributing to social participation in aging
adults, Quebec, Canada
D. Naud, M. Levasseur
Research Center on Aging, Sherbrooke, Québec,
Canada
Objectives: This study verified the associations of
individual and environmental factors with social
participation in aging adults.
Method: The cross-sectional 2008-2009 Canadian
Community Health Survey ¬- "Healthy Aging" was
analysed (N=5,217, 45 years old and over, in
Quebec, Canada). Social participation was
estimated by combining monthly frequencies of
engagement in eight types of community activities.
Individual factors were assessed by a series of
sociodemographic and health related questions.
Environmental factors were measured using
Desktop Mapping Technologies Inc.'s Points of
interests and Statistics Canada's 2006 census, at
the dissemination area (DA) level. Because of the
low count of individuals per DA, multilevel
modelling was not suitable and hierarchical
stepwise regression models were realised,
controlling for age, gender and health condition.
Results: Among environmental correlates, greater
social participation was associated with socially
favoured areas (p=0.05) and living in a small town
(30K-99K; p<0.01), surprisingly, proximity to
services was not significant. Among individual
correlates, greater social participation was
associated with being a women (p<0.001), having
at least a high school diploma (p<0.01), being born
in Canada (p=0.01), doing physical activities
weekly (p<0.001) and having a driver's licence
(p<0.001). Together and controlling for age and
health condition, these individual and
environmental factors explained 24% of the
83
variance in social participation (p<0.001).
Conclusions: According to variables considered in
these databases, individual factors seemed to
contribute more to social participation than
environmental factors. Providing decision makers
with a better understanding of factors contributing
to social participation is essential for designing a
favourable environment for aging adults.
O184
The impact of supervisory support and health
care aid self-determination on individualized
care in long-term care settings
1
2
Sienna Caspar , Kathy McGilton
1
University of Lethbridge, Lethbridge, AB, Canada,
2
Toronto Rehabilitation Institute, Toronto, ON,
Canada
Purpose: Individualized care is described as an
interdisciplinary approach to care that
acknowledges care recipients as unique persons
and is practiced through consistent staff-resident
relationships. Individualized care is widely
recognized as best practice in long-term care
(LTC) facilities. The purpose of this study was to
examine the influence of supportive supervisory
practices and health care aides' (HCAs) selfdetermination (motivation supported by intrinsic
tendencies to behave according to one's beliefs
and values) on HCAs' perceived ability to provide
individualized care to LTC residents.
Design and Methods: A cross-sectional study was
carried out in four LTC facilities in Western
Canada. A total of 131 HCAs participated in the
study. Stepwise multiple regression was used to
answer our research questions. Individual-level
HCA predictors were entered at Step 1 and
measures of supervisory support and HCA selfdetermination at Step 2 with individualized care as
the outcome.
Results: The total variance explained by the final
regression model was 44.4%, F (2, 121) = 48.3, p
< .0001. In the final model, only supervisory
support and self-determination were statistically
significant, with self-determination recording a
higher beta value (beta = 0.18, p < .0001) than
supervisory support (beta = 0.11, p < .0001).
Implications: Developing initiatives aimed at
supporting HCAs' self-determination in LTC
settings and focusing on developing supportive
supervisory relationships with HCAs may be
important and effective means by which to
increase the provision of individualized care in
these institutions.
O185
Predictors of Care Aide Burnout: Modifiable
Features of the Work Environment in Long
Term Care
1
1
Stephanie Chamberlain , Matthias Hoben , Andrea
1
2 ,3
1
Gruneir , Janet Squires , Greta Cummings ,
1
Carole Estabrooks
1
2
3
Ottawa Hospital Research Institute, Ottawa,
Ontario, Canada
Background: Our study examined care aide
attributes, organizational context, and frequency of
dementia-related resident responsive behaviours
associated with burnout. Burnout is defined as the
experience of emotional exhaustion, cynicism, and
lack of professional efficacy. Care aide burnout has
implications for turnover, staff health, and quality of
care.
Methods: We used surveys collected from 1194
care aides from 30 urban nursing homes in 3
Western Canadian provinces. We used a mixedeffects regression analysis to assess individual and
organizational predictors of care aide burnout. We
measured burnout using the Maslach Burnout
Inventory, Short Form.
Results: We found that care aides were at high
risk for emotional exhaustion and cynicism, but
report high professional efficacy. Statistically
significant predictors of emotional exhaustion
include English as a second language, medium
facility size, organizational slack-staff,
organizational slack-time, health (mental and
physical) and dementia-related responsive
behaviours. Statistically significant predictors of
cynicism include age, English as a second
language, unit culture, evaluation (feedback of
data), formal interactions, health (mental and
physical) and dementia-related responsive
behaviours. Statistically significant predictors of
professional efficacy were unit culture and
structural resources. Greater care aide job
satisfaction was significantly associated with
increased professional efficacy.
84
Conclusion: This study suggests that individual
and organization features are both predictive of
care aide burnout. Unlike individual or facility
characteristics, elements of the organizational
context are potentially modifiable, and were
associated with each of the three burnout sub
scales.
O186
Structural Impact on Gendered Expectations
and Exemptions for Family Caregivers in
Hospice Palliative Home Care
1
2
Nisha Sutherland , Catherine Ward-Griffin , Carol
2
3
McWilliam , Kelli Stajduhar
1
Lakehead University, Thunder Bay, ON, Canada,
2
Western University, London, ON, Canada,
3
University of Victoria, Victoria, BC, Canada
Evidence of gender differences in the amount and
type of care provided by family caregivers in
hospice palliative home care suggests potential
inequities in health and health care experiences.
As part of a critical ethnographic study examining
gender relations among seniors with cancer, their
family caregivers, and primary nurses, this
presentation describes gendered expectations and
exemptions for family caregivers within the
sociopolitical context of end-of-life at home. Data
were collected from in-depth interviews (n=25);
observations of agency home care visits (n=9); and
analyses of policy and home care agency
documents (n=12).
Employing a critical feminist lens, a gender-based
analysis revealed that hospice palliative home care
policies draw on a distinction between public and
private spheres to construct end-of-life at home as
natural and apolitical. Embedded in institutional
discourses of privacy, autonomy and self-efficiency
of the family was an implicit assumption that family
would assume responsibility of care, shaping
gendered expectations and exemptions and
limiting choices and opportunities for both male
and female caregivers. Findings from this study
suggest that in addition to aiming interventions at
individual caregiver’s needs and problems, health
care providers and policy makers require a critical
perspective to assist them to view how the family
caregiver role is shaped by structures that control
the availability of social supports and resources.
End-of-life at home should be considered a public
rather than a family responsibility, thus directing
interventions towards the social, political, and
economic conditions that shape gendered
experiences.
O187
Partenaires dans le continuum de soins et de
services? Point de vue de proches aidants de
personnes en perte d’autonomie vivant avec
une maladie chronique ou une démence
1 ,6
2
Marjolaine Landry , Marie-Pascale Pomey ,
2
3
Philippe Karazivan , Djahanchah P. Ghadiri ,
2
4
5
Nicolas Fernandez , Louise Belzile , Mathieu Roy
1
Université du Québec à Trois-Rivières, -, Canada,
2
3
Université de Montréal, -, Canada, HEC
4
Montréal, Montréal, Canada, Université de
Sherbrooke et Centre de recherche sur le
5
vieillissement, -, Canada, CIUSSS de l’Estrie 6
CHUS, -, Canada, IUPLSSS du CIUSSS de
l’Estrie - CHUS, -, Canada
Les objectifs de cette étude visaient notamment
à identifier, du point de vue de proches aidants de
personnes âgées atteintes d’une maladie
chronique ou d’une démence, les facteurs facilitant
et les facteurs limitant leur intégration comme
partenaires aux professionnels de la santé. Dans
le cadre de cette étude exploratoire, neuf (n = 9)
proches aidants, soit huit femmes et un homme,
ont accepté de participer à une rencontre de
groupe focus enregistrée, et dont les verbatim
furent analysés suite à un co-codage. Les
principaux résultats de l’étude indiquent que les
proches aidants identifient le fait qu’ils ne se
sentent pas considérés comme de réels
partenaires de soins avec les professionnels de
santé à travers le continuum. À cet effet, une
perspective utilitariste de leur rôle est soulignée à
quelques reprises par les participants dont à
travers le constat qu’ils ont le sentiment d’être les
employés des professionnels de la santé et d’avoir
l’impression d’être laissés à eux-mêmes, sauf
lorsque les professionnels auraient besoin d’eux.
Les résultats indiquent aussi que les
connaissances des proches aidants ne seraient
pas systématiquement considérées dans la
relation avec les professionnels. Un manque de
fluidité de transmission de l’information entre les
intervenants ainsi qu’un certain manque de
connaissances de leur part notamment quant aux
ressources d’aide est aussi souligné. Cette étude
met en lumière certains éléments pouvant
contribuer à mieux soutenir les proches aidants
comme partenaires ainsi que la pertinence de
développer des mécanismes pour mieux intégrer
85
ceux qui le désirent comme réels partenaires de
soins.
O188
Examining the Diversity of Older Adult Centres
across Ontario
1
2
1
Christine Sheppard , Lise Dube , Anita Myers ,
3
Sue Hesjedahl
1
2
Canada, St. Clair West Services for Seniors,
3
Toronto, Ontario, Canada, Older Adult Centres'
Association of Ontario, Caledon, Ontario, Canada
Conclusions: The findings illustrate the diversity
of OACs and the influence of centre characteristics
on program offerings, challenges experienced, and
evaluation practices.
O189
Making the Most of Mealtimes: Preliminary
findings from a national prevalence study on
food intake in long-term care
1
2
Objectives: As little is known about older adult
centres (OACs), our objectives were to: 1) profile
OACs to determine who they serve, the programs
and services offered and associated challenges;
and 2) examine how factors such as centre type
and size influence challenges concerning funding,
infrastructure and service delivery.
Susan Slaughter , Christina Lengyel , Natalie
3
4
5
Carrier , Lisa Duizer , Catriona Steele , Heather
6
Keller
1
2
3
Canada, University of Moncton, Moncton, New
4
Brunswick, Canada, University of Guelph, Guelph,
5
6
Ontario, Canada, Schlegel-University of Waterloo
Research Institute for Aging, Waterloo, Ontario,
Canada
Methods: An e-survey was sent to 126 OACs
across Ontario; 79 (59%) completed the survey.
Data was analyzed to compare centre type (Nonprofit (NP) versus municipal), size, and stand-alone
(SA) status (SA versus part of a community
agency).
Introduction: Older adults living in long-term care
(LTC) facilities are nutritionally vulnerable. The
purpose of the CIHR-funded Making the Most of
Mealtimes (M3) prevalence study is to measure the
extent of poor food intake and its determinants for
older adults in LTC.
Results: Centres varied widely with respect to
number of staff (0-69), volunteers (10-730), and
budgets (13K-3.6M); size impacted operational
characteristics. Participants were primarily female,
aged 65-84 (68%). Common programs were
games (96%) and exercise (95%); common
services were health promotion (73%), foot care
(60%), falls prevention (51%), chronic disease
management (42%), and elder abuse (41%). NPs
were more likely to offer ethno-cultural (p=.013)
and night (p=.004) programs. NPs were more
concerned about obtaining/sustaining funding
(p=.07) and utility costs (p=.004), while
small/medium centres were more concerned with
attracting volunteers (p=.018); SA centres reported
concerns with building structure limiting growth
(p=.017) and keeping participant fees affordable
(p=.02). NPs, SA and medium/large centres were
more likely to do strategic planning (p<.05). NPs
were more likely to obtain participant feedback via
focus groups or interviews (p<.05) and use
standardized measures to assess outcomes
(p<.05).
Method: Twenty residents were randomly sampled
from each of 32 representative LTC facilities in
Alberta, Manitoba, Ontario and New Brunswick.
Approximately half were for-profit and half not-forprofit. Food intake was measured and observed for
639 residents (≥65 years; medically stable; English
or French speaking). A wide range of determinants
of intake were measured at the resident, staff,
facility and provincial levels, and across the key
domains: meal quality, meal access and mealtime
experience.
Results: Participants' mean age was 86.8±7.8
years; 69% were women; 65% of participants had
dementia. Less than half (43%) had normal
nutritional status. Over half (59%) of participants
met the dietary reference intake for protein.
Nationally, 43% of participants were at risk for
dysphagia. Alberta residents had the highest
dysphagia risk (65%) compared with the lowest
risk in Ontario (28%). Nationally, 23% required
some degree of physical assistance to eat. Mean
mealtime duration was 40±13 minutes. Eating
challenges of participants were identified.
86
1 ,5
2
Conclusions: This landmark prevalence study
provides an in-depth examination of the food and
fluid intake of LTC residents and examines the
resident, staff, facility and provincial factors
associated with intake. Next steps for this research
program are to prioritize and pilot complex
interventions targeting the most influential
determinants of food intake.
Shari Brotman , Andrea Daley , Melissa St.
2
2
3
Pierre , Judith A. MacDonnell , Jane Aronson ,
4
Loralee Gillis
1
2
McGill University, Montreal, QC, Canada, York
3
University, Toronto, ON, Canada, McMaster
4
University, Hamilton, ON, Canada, Rainbow
5
Health Ontario, Toronto, ON, Canada, CREGES,
O190
This presentation addresses the issue of homecare
in the context of aging within LGBTQ communities.
It describes the unique experiences of queer older
adults and their caregivers in providing/receiving
care and the invisibility of these relationships within
mainstream health and social care services. Using
findings which emerged from a mixed methods
study on LGBTQ homecare access and equity in
Ontario, this presentation describes the unique
realities faced by communities in their efforts both
to provide care and to be recognized by/gain
access to homecare services. The findings
presented provide a basis for reconsidering how
LGBTQ older adults and their caregivers are
perceived by and experience home/care services,
and demonstrate resistance and resilience in
developing alternative forms of support to
complement, or in the absence of appropriate care,
identify other care options. Recommendations for
transforming mainstream home care services are
highlighted through the introduction of an adapted
Access and Equity Framework.
Invisible Labour, Invisible Workers: A Scoping
Review of Home Support Worker Safety
Marilyn Macdonald
Dalhousie University, Halifax, Canada
Life expectancy is increasing in high income
countries accompanied by rising rates of chronic
diseases and varying levels of disability. The
inability to perform at least one activity of daily
living for people 75 and older varies from a low of
17% in a high income country to 40% in
developing countries (WHO Health and Aging,
2015). The need for assistance with activities of
daily living in this country is largely met by family
members and home support workers. Although
injury rates for home care workers are not
available, those for nursing home workers in the
US are and they triple the national average across
all industries. In Canada workers in health and
social services industries lead the way in injuries
with 40,814 in 2013, exceeding manufacturing and
construction injury rates (Association of Workers
Compensation Boards of Canada). The safety and
wellbeing of healthcare workers in general and the
home support worker in particular is the subject of
this scoping review. Four patterns associated with
HSW safety were identified: work environment
induced injuries (particularly musculoskeletal
disorders), interpersonal factors, injury prevention
initiatives, and human resources planning. The
work environment of the HSW is non-standardized
and unpredictable, leaving the worker unable to
employ learned strategies to prevent injuries.
Home support workers spend considerable time
with clients and extended family and require
considerable skill and knowledge to navigate the
home situation. Injury prevention research and
initiatives need to consider the unique and
unpredictable nature of the home setting.
O191
Re-imagining ‘homecare' in the context of
aging within LGBTQ communities
O192
Characterizing changes in expected health care
resource utilization among home care clients in
Ontario
1
1
4
Brent Gali , Paul Brewster , Jeff Poss , Cheryl
2
5 ,1
3
Beach , Carl V. Asche , Andrew R. Mitz , Sandra
1
1
1
R. Hundza , Julie Gorenko , Debra Sheets , Stuart
1
W.S. MacDonald
1
University of Victoria, Victoria, BC, Canada,
2
Canadian Institute for Health Information, Ottawa,
3
ON, Canada, Laboratory of Neuropsychology,
Division of Intramural Research, National Institute
of Mental Health, National Institutes of Health,
4
Bethesda, MD, USA, University of Waterloo,
5
Waterloo, ON, Canada, University of Illinois
College of Medicine at Peoria, Peoria, IL, USA
Background: Supporting seniors with complex
health needs at home is an increasing priority in
Canada. As the aging population increases, the
demand for services that support home care will
become of even greater importance. This study
87
aims to identify changes in health care utilization
over time among home care clients in Ontario.
Methods: We conducted a population-based
cohort study of Ontario home care clients aged ≥65
years who completed at least two Resident
Assessment Instrument – Home Care (RAI-HC)
assessments using the CIHI Home Care Reporting
Service database. We used existing measures:
Resource Utilization Group-version 3 for Home
Care (RUG-III/HC) and CMI (Case Mix Index) in
the RAI-HC to assess changes in expected health
care resource utilization. Linear mixed models
were used to estimate changes in the CMI among
individuals over time.
Results: The study sample (n=314,851) was
predominantly 85+ years of age (62%) and female
(61%) with over 9.5 years of follow-up time. At the
time of first assessment, 20% had dementia, 56%
co-resided with a caregiver and the mean CMI was
1.0. The rate of CMI increased by 0.09 yearly
when adjusted by age and sex (p<0.0001). We
also found that dementia status increased the CMI
rate by 0.04 (p<0.0001) and informal caregiver
status decreased the CMI rate by 0.03 (p<0.0001).
Conclusions: Relative to baseline, we observed a
10% annual increase of expected health care
utilization for the population. We are presently
developing a prediction model to identify those at
greatest risk for becoming a high resource user.
O193
Electronic Coordinated Care Plan in South
Simcoe Northern York Region (SSNYR)
HealthLink
1
on the Healthlinks goal of reducing health care
costs for complex patients while enhancing the
experience for those patients with the greatest
health care needs. All heathcare providers within
Healthlinks and the Central Local Health Integrated
Network (LHIN), including hospitals, physicians, inhome support services and a wide variety of
community partners, are now able to work together
to provide integrated services to achieve best
practice patient care. The implementation of a
standardized and collaborative approach across
the LHIN means that patients have timely and
relevant access to the care and resources they
need, while avoiding unnecessary trips to acute
healthcare institutions. Change concepts includes
a Healthlink Care Coordinator to share the care
plans electronically to care team members. The
CCPs are accessible by care team members at
point of care, for example in ED, at the clinics or
other care centres. To date, SSNYR Healthlink has
uploaded 240 CCPs with multiple Health Service
Providers involved. Our work has demonstrated
decrease in ED visits and Hospitalizations.
O194
Early Advance Care Planning: Opportunities,
Barriers and Limitations
1 ,2
2
3
Kristina Miller , Lisa Faden , Lorelei Lingard ,
4
4
1
Valerie Shulz , Asha Rawal , Kristen Bishop , Ravi
4
Taneja
1
Health and Rehabilitation Sciences, London, ON,
2
Canada, Centre for Education Research &
Innovation, Schulich School of Medicine &
3
Dentistry, London, ON, Canada, Centre for
Education Research & Innovation and Department
4
of Medicine, London, ON, Canada, London Health
Sciences Centre, London, ON, Canada
1
Ana MacPherson , Rosalyn Gambell , Anna
1
1
2
Morrison , Amanda Hearn , Debra Walko
1
Southlake Regional Health Centre, Newmarket,
2
ON, Canada, LOFT, Newmarket, ON, Canada
Healthlinks is a coalition of community partners
providing intese care coordination with enhanced
collaboration between patients and their care team
to develop a documented Coordinated Care Plan
(CCP). The CCP Project is an innovative new
approach to the delivery of care for chronic
disease and complex patients. Through enhanced
utilization of existing services, healthcare providers
can now instantly and securely collaborate to
better serve the needs of complex care patients.
This initiative is a crucial systems change, focusing
Introduction: Most older Canadians have not
completed their Advance Care Plans (ACPs).
While experts advocate developing ACP early,
while in apparent good health, evidence does not
yet show that early ACP results in better end of life
(EOL) care. Therefore, this study investigated the
nature of ACP-related activities in healthy elders in
order to understand the barriers and opportunities
that exist for promoting early ACP.
Methods: Using a qualitative research design
informed by constructivist grounded theory, 20
community-dwelling seniors (65 ± 7.2 yrs) who had
the ability to make independent decisions about
their health-care participated in semi-structured
interviews. Four months later, we followed up with
88
a subset of 10 participants to find out whether their
ACPs had changed in the interim. Interviews were
audio-recorded and transcribed. Data is being
analyzed using the constant comparative method.
Results: Preliminary results indicate that
participants had made progress with their ACPs
since the first round interviews. Their decisionmaking was strongly influenced by personal
experiences rather than knowledge of clinical
interventions. In most cases, lack of context for
future scenarios in which ACPs would be utilized
precluded tangible decision-making.
Conclusions: Our research shows that healthy
laypersons are challenged to construct ACPs that
express concrete preferences for EOL care.
However, participants were able to become more
explicit about their conversations with their
substitute decision makers. These findings suggest
that the focus of ACP should be on meaningful
discussions about values and rather than on
decisions about specific interventions.
O195
Traumatisme crânien mineur chez les
personnes âgées : facteur de déclin fonctionnel
?
1 ,2
2 ,4
1 ,4
AAB Brousseau , ME Émond , MJS Sirois ,
3 ,5
3 ,6
3 ,7
3
RD Daoust , LEG Griffith , EL Lang , JL Lee
,9
3 ,8
10 ,11
1 ,3
, JJP Perry , MCO Ouellet
, RV Verreault ,
2 ,11
2 ,11
SB Berthelot , EM Mercier , NAB Allain1 ,3
1
11
Boulé , VB Boucher , PAT Tardif , NLS Le
2 ,3
Sage
1
Centre de recherche du CHU de Québec, Axe
Santé des Populations et Pratiques optimales en
santé, Unité de recherche en vieillissement,
2
Québec, QC, Canada, Département de Médecine
Familiale et Médecine d'Urgence, Québec, QC,
3
Canada, The Canadian Emergency Department
Team Initiative, on Mobility in aging, Québec, QC,
4
Canada, Centre de Recherche du CHU de
Québec et Centre d'Excellence sur le
Vieillissement de Québec, Québec, QC, Canada,
5
Hôpital du Sacré-Coeur de Montréal, Université
6
de Montréal, Québec, QC, Canada, Department of
clinical Epidemiology and Biostatistics, McMaster
7
University, Hamilton, ON, Canada, Bumming
School of Medicine, University of Calgary, Calgary,
8
ALB, Canada, Department of Emergency
Medicine, School of Epidemiology, Population,
Health and Preventive Medicine, University of
9
Ottawa, Ottawa, ON, Canada, Department of
Emergency Services and Scientist, clinical
epidemiology unit, Sunnybrook Health Sciences,
10
Toronto, ON, Canada, Centre de Recherche et
Centre Hospitalier Universitaire de Québec,
11
Québec, QC, Canada, Centre de recherche du
CHU de Québec, Axe Santé des Populations et
Pratiques optimales en santé, Unité de recherche
en Traumatologie, Québec, QC, Canada
Introduction : Les traumatismes crâniens mineurs
(TCm) chez les personnes âgées sont fréquents et
les conséquences fonctionnelles à long terme sont
encore méconnues.
Objectifs : Comparer le déclin fonctionnel chez les
patients de 65 ans et plus ayant subi un TCm à
ceux ayant subi un traumatisme mineur sans TCm.
Méthode : C’est une analyse post-hoc effectuée
sur une base de données prospective provenant
de 8 départements d’urgence canadiens. Les
patients inclus sont âgés de 65 ans et plus,
préalablement autonomes et ayant consulté à
l’urgence pour un traumatisme mineur. L’issue
principale est le déclin fonctionnel à six mois
mesuré dans les deux groupes à l’aide du test
validé OARS. Le statut cognitif et l’impact
fonctionnel d’une blessure concomitante a été
évalués et comparés dans les deux groupes.
Résultats : Un total de 344 patients dans le
groupe TCm et 582 dans le groupe traumatismes
mineurs sans TCm ont été inclus. Après six mois,
10.8% des patients du groupe TCm ont subi un
déclin fonctionnel comparé à 11.9% dans l’autre
groupe (RR=0.91 [IC 95% 0.62-1.32]). Le risque
relatif de souffrir d’un déclin cognitif à six mois est
de 0.95 [IC 95% 0.73-1.24]. Enfin, la présence
d’une blessure concomitante dans le groupe TCm
ne semble pas affecter le déclin fonctionnel
(RR=1.16 [0.60-2.25]).
Conclusion : Dans une population gériatrique, le
fait de subir un TCm ne semble pas être associé
avec un pronostic fonctionnel plus défavorable,
comparativement aux traumatismes sans TCm.
O196
Traumatic Brain Injuries and Falls in Older
Adults
Steven McFaull, Jenini Subaskaran, Natasha
Kuran, Wendy Thompson, Simone Powell
Public Health Agency of Canada, Ottawa, Canada
89
Falls are the leading cause of head injury
hospitalizations among adults over 60 years.
Resultant traumatic brain injuries (TBI) are
important outcomes of falls among older adults.
The Seniors' Falls in Canada: Second Report
noted that TBI contribute to morbidity related to
injury-causing falls, however there was limited
analyses of data specific to this type of injury. This
presentation will shed more light on TBI as a factor
in hospitalization-linked falls for older Canadian
adults, risk factors, and fall prevention measures.
Methods: Cases were extracted from the Hospital
Morbidity Database (HMDB, Canadian Institute for
Health Information). Incidents were included if the
most responsible diagnosis was an intracranial
injury, the external cause of injury was a fall and
the patient was age 60 years and older.
Results: In 2010, 50% of the 17,558
hospitalizations related to traumatic brain injuries
across Canada were experienced by adults 60+.
Falls accounted for 78% of hospitalizations for
TBIs in older adults. These findings will be related
to the data and risk factors on older adult falls
published by the Public Health Agency of Canada
to ascertain appropriate points of intervention.
Conclusions: TBI resulting from a fall is a
significant issue for adults over the age of 60 in
Canada. The increased hospitalization rate related
to falls among older adults, in addition to the
increased number in the Canadian population will
only escalate this issue. This data can help to
identify key points of intervention to prevent the
falls and associated TBIs.
O197
Enhancing quality of life in seniors with
neurocognitive disorders: A rapid review and
development of a Decision Box
1 ,3
2 ,3
Émilie Fortier-Brochu , Michèle Morin , Philippe
3 ,5
3 ,6
1 ,2
Voyer , Edeltraut Kröger , France Légaré ,
1 ,2
7
Holly Witteman , Charo Rodriguez , Bernard
8
1
Martineau , Juliette Bruneau-Lafontaine , Beatriz
1
1 ,3
Valera , Anik Giguère
1
Department of Family Medicine and Emergency
Medicine, Université Laval , Québec, Canada,
2
Research Center of the CHU de Québec, Québec,
3
Canada, Quebec Excellence Center on Aging,
4
Québec, Canada, Department of medicine,
5
Université Laval , Québec, Canada, Faculty of
nursing, Université Laval , Québec, Canada,
6
Department of Pharmacy, Université Laval,
7
Québec, Canada, Department of Family Medicine
and Emergency Medicine, McGill University,
8
Montréal, Canada, Department of Family Medicine
and Emergency Medicine, Université de
Sherbrooke, Sherbrooke, Canada
Background: In our recent study, key
stakeholders valued quality of life (QoL) the most
as an indicator of the quality of senior care. We
reviewed the impact of interventions on QoL in
seniors with neurocognitive disorders (SwNDC),
and developed a Decision Box to support shared
decision-making between clinicians, seniors and
caregivers when choosing among these
interventions.
Methods: We identified secondary sources
(scientific summaries, guidelines, systematic
reviews) reporting the impact of any intervention
on QoL in SwNCD. We then searched for primary
studies to fill gaps in evidence. We prioritized
inclusion of systematic reviews, then randomized
controlled trials (RCT) and other study designs. We
extracted designs, sample sizes and probabilities
of benefits/harms. We converted all probabilities in
absolute risk reductions (ARR). We assessed
quality of evidence using the GRADE approach.
We then asked 3 experts in the care of SwNCD to
validate the Decision Box content. A single
reviewer conducted each step.
Results: Out of 1596 screened, we included 46
reports (18 systematic reviews, 1 scoping review,
22 RCTs, 5 other designs; 22 interventions, 16
non-pharmacological). QoL was a primary outcome
for only nine of these interventions. QoL improved
with: cognitive stimulation (ARR=66%), personcentered interventions (ARR=48%), therapeutic
robots (ARR=42%), art therapy (ARR=42%),
memory clinic consultations (ARR=14%) and
interventions targeting caregivers (ARR=12%).
QOL did not improve with pharmacological
interventions. Number of potential harms by
intervention ranged from 0 to 6 (e.g. side effects,
accessibility).
Conclusions: Evidence on interventions to
improve QoL in SwNCD remains scarce. A few
non-pharmacological approaches seem potentially
helpful.
O198
90
2
Mind over matter: Exploring Parkinson’s
disease, health-related perceptions and
behaviours, and optimal aging
Ben-Gurion University of the Negev, Be’er Sheva,
Israel
Christie Silversides, Brad Meisner
Dalhousie University, Halifax, NS, Canada
Research examining optimal aging, despite a
degenerative disease diagnosis, is a burgeoning
area of gerontology. Parkinson’s disease (PD) is
the most common neurological disease associated
with aging, after Alzheimer’s, affecting almost
70,000 Canadians. This prevalence will increase
as baby boomers age. The symptomology of PD is
unpredictable with losses in independence, quality
of life, and mental health. Evidence shows that
health-promoting behaviours can delay/attenuate
some negative aspects of PD; however, these
behaviours are not often endorsed. The objective
of this study was to gain a deeper understanding of
how the diagnosis of PD influences health-related
perceptions and behaviours in an optimal aging
context. Qualitative data were collected through
one-on-one, semi-structured interviews with five
individuals with PD, diagnosed within the last five
years, from the Maritimes. Interviews were
transcribed and analyzed using constant
comparison coding procedures. Thematic results
indicated that: a) PD affects physical, mental, and
social well-being, over time, from pre-to-post
diagnosis; b) as PD progresses, participants’
priorities shifted from physical health to an
emphasis on mental and social health; c)
participants’ proactively maintained a sense of
control over their PD through participation in
health-promoting interventions, self-advocacy, and
social support seeking; and d) engagement in
health-promoting behaviours was partially
motivated by the desire to reduce dependence on
pharmaceuticals and to mitigate strained
relationships with PD healthcare providers. Overall,
findings demonstrate the need to represent PD as
a complex disease, but with simultaneous,
dynamic, multi-dimensional, and under-recognized
health processes. Implications on future PD
research, policies, and practices will be discussed.
Though there is a high rate of comorbidity between
bipolar disorder (BD) and substance use, and
considerable individual and societal costs of this
comorbidity, research is limited on why substance
misuse is so pervasive among those with BD. Such
research is even more limited among samples of
middle-aged and older adults. The current
exploratory study used a life course perspective to
examine substance use over time and across
mood states (e.g., depression vs. mania) in a
sample of middle-aged and older adults who selfreported BD and regular substance use. The
research question guiding this work was, What are
the current and lifetime experiences, meanings,
and interpretations of substance use in a sample of
adults living with BD? In-depth semi-structured
interviews were collected from 12 participants (9
women and 3 men; mean age 49 years old) from
five countries (Canada, United States, New
Zealand, Australia, and South Africa). Thematic
analysis revealed participants’ personal theories
regarding the comorbidity of BD and substance
use. Primarily, participants endorsed the use of
alcohol and drugs, particularly marijuana, as a form
of self-medication, which has evolved over their
lives. Participants reported the use of alcohol and
drugs to relieve stress or help regulate emotions;
and discussed why they use substances to selfmedicate BD symptoms. Despite known health
risks, this sample of participants actively and
regularly used substances. Thus, personal reasons
for self-medicating should be incorporated into
harm reduction models of treatment.
O200
Depression and Chronic Conditions among
Aboriginal Canadian seniors
1
1
Simona Bignami , Yves Carrière , Catherine
2 ,1
Herba
1
2
Université de Québec à Montréal, Montréal,
Canada
O199
Alcohol and drug self-medication among
middle-aged and older adults with bipolar
disorder
1
1
1
Sarah Canham , David King , Atiya Mahmood ,
1 ,2
Norm O'Rourke
1
Despite its relevance as a key source of
vulnerability for the growing population of
Aboriginal seniors, the prevalence and key
correlates of depression, and particularly chronic
conditions and disabilities, are currently unknown
in this population. By drawing from the research
fields of population aging and mental health, we
aim to fill this gap and to examine these issues
91
with rich and underexploited survey data collected
from Aboriginal seniors in 2012 by the Aboriginal
Peoples Survey and the Canadian Community and
Health Survey. Specifically, in this paper our
objective is threefol: to assess the prevalence of
depression among Aboriginal and non-Aboriginal
adults age 55 and over, and to compare it with the
prevalence in younger segments of the two
populations; to assess and compare the
prevalence of chronic conditions among Aboriginal
and non-Aboriginal adults age 55 and over; and to
identify the individual, socioeconomic and
behavioral characteristics of Aboriginal and nonAboriginal seniors who reported mental distress
and/or chronic conditions.
O201
The promise and the experience of assisted
living: Findings from a narrative study
Jasmyne Rockwell
Columbia, Canada
Since 2001, British Columbia has seen an
expansion in the assisted living (AL) segment of
housing for older adults. AL is promoted as offering
moderate levels of personal care as well as social
and recreational opportunities for older adults, in
an environment of choice, privacy, independence,
individuality, dignity and respect.
To date, there have been few studies that examine
how well AL facilities are upholding these intended
goals and values. This exploratory study employed
in-depth narrative analysis of four older adults'
relocation stories, gathered over the period of a
year, to illuminate important aspects of moving to
this environment.
Findings indicate that there are contradictions
between the promise and experience of AL. In
particular, participant accounts highlight a sense of
social isolation rather than social connection upon
relocation, as well as restrictions to choice in a
variety of areas including dining and recreational
pursuits. However, findings also illuminate positive
practices in AL that can support residents to feel
empowered and involved in their new community,
such as providing in-suite cooking facilities,
fostering relationships between all stakeholders,
and regularly soliciting resident input on
organizational practices. Continued research and
service improvement will help to narrow the gap
between the promise and the experience of
moving to AL.
O202
Depression and Aggressive Behaviour in
Continuing Care: How Cognitive Impairment
Might Not Explain the Whole Story
Éric R. Thériault
Cape Breton University, Sydney, Nova Scotia,
Canada
There is little research that has examined the
relationship between depression and aggressive
behaviour among older adults. Most of this
research has focused on older adults with
neurocognitive disorders. These studies have
indicated that aggressive behaviour and
depression are associated with cognitive
impairment in older adults and that this aggression
is linked to depressive symptoms. However, these
studies do not compare the relationship between
aggressive behaviour and depression in an older
population with and without cognitive impairment.
This study examined aggressive behaviours,
depressive symptoms in those with and without
cognitive impairment. This study examined data
form the Resident Assessment Instrument (RAI), a
comprehensive assessment that measures health
and well-being, in those receiving institutionalized
care in 7 provinces and 1 territory (n=2, 682, 612;
Mage = 80.42, SD=11.5). This data was provided
by the Continuing Care Reporting System by the
CIHI. Depression, cognition and aggressive
behaviours were all measured with scales that are
embedded within the RAI.
This study examined these variables within the
general sample (not controlling for cognition), but,
also among those with and without cognitive
impairment. It was found that a relationship
between aggressive behaviour and depressive
symptoms was present in all three groups. But,
also, again among all three groups, that those with
symptoms of depression rated higher on the
Aggressive Behaviour Scale, and that more
individuals with depressive symptoms
demonstrated aggressive behaviours.
These findings indicate that regardless of cognitive
status, older adults receiving institutionalized care
with depressive symptoms are more likely to
exhibit aggressive behaviours.
O203
92
De l'hospitalisation à l'institutionnalisation de
l'aide : identification des facteurs de risque
psychologiques
Céline Racin
Université Paris Descartes, Sorbonne Paris Cité,
Paris, France
Cette recherche longitudinale s'intéresse à
l'identification des facteurs de risque
psychologiques chez vingt personnes âgées de
plus de 80 ans, hospitalisées et confrontées à
l'issue de leur hospitalisation à la nécessité de
recourir à des soins de longue durée, à domicile
ou en institution d'hébergement.
Une méthodologie originale, quantitative et
qualitative, est mobilisée pour repérer les fragilités
mais également les ressources psychiques
pouvant servir de leviers thérapeutiques, afin de
mieux comprendre les réactions des personnes
âgées aux propositions d'aides qui leur sont faites :
évaluation de la dépression, des processus
cognitifs (tests neuropsychologiques), de la
dynamique du fonctionnement psychique
(épreuves projectives : Rorschach et Thematic
Apperception Test, entretiens cliniques).
Les résultats montrent que les effets de la
confrontation à la dépendance renvoient à une
grande diversité d'expériences, liée à la rencontre
entre des facteurs externes (changements
significatifs qui interviennent dans le cadre de vie
quotidien, dans les rôles sociaux et familiaux) et la
vulnérabilité de chaque individu aux
problématiques psychiques (confrontation à la
perte, à la passivité) réactivées à cette occasion.
Nous insisterons particulièrement sur la forte
sensibilité dépressive qui se dévoile et montrerons
combien la possibilité de bénéficier sereinement
d'une position d'étayage dès la phase
d'hospitalisation favorise l'adaptation à la relation
d'aide et de soutien ultérieure, mais que ce
dégagement reste souvent difficile à négocier.
Nous conclurons sur la façon dont les conflits
inhérents au travail d'élaboration des épreuves que
donne à vivre la dépendance dans le vieillissement
viennent s'exprimer dans les tensions qui
entourent le consentement au projet
d'institutionnalisation.
O204
Caring In Spite Of: Residential Care Aides'
Experiences of Dementia Care Provision
Heather Cooke, Neena Chappell, Kelli Stajduhar
University of Victoria, Victoria,BC, Canada
Situated on the lowest tier in the health-care
hierarchy, Residential Care Aides (RCAs) are the
least educated and lowest paid, afforded as little
power, respect or recognition as those for whom
they provide care. Yet, in providing the majority of
hands-on care for persons with dementia, RCAs
wield considerable practical power and influence.
While much is known about the structural
constraints facing RCAs in their work environment,
far less is known about how they provide care in
light of such constraints. As part of a larger
ethnographic study examining the influence of the
physical and organizational care environment on
care provision, in-depth interviews with 29 staff (21
RCAs, 3 LPNs, 5 managers) and more than 230
hours of participant observation were conducted in
two nursing homes with specialized dementia
units. Both sites featured characteristics
considered central to care quality - small-scale,
home-like environments, well-remunerated and
trained staff, and high staffing ratios. Three key
themes emerged; ‘on being bum wipers and
bottom feeders' (i.e., RCAs' experiences of
disempowerment); ‘on valuing and negotiating
relationship' (i.e., the centrality of co-worker and
supervisory relationships) and ‘on breaking
procedure' (i.e., RCAs selective resistance of
regulatory and institutional procedures). Given the
pivotal role RCAs play in shaping point-of-care
decisions, it is essential we find ways to redress
their continued devaluation. Integrating RCAs
more fully into resident care and unit decisionmaking, supporting the establishment of quality
working relationships, and inviting their input into
policy making that supports their daily care realities
offer a good starting point.
O205
Community engagement to identify continuing
care issues in rural Alberta
1
2
Lars Hallstrom , Sandra Woodhead Lyons , Emily
2
Dymchuk
1
Alberta Centre for Sustainable Rural
Communities, University of Alberta, Camrose, AB,
2
Canada, Institute for Continuing Care Education
and Research, Edmonton, AB, Canada
Objectives: This paper discusses the methods
and results of eight community consultations which
identified major gaps, barriers, and realities for
continuing care (CC) in rural northern Alberta.
Methods: The Institute for Continuing Care
Education & Research and the Alberta Centre for
93
Sustainable Rural Communities held eight
community consultations in northern Alberta
between 2011 and 2016. Participants included
representatives from post-secondary institutions
(PSIs), CC and other health care providers,
community/non-governmental organizations,
community leaders, and local politicians. The
consultations were done using a café conversation
technique with discussion broken into four rounds
with specific questions for each, followed by a
plenary debrief and discussion. All participants
were randomly assigned to a table with an
assigned table host. Participants were also
provided with a background report and materials
specific to their region or community prior to the
event.
Results: These consultations i) identified local
gaps/issues in CC programming and resources, ii)
identified whether these issues could be
addressed by PSIs through training and education
programs for students and/or practitioners, and/or
research and iii) provided an opportunity to
connect with others within the region. While there
is variation between consultations, there are also
overarching issues.
Conclusions: Community consultations are
effective in engaging people in discussion about
CC and to focus on the successes and gaps within
the specific catchment areas. They provide an
excellent opportunity for PSIs to learn more about
what is needed in terms of research and curriculum
in order to help enhance care and build capacity in
rural areas.
O206
Transferring Knowledge into Policy in LongTerm Care Using the Delphi Technique
with differing perspectives, interests, and
obligations.
In stage one, LTC staff discussed in focus groups,
vignettes of ethical issues in practice. Data
revealed staff use various normative ethical
frameworks, and typically do not have difficulty
determining the ethical thing to do, though
frequently experience moral distress (MD) - being
aware of the ethical thing to do, though feeling
powerless to act accordingly as a result of real, or
perceived, institutional constraints.
Thus informed, stage two explores how interaction
between frontline practice, organizational
philosophies, and public policy promotes and/or
hinders the development of an ethical culture in
LTC. Delphi was used to facilitate consensus
building between stakeholders through an iterative
process of knowledge production, reflection and
translation. Initial findings suggest strong
organizational/political leadership, interprofessional collaboration, and innovative thinking
are required to facilitate the alignment of public
and organizational policies, and the development
of ethical cultures in LTC; reducing MD, improving
care environments and quality of life. Exploring the
complex ethical landscape in LTC, on which there
is limited empirical knowledge, Delphi bridges the
gap between what we know, how we act, and how
to move forward with ethics in LTC.
O207
Understanding the needs of caregivers of
persons with dementia before and after driving
cessation
1
2
2
Michelle Greason
Brunswick, Canada
Alexander Crizzle , Gary Naglie , Sarah Sanford ,
1
1
Sarah Laberge , Meghan Gilfoyle , Paweena
3
3
2
Sukhawathanakul , Holly Tuokko , Mark Rapoport
1
2
3
University of Victoria, Victoria, Canada
Here I present the application of Delphi
methodology as an innovative means of exploring
and developing ethical practice in long-term care
(LTC) in a two-stage research project. Much
research on ethics in LTC focuses on abstract
ethical frameworks. With increasing interest in
empirical ethics, a more complex picture is
emerging: ethics being a dynamic, negotiated,
situated practice involving multiple stakeholders
Objectives: While prior studies have generally
focused on the loss of driving privileges for the
driver, little information exists on how
family/informal caregivers contribute to the
decision-making process or how they cope with
spousal driving loss. The objective of this study is
to better understand the needs of caregivers of
drivers and ex-drivers with dementia regarding
driving cessation.
94
Methods: We conducted three focus groups and
three semi-structured interviews with caregivers of
persons with dementia across three sites (Toronto,
ON; Waterloo, ON; Victoria, BC). Questions of
inquiry revolved around challenges caregivers
experience regarding their partner’s driving or
driving cessation, strategies they employ to make
decisions about driving cessation and how they
cope with the transition to non-driving.
Results: Thirteen caregivers participated; eleven
spouses and two adult children (both daughters) of
six current and seven former drivers with dementia.
The sample ranged in age from 54 to 86 (mean
age 69.2), were primarily women (12 women;1
man) who lived in urban residences (92%).
Preliminary findings suggest that caregivers find
the process of monitoring driving and/or driving
cessation to be stressful and that they often feel
unsupported by those in positions of authority.
Conclusion: Results will be used to inform the
development of an intervention targeting drivers
with dementia and their caregivers to support the
transition to non-driving.
O208
La reconnaissance des proches aidants : une
stratégie pour soutenir la personne âgée
hospitalisée
1
2
Louise Bélanger , Anne Bourbonnais , Roxanne
1
Bernier
1
Université du Québec en Outaouais, Gatineau,
2
Canada, Université de Montréal, Montréal,
Canada
Les personnes âgées font partie d’un système
social, composé de leur famille, d’amis ou d’autres
personnes ressources, qui influence leur qualité de
vie. L’hospitalisation d’une personne âgée
provoque des changements dans l’apport de ce
système. En plus de l’état de santé précaire
justifiant une hospitalisation, ces changements
peuvent la déstabiliser et nuire à son
rétablissement en contribuant, par exemple, à
l’apparition de syndromes gériatriques comme la
malnutrition, l’immobilisation, le délirium. Les
infirmières et les proches aidants peuvent aider à
diminuer l’isolement de la personne âgée
hospitalisée de son système social habituel et
soutenir son rétablissement à l’aide de diverses
interventions non pharmacologiques. Une étude de
cas multiples, considérée pilote, auprès de quatre
cas dans lesquels on retrouve des personnes
âgées, des proches aidants et des infirmières (n =
13) a été réalisée pour comprendre la
communication entre les proches aidants et les
infirmières, leurs effets sur la personne soignée et
les facteurs contextuels qui influencent cette
communication. Les résultats font, entre autres,
ressortir que les proches aidants qui sont présents
auprès de la personne âgée hospitalisée et ont
confiance dans les soins offerts sont plus reconnus
par les infirmières. Ces résultats permettent de
souligner la nécessité, pour les soignants, de
reconnaitre tous les types de proches aidants. De
plus, des études ultérieures sont nécessaires pour
mieux comprendre ce phénomène et concevoir
des interventions favorisant des modèles de
communication positifs avec les proches aidants
des personnes âgées hospitalisées
O209
Changes in Social Support and Sense of
Purpose during the Transition into Older
Adulthood
1
2
2
Nathan Lewis , Sara Weston , Joshua Jackson ,
1
Patrick Hill
1
Carleton University, Ottawa, ON, Canada,
2
Washington University in St. Louis, St. Louis, MO,
USA
Socioemotional selectivity theory suggests that
close relationships become increasingly more
influential on emotional regulation and
psychological wellbeing in older adulthood. While
past findings have suggested that social
integration and relationship quality are predictors
of sense of purpose in adulthood, it is not
understood how support in different relationships
may influence purpose during the transition into
older adulthood. The current study sought to
explore the relationships between sense of
purpose in life and positive and negative perceived
support in the context of relationships with one’s
spouse, children, family, and friends. Data were
drawn from the 2006, 2010, and 2014 waves of the
Health and Retirement Study of American adults
(Mage = 66 and n = 7635 at time one). We used
Bivariate latent growth models to examine the
relationships between changes in sense of
purpose and in perceived social support over time.
While a small mean-level decline in purpose was
observed across the three waves, significant interindividual variability in change patterns was
observed. Strong positive associations were found
between change in sense of purpose and change
95
in positive support across waves, particularly for
spouse and friend support. Increases in negative
social support were associated with decreasing
sense of purpose especially when negative
support came from a spouse or child. The current
findings point to the importance of close
relationship support in older adult’s sense of
purpose. These findings will lead to a discussion
on ways to better foster older adult sense of
purpose in contexts such as retirement
communities.
O210
How do older adults and their families perceive
their experiences of care in emergency
departments?
1 ,2
1 ,3
Deniz Cetin-Sahin , Jane McCusker , Francine
4 ,5
6 ,5
4
Ducharme , Nathalie Veillette , Sylvie Cossette
,5
7 ,5
7 ,8
, T. T. Minh Vu , Alain Vadeboncoeur ,
3 ,1
Antonio Ciampi
1
St. Mary's Research Centre, Montreal, QC,
2
Canada, Centre for Research in Aging, Donald
Berman Maimonides Geriatric Centre, Montreal,
3
QC, Canada, Department of Epidemiology,
Biostatistics, and Occupational Health, McGill
4
University, Montreal, QC, Canada, Faculté des
sciences infirmières, Université de Montréal,
5
Montreal, QC, Canada, Centre de recherche de
l’Institut universitaire de gériatrie de Montréal,
6
Montreal, QC, Canada, École de réadaptation,
Université de Montréal, Montreal, QC, Canada,
7
Faculté de médecine, Université de Montréal,
8
Montreal, QC, Canada, Montreal Heart Institute,
Objectives: To provide a platform for quality
improvement initiatives, we explored the
experiences of an emergency department (ED)
visit among older patients and their family
members.
Methods: As part of a multi-site study of the ED
care of older adults, we recruited patients aged
75+ who were discharged home at 4 urban EDs. If
patients were cognitively impaired or medically
unstable, a proxy family member was recruited. A
telephone interview about 1 week after the visit
included open-ended questions on what patients
liked the most about care they received and what
could have been improved during the ED visit. The
interviews were tape-recorded and transcribed
verbatim. Inductive thematic analysis was
performed using QDA Miner software.
Results: At one ED, 16 patients and 10 proxies
provided qualitative responses. The following three
themes emerged: 1)participants valued staff
personal and professional attributes the most,
which reassured them of the quality of care they
received; 2)staff communication skills not meeting
older patients' needs and fluctuating health status
during the visits disconnected them from their care
processes, and clear, precise, consistent, guiding,
properly paced, and detailed information was
expected; 3)logistical procedures, physical
environment, and waiting processes were found
burdensome, most being attributed to the health
care system. Data analyses are in progress to
compare patient vs proxy experiences across
4EDs.
Conclusions: These findings suggest several
areas for improvement of emergency care for older
adults. Personal aspects of care and clear
communication appear to be the most important,
potentially remediable factors from the patient
perspective.
O211
Effect of Assistive Technology Interventions on
Users and Their Caregivers
1 ,7
2 ,8
3
Ben Mortenson , Jeffrey Jutai , Marcus Fuhrer ,
1
4
5
Jessica Bilkey , Michelle Plante , Frank Deruyter ,
6
Louise Demers
1
2
Columbia, Canada, University of Ottawa , Ottawa,
3
Ontario, Canada, National Institutes of Health,
4
Bethesda, Maryland, USA, Institut Universitaire de
Gériatrie de Montréal, Montreal, Quebec, Canada,
5
Duke University , Durham, North Carolina, USA,
6
University of Montreal, Montreal, Quebec,
7
Canada, International Collaboration On Repair
Discoveries, Vancouver, British Columbia, Canada,
8
Bruyère Research Institute , Ottawa, Ontario,
Canada
Background: Assistive technology is provided to
make people more independent, but there is
limited knowledge about the impact of these
devices on their informal caregivers, who provide
80% of required care.
Objective: A study was conducted to investigate
whether a tailored assistive technology intervention
would improve community dwelling, older adults'
independence in performing activities and
decrease the perceived burden of their informal
caregivers compared to customary care.
96
Methods: A Single-blind, randomized controlled
trial with follow-up at 6-, 22-, and 58-weeks post
intervention was conducted with 94 dyads. The
experimental assistive technology intervention
followed a standardized multi-step procedure and
emphasized collaboration between older adults
and their informal caregivers, and the provision of
assistive technology in an expense-free and timely
manner. The Functional Autonomy Measurement
System was used to assess assistive technology
users' functional independence, and the Caregiver
Assistive Technology Outcome Measure was used
to assess caregiver activity specific and overall
burden.
Results: Groups were comparable at baseline.
Although the experimental intervention addressed
significantly more caregiver identified needs, there
were no significant differences between the
experimental and comparison groups' outcomes
overtime. However, despite significant declines in
independence among all care recipients,
caregivers in both groups experienced reduced
activity specific and overall burden over time.
Conclusion: It is likely that the lack of significant
differences between the experimental and control
groups is due to the correspondence between the
interventions. Even so, it appears that this kind of
assistive technology intervention has a beneficial
effect on caregivers, which supports the provision
of these devices.
Poster Presentations/Presentations par
affiches
P1
An exploration of regional variations across a
set of potential quality indicators for seriouslyill home care clients in Ontario
Lisa Harman, Nicole Williams, Dawn Guthrie
Wilfrid Laurier University, Waterloo, Ontario,
Canada
This study explored potential differences between
seriously-ill (SI) home care clients and all other
clients, stratified by region, on a subset of home
care quality indicators (QIs) developed by interRAI.
Secondary analysis of Resident Assessment
Instrument for Home Care data for Ontario from
2009-2013 (n=263,767) was used to examine the
rates of nine QIs thought to be relevant to the
needs of older (65+) SI clients. The rates were
generated for the 14 Local Health Integration
Networks (LHINs) to compare the SI group vs. all
others. Serious illness was defined as a prognosis
of less than six months or the presence of severe
health instability.
Within the overall sample, 50.7% were aged 85+,
and 65.6% were female. The highest rates among
the nine QIs included hospitalization (40.5%), daily
pain (38.5%), falls (36.3%), and social isolation
(18.9%). SI clients had higher rates on each of the
nine QIs studied. The QIs with the largest
differences, between the two groups, were
hospitalization (22.7% higher in SI group), negative
mood (19.0% higher) and delirium (16.1% higher).
Among the SI clients, the QIs that displayed the
largest absolute differences across LHIN were
hospitalization (range =17.9%), falls (17.5%),
social isolation (15.3%), negative mood (15.3%)
and delirium (14.8%).
Hospice palliative care services in Ontario are
undergoing a process of restructuring and this
research can assist in understanding where
potential quality issues may exist, which can
ultimately contribute to quality improvement
initiatives in this sector.
P2
Perceptions of positive aging among homecare
workers: A qualitative analysis
1
1
Ariane Seguin , Brittany Barber , Janice
2
3
1
Chalmers , Keri-Leigh Cassidy , Brad Meisner
1
School of Health and Human Performance,
Dalhousie University , Halifax NS, Canada,
2
Northwood Homecare, Northwood Inc., Halifax
3
NS, Canada, Department of Psychiatry, Dalhousie
University , Halifax NS, Canada
The definition of aging is undergoing a paradigm
shift away from a biomedicalized focus on deficits
and losses to one that includes strengths and
possibilities. Given that aging perceptions
influence health-related behaviour, care, and aging
outcomes, there is a need to explore the meanings
attributed to the concept of ‘positive aging’
particularly among health professionals who
provide care to older adults. Thus, the objective of
this project was to explore how homecare workers
understand positive aging. As part of a larger
educational program evaluation, 299 homecare
workers answered the following open-ended
survey question: “What does the term ‘positive
97
aging’ mean to you?”. Qualitative data were coded
according to constant comparison analytical
techniques. Five overarching themes of positive
aging emerged: a) multi-dimensional and dynamic
aspects of health, b) optimizing aging through
asserting personal agency, c) quality of life
maintenance despite experienced losses or
unfavourable circumstances, d) physical, cognitive,
and social activity engagement, and e) affirming
attitude toward self, life, and aging. Overall,
similarities and differences exist between how
homecare workers define positive aging compared
to other definitions in the extant literature. This
study provides additional evidence to address the
gap in current research on positive aging among
health care professionals. Results suggest a need
for further educational programming for
professionals who provide direct care to older
adults. Presenting aging in a positive and realistic
way may direct individual, institutional, and systemlevel change to support positive experiences and
outcomes of homecare workers and older care
recipients alike.
recognizing that resident behaviour is
communication based on need; and (3) there were
associations between in-service training and
continuing education with competencies. TR
graduates have low confidence in completing RAIMDS, assessing spirituality, and assessing
physical health and illness conditions. The recent
TR graduates revealed that learning about aging
topics in courses are associated with confidence
levels in gerontological competencies and that
internship/placement experience was not
associated with confidence levels in gerontological
competencies.
P3
Online Interventions for Family Caregivers of
Persons with Dementia: An Integrative Review
and Recommendations for Practice
Perceived Competencies for Seniors Care in
Long Term Care Homes: An Examination in
Therapeutic Recreation Undergraduate
Curricula
Kristin Prentice
Background: Therapeutic recreation (TR) is an
important contributor to the health and well-being
of residents living in long term care (LTC). In order
to enhance quality of life of residents, it is essential
that Therapeutic Recreationists have
gerontological competencies and knowledge
relevant to LTC.
Aims: To determine: (1) the confidence levels of
Therapeutic Recreationists' and recreation staff in
performing gerontological competencies in LTC
and (2) Therapeutic Recreationists' perceived gaps
in their gerontological competencies.
Methods: A quantitative descriptive study was
conducted. A survey was distributed to LTC homes
in Ontario.
Findings: Recreation staff (1) have the least
amount of confidence in writing care plans and
assessing spirituality; (2) they have the most
confidence in implementing programs for residents
with dementia and physical disabilities, and
Discussion: Further research should examine
gerontological competencies and gerontological
content in TR curricula including practitioner
perspectives of required competencies and gaps in
the LTC setting. This will assist educators and
professionals in designing programs for TR
candidates that will adequately prepare them for
working with older adults living in LTC.
P4
Tracy Wildeman, Wendy Duggleby, Dorothy
Forbes
University of Alberta, Edmonton, Canada
Objectives: Family caregivers of persons with
dementia often experience negative health effects
as a result of caregiving. There is an urgent need
for interventions to support caregivers in their work.
The purpose of this integrative literature review
was to assess the current research on online
interventions for family caregivers regarding the
approach, content, quality of research and
limitations.
Method: Electronic databases were searched for
published research on online interventions for
caregivers of persons with dementia. A total of 18
articles met the inclusion criteria and were included
in the review.
Results: Online interventions for family caregivers
can be effective in improving outcomes (in
particular depression and anxiety) for this
population. Caregivers reported these
interventions to be easy to use and convenient.
Gaps in the research include limited numbers of
larger evaluation studies, high participant attrition
98
rates, and lack of studies exploring caregivers'
perceptions of online interventions. Online
interventions are viewed as beneficial by
caregivers of persons with dementia, and further
research is required in this area.
Conclusions: Based on the findings of the review,
health care practitioners should recommend online
interventions that can be customized to individual
need, offer multiple components, are not time
consuming and offer opportunities for connection
with other caregivers. Health care practitioners can
also contribute to research in this field by
encouraging caregivers of persons with dementia
to participate in further research.
P5
efficace. Cependant, il existe peu de
connaissances sur la façon d’intégrer les
personnes âgées et leur famille à cette prévention.
Des études devraient être effectuées afin de mieux
comprendre les besoins de cette dyade et de
développer des interventions pour favoriser leur
participation active à la prévention du délirium
postopératoire.
P6
Family Caregivers' Remote Support Needs after
Provision of Assistive Technology: Preliminary
results
1 ,2
Les interventions de prévention du délirium
postopératoire chez les personnes âgées en
milieu hospitalier : une revue critique des écrits
1
1 ,2
M.-H.L. Lalonde , A.B. Bourbonnais
1
Université de Montréal, Montréal/Québec,
2
Canada, Centre de recherche de l’Institut
universitaire de gériatrie de Montréal,
Montréal/Québec, Canada
Le délirium est un trouble cognitif aigu et fluctuant
qui se manifeste chez plus de 74% des personnes
âgées à la suite d’une chirurgie. Il implique
d’importantes conséquences, telles que des
hospitalisations prolongées, un déclin fonctionnel
et cognitif chez les personnes âgées, ainsi qu’un
sentiment de fardeau chez les proches et les
soignants. Les professionnels de la santé d’une
unité de chirurgie doivent connaître les
interventions de prévention du délirium basées sur
les résultats probants. Le but de cette affiche est
de présenter de façon critique les écrits sur la
prévention du délirium postopératoire chez les
personnes âgées en milieu hospitalier. Des écrits
scientifiques publiés entre 2005 et 2016 ont été
repérés de façon systématique dans CINAHL,
Pubmed et Cochrane avec divers mots clés. La
qualité méthodologique des écrits primaires a été
évaluée avec un outil fiable développé à
l’Université de McGill, soit le MMAT. La qualité des
revues systématiques a été évaluée avec l’outil RAMSTAR et celle des guides cliniques avec l’outil
AGREE. Les résultats indiquent l’importance
d’appliquer précocement plusieurs interventions
non-pharmacologiques de prévention. Notamment,
plusieurs études recommandent de créer un
partenariat de soins avec les personnes âgées et
leur famille pour une prévention du délirium plus
2 ,3
D Gélinas-Bronsard , S Ahmed , WB
4
1 ,2
2 ,3
5
Mortenson , C Guay , A Moreno , M Guay , C
1 ,2
Auger
1
2
Canada, Centre de recherche interdisciplinaire en
réadaptation du Montréal métropolitain, Montréal,
3
Québec, Canada, McGill University, Montréal,
4
Québec, Canada, University of British Columbia ,
5
Vancouver, British Columbia, Canada, Université
de Sherbrooke, Sherbrooke, Québec, Canada
Background: Family caregivers play a crucial role
in caring for older adults with disabilities; however,
few interventions exist to support them, particularly
when assistive technology (AT) (e.g. mobility aids,
cognitive aids) is required to perform daily living
tasks.
Objective: To explore how to offer remote support
(monitoring and training), through a web-based
portal (MOvIT-PLUS), to pairs of older adults and
their family caregivers after the provision of AT.
Methods: Using an iterative user-centred design
approach, individual open-ended interviews were
conducted with 30 stakeholders representing ATusers, caregivers, clinicians, decision makers,
community partners, and researchers. The first
part of the interview explored past experiences
with AT provision to identify end-user needs, while
the second part presented a mock-up of the
MOvIT-PLUS portal to encourage concrete
exchanges about the desired functionalities of the
future portal. A modified content analysis approach
identified themes developed from a mix of
emerging and expected concepts.
Results: Preliminary analysis indicates positive
convergent opinions of stakeholders about remote
99
counselling using a regular phone and humansupported web-based teletraining tools, such as
videoconferencing. Divergent opinions are noted
regarding monitoring functionalities (e.g.
automated calls, email, mobile phone, texting) and
training components such as a video bank of ATrelated tasks and an accessibility database.
Conclusion: These results will help prioritize
which functionalities will be included in the MOvITPLUS portal to ensure adequate follow-up after
assistive technology provision. Future studies will
also evaluate the impact of this new intervention
on caregivers' perceived burden and quality of life.
individuals with higher (OR=0.27; CI=0.12-0.60) vs
lower brain weight (OR=0.75; CI=0.14-5.72).
Conclusions: While brain weight and atrophy
were negatively associated with cognitive
resilience, the negative impact of atrophy was
strongest among those with higher brain weight.
This may reflect a floor effect, where low brain
weight exhausts resilience and thus no further
association with atrophy is seen. These findings
suggest the importance of lifespan approaches to
support brain development in early life and prevent
brain pathology in late life.
P8
P7
Is bigger better? How brain weight and cortical
atrophy contribute to cognitive resilience in the
Nun Study
1
1
Michael L. MacKinley , Maryam Iraniparast ,
1
1
Sanduni M. Costa , Colleen Maxwell , Karen
2
1
SantaCruz , Suzanne L. Tyas
1
University of Waterloo, Waterloo, ON, Canada,
2
University of New Mexico, Albuquerque, NM, USA
Background: Brain weight, a factor largely
developed in early life, and brain atrophy, a factor
typically associated with advanced age, may both
contribute to cognitive resilience, defined as the
absence of dementia despite the presence of
Alzheimer neuropathology. Our aim was to
determine the contributions of brain weight and
atrophy to cognitive resilience.
Method: Alzheimer neuropathology (CERAD
criteria) was diagnosed in 213 participants (128
with dementia [DSM-IV criteria], 85 cognitively
resilient) from the Nun Study, a longitudinal study
of 678 religious sisters aged 75+. Brain weight was
classified as low vs higher (lowest vs upper 2
tertiles) and atrophy was defined as
present/absent. Logistic regression models were
adjusted for age at death and apolipoprotein E.
Results: Both atrophy (odds ratio [OR]=0.27; 95%
confidence interval [CI]=0.14-0.54) and low brain
weight (OR=0.34; CI=0.17-0.63) were individually
associated with significantly lower likelihood of
cognitive resilience. Effects were maintained when
combined in the same model (low brain weight:
OR=0.41; CI=0.21-0.78; atrophy: OR=0.33;
CI=0.16-0.66). However, when stratified by brain
weight, the effect of atrophy was stronger among
Frailty assessment to help predict patients at
risk of Emergengy Department induced
delirium
1 ,2
1 ,2
1 ,2
2
M Giroux , M Emond , MJ Sirois , V Boucher ,
4 ,5
6
7
1 ,2
R D'aoust , E Gouin , M Pelletier , S Berthelot ,
1 ,3
1 ,2
1 ,2
P Voyer , L Moore , S Lemire , ME
1 ,8
Lamontagne
1
2
Université Laval, Québec, QC, Canada, CHU de
3
Québec, Québec, QC, Canada, Centre
d'excellence du vieillissment de Québec, Québec,
4
QC, Canada, Université de Montréal, Montréal,
5
QC, Canada, Hôpital du sacré-coeur de Montréal,
6
Montréal, QC, Canada, Centre hospitalier régional
7
de trois-rivière, Trois-rivière, QC, Canada, Centre
hospitalier régional de lanaudière, Lanaudière, QC,
8
Canada, Centre intégré de recherche en
réadaptation et en intégration sociale, Québec,
QC, Canada
Introduction: Delirium is a frequent complication
among seniors in the emergency department (ED).
This condition is often underdiagnosed by ED
professionals even though it is associated with
functional & cognitive decline, longer hospital
length of stay, institutionalization and death. Frailty
is increasingly recognized as an independent
predictor of adverse events in seniors and
screening for frailty in EDs is now recommended.
The aim of this study was to assess if screening
seniors for frailty in EDs could help identify those at
risk of ED-induced delirium.
Method: This study is part of the ongoing
multicenter prospective cohort MIDI-INDEED
study. Patients were recruited after 8 hours of ED
exposure & followed up to 24h after ward
admission. Frailty was assessed at ED admission
using the Canadian Study of Health and AgingClinical Frailty Scale (CSHA-CFS) which classified
100
seniors from robust (1/7) to severely frail (7/7).
Seniors with CSHA-CFS ≥ 5/7were considered
frail. Delirium was assessed using the CAM.
Results: 370 patients were recruited. Preliminary
data show an incidence of ED-induced delirium of
10%. Average frailty score at baseline was 3.5. 72
patients were considered frail, while 289 were
considered robust. Among the frail seniors, there
were 48.4% (30-66) patients with ED-induced
delirium vs 17.9% (13.7-22.0) in the non-frail ones
(p<0.0001).
Conclusion: Increased frailty appears to be
associated with increased ED-induced delirium.
Screening for frailty at emergency triage could help
ED professionals identify seniors at higher risk of
ED-induced delirium.
P9
interval [CI]=0.33-1.79), and there was no
significant benefit of speaking two or three
languages. However, those speaking four or more
languages showed a significant five-fold increase
in their likelihood of resilience, with those speaking
less than four languages at a correspondingly
lower likelihood of resilience (OR=0.20; 95%
CI=0.04-0.97).
Conclusions: Multilingualism may contribute to
building cognitive resilience. However, this effect
was only observed among those speaking four or
more languages, and there was no benefit among
bilinguals in this population where bilingualism is
the norm. When considered within the context of
each population, multilingualism may be an
important consideration in strategies to increase
cognitive resilience and thus reduce the impact of
AD.
P10
Does speaking more than one language
contribute to cognitive resilience against
Alzheimer's disease?
1
2
Sanduni M Costa , Philip D St. John , Myra A
1
1
Fernandes , Maryam Iraniparast , Michael L
1
1
1
MacKinley , Danielle O Fearon , Suzanne L Tyas
1
2
Objective: Multilingualism has been hypothesized
to reduce the risk of Alzheimer's disease (AD), but
findings have been inconsistent. Our aim was to
examine the association between multilingualism
and cognitive resilience, defined as the absence of
dementia despite the presence of Alzheimer
neuropathology.
Methods: The Nun Study is a longitudinal study in
the United States of religious sisters 75+ years.
The analytic sample (n=135) was restricted to
those with a neuropathologic diagnosis of AD (NIARI criteria). Dementia status (DSM-IV criteria) was
based on the last cognitive assessment before
death. Multilingualism was determined through
convent archival records. Logistic regression
models were adjusted for age at death, education,
apolipoprotein E (APOE), and birth within or
outside the United States to control for immigration
effects.
Results: Speaking one language did not
significantly reduce the likelihood of cognitive
resilience (odds ratio [OR]=0.76; 95% confidence
Can training on the Apple iPad increase
reading speed in older adults?
1 ,2
1 ,2
Elliott Morrice , Aaron Johnson , Julie-Andrée
3 ,4
2 ,3
Marinier , Walter Wittich
1
Concordia University, Montreal, QC, Canada,
2
CRIR/Centre de réadaptation MAB-Mackay du
CIUSSS du Centre-Ouest-de-l’Île-de-Montréal,
3
Montreal, QC, Canada, School of Optometry,
University of Montreal, Montreal, QC, Canada,
4
CRIR/Institut Nazareth et Louis-Braille du CISSS
de la Montérégie-Centre, Montreal, QC, Canada
Older adults with low vision frequently report
problems with reading. Magnification can improve
reading performance by up to 200%, yet, current
magnification aids can be expensive or bulky. We
have previously shown that the Apple iPad offers
comparable performance in improving reading
speeds, in comparison to a CCTV. Here, we
explored whether previous experience with the
Apple iPad or CCTV impact reading speed.
We recruited 85 participants above the age of 50
with low vision who were literate and cognitively
capable of whom 54 had Age-Related Macular
Degeneration. To assess reading, participants read
standardized iReST texts and were tested for
comprehension. We compared reading speed on
the Apple iPad to that with the CCTV and baseline
measures.
101
All assistive devices improved reading rates in
comparison to baseline
(F(1.42,119.43)=192.38, p<.001, ωp²=1.50),
however, there was no difference in improvement
across devices (M=1.29, SE=2.29, p > .05). When
experience was taken into account, those with
iPad experience read on average 14 words per
minute faster (M = 83.82, Glass's Δ = 0.28) than
those without (M = 69.94, Glass's Δ = 0.40),
whereas CCTV experience did not influence
reading speed.
socioemotional aging. We argue that evidence of
increasing symptoms of depression and anxiety
with age is due to the use of measures that
emphasize somatic complaints, complaints which
are increasingly common with aging. Our finding
of a slight worsening of mental health among the
oldest old is consistent with a recent theory
suggesting general improvements in mental health
with age, significant vulnerabilities that are
especially common near the end of life may be
attributed to the slight decline in mental health.
As no differences in the improvement of reading
rates were found among the conditions, the Apple
iPad is as effective as current assistive devices for
our participants. Taking previous experience with
the devices into account, those who have had
experience with the iPad read approximately 14
words/minute faster compared to the CCTV.
P12
P11
Prevalance of depression and anxiety usually
decreases with age: A life-span review
1
1
Lindsay Berard , Corey Mackenzie , Sarah
2
3
Raposo , Georgia Maclean
1
University of Manitoba, Winnipeg, MB, Canada,
2
3
Stanford University, Stanford, CA, USA, Mount
Royal University, Calgary, AB, Canada
Aging is typically associated with declines or
losses in the physical, cognitive, and social
domains. Despite these multiple losses, research
suggests that mental health may actually improve
into old age. This study was conducted to review
the epidemiologic literature from 2000 to 2016 to
clarify the influence of age on the prevalence of
depressive and anxiety disorders and symptoms.
Our systematic review focused on large
epidemiologic studies measuring past-year
prevalence of depressive disorders, anxiety
disorders, or symptoms of depression, anxiety, or
distress in community-based samples. The
majority of studies, including those focusing on
subgroups of older adults, found decreasing rates
of depressive and anxiety disorders with age, with
a slight up-turn among the oldest-old. A mixed
pattern emerged with respect to symptoms.
Studies focusing on symptoms of distress
generally showed decreasing rates with age,
whereas those focusing on symptoms of
depression and anxiety tended to show an
increase. The primary finding from this review, that
of positive changes in well-being with age, is
consistent with recent theoretical views of
L'association entre les relations sociales et la
qualité du sommeil chez les aînés : une étude
populationnelle
1 ,2
Virginie Proulx-Tremblay , Sébastien Grenier
1 ,2
1
Arnaud Allary , Fethia Benyebdri
1
2
CRIUGM, Montréal, Canada, Université de
Montréal, Montréal, Canada
1 ,2
,
Au Canada, 1 aîné sur 2 rapporte des difficultés de
sommeil qui peuvent diminuer la qualité de vie.
Plusieurs facteurs ont été associés à une moins
bonne qualité de sommeil chez les aînés, dont le
sexe, la consommation de benzodiazépines et la
présence d'un trouble anxieux ou de l'humeur. La
présence de conflits relationnels peut perturber le
sommeil, mais aucune étude n'a isolé l'effet des
conflits relationnels sur la qualité du sommeil chez
les aînés en contrôlant pour les facteurs
susmentionnés.
Cette étude a donc comme objectif d'explorer de
quelle façon les relations sociales sont associées à
la qualité du sommeil chez les aînés. Les données
de cette étude proviennent d'un échantillon
populationnel (ESA) comprenant 2468 Québécois
âgés de 65 à 96 ans.
Les relations sociales ont été divisées en trois
dimensions : les aspects structuraux, les aspects
fonctionnels positifs et négatifs. Les bons
dormeurs ont été identifiés sur la base d'un résultat
inférieur à 4 sur l'échelle de Pittsburgh Sleep
Quality Index (PSQI), comparativement aux
mauvais dormeurs qui devaient obtenir un résultat
supérieur à 5.
Des régressions logistiques ont été effectuées
pour comparer les bons des mauvais dormeurs
quant aux différentes dimensions de leurs relations
sociales. Les résultats ont démontré que les
mauvais dormeurs avaient significativement plus
de conflits avec leurs proches que les bons
dormeurs (RC : 1,401; IC95% = 1,001-1,957; p =
0,049). Nos résultats suggèrent qu'il est important
102
d'inclure des stratégies d'intervention ciblant les
difficultés relationnelles dans les traitements pour
l'insomnie chez les aînés.
P13
Buffering the Stress of Aging: Relationships
among Social Group Memberships, Coping,
and Mental Health
Olivia Pochopsky, Renate Ysseldyk, Kim
Matheson, Hymie Anisman
Carleton University, Ottawa, Canada
This study sought to understand the role that social
group memberships play in reducing stress-related
psychological disturbances among older adults.
Given the importance ascribed to social
connectedness and adaptive coping in maintaining
psychological health, social participation, coping
strategies, depressive symptoms, and general
well-being (i.e., having basic human needs fulfilled)
were assessed among healthy adults (N=74) with
a mean age of 55 years (SD=15.40). Social groups
were coded into five types: volunteer, religious,
physically-active, community, and hobby-related.
Importantly, retirement was positively associated
with self-reported depressive symptoms, whereas
belonging to particular groups was related to more
adaptive coping and better mental health.
Specifically, participation in volunteer groups was
negatively associated with depressive symptoms
and positively associated with general well-being.
As expected, participation in religious groups was
strongly positively associated with the use of
religious coping, but negatively associated with the
use of two traditionally aversive coping strategies:
rumination and emotional expression; moreover,
less reliance on rumination accounted for less selfreported depression and greater general wellbeing. However, belonging to a physically-active
group was positively associated with cognitive
restructuring, active distraction, and using humour
to cope, and the use of active distraction
accounted for fewer depressive symptoms and
greater general well-being. Taken together, these
findings highlight the importance of continuing
social participation throughout the lifespan;
however, while various types of social group
memberships appear to be important for
maintaining mental health, the coping mechanisms
through which these relationships exist may be
qualitatively different depending on the type of
group identity.
Facilitators and barriers of aging-related
technologies: Innovators’ perspectives
1
1
1
Melissa Koch , Ayse Kuspinar , Maggie MacNeil ,
2
1
Don Juzwishin , Paul Stolee
1
University of Waterloo , Waterloo , Canada,
2
Alberta Health Services , Edmonton, Canada
Objectives: Health technologies offer many
potential benefits for a growing population of older
Canadians but innovators can find it challenging to
navigate their technologies through complex
innovation processes (e.g., evaluation,
policy/regulatory approval, reimbursement). As part
of a Canadian research network focused on aging
and technology - AGE-WELL - we examined the
perspectives of innovators on the facilitators and
barriers related to the commercialization and
adoption of aging-related health technologies.
Method: We surveyed leaders of all 15 current
AGE-WELL technology development projects, with
follow-up semi-structured interviews with four
project leaders. Survey questionnaires were
analyzed using descriptive statistics and content
analysis. Interviews were audio-recorded,
transcribed verbatim and inductively analyzed
using NVivo11, with line-by-line coding by two
independent researchers.
Results: AGE-WELL innovators reported a varied
understanding about the stages of the innovation
processes relevant for aging-related technologies
in Canada. Innovators identified barriers related to
the initial stages of their work - including
recruitment of study participants and usabilitytesting, as well as related to the regulatory,
commercialization and reimbursement processes
undertaken subsequently - such as identifying an
appropriate payer. Innovators identified facilitators
such as collaboration and involvement of key
stakeholders (e.g., clinicians, industry, end-users)
to provide expertise, and university
commercialization departments.
Conclusions: Innovators developing aging-related
health technologies face or anticipate significant
challenges in the successful adoption of new
innovations. Based on these findings and related
work of our team, we are developing educational
and other resources to help support innovators
through processes of innovation, approval and
safe adoption of new technologies for older
persons.
P14
103
1
P15
Banking for the Future: Financial Literacy and
the Money Management Experiences of Older
Aboriginal Adults in Canada
1
2
Erin Relyea , Raza M. Mirza
1
University of Toronto Factor-Inwentash School of
2
Social Work, Toronto, Ontario, Canada, National
Initiative for the Care of the Elderly, Toronto,
Ontario, Canada
Lifelong income disparity between Canada’s
Aboriginal and non-Aboriginal populations
perpetuates marginalization in later years. More
importantly, greater inequality exists between
Aboriginal older adults who live on-reserve,
earning below the low-income cut-off and facing
unique financial challenges, versus those who live
off-reserve. In 2009, the Canadian government
acknowledged the need for a financial literacy
strategy to address financial knowledge gaps
within the Canadian population, specifically those
faced by Aboriginal older adults. This study, the
first in Canada, uses a mixed methods research
design, drawing on results from a consensus
meeting (n=15), survey (n= 50), and focus group
data (n=25) to better understand the financial
realities of elderly Aboriginals who live on and off
reserves. The results indicate that the financial
capabilities of older Aboriginals are not well
understood and that tailored money management
initiatives must take into consideration the lower
income of Aboriginal older adults. Strategies to
improve financial literacy are also complicated by
the implications of status, tax-exemptions, reserve
status, lower incomes for women due to social
obligations, and band laws. The knowledge gained
from this study has led to the development of
financial literacy resources that address the
following issues: navigating financial resources
and benefits, saving and education for
grandchildren, special legal and tax issues of
Aboriginal older adults, and band issues. This
study demonstrates the complexity of financial
issues faced by the Canadian Aboriginal
community, and the need for diverse programs in
order to address the specific gap in financial
knowledge for the growing elderly Aboriginal
population.
P16
1
2 ,1
Sarah Main , Paul Stolee , Veronique Boscart ,
3
4
Julie Wheeler , Matilda Kress
1
2
Canada, Conestoga College, Waterloo, Ontario,
3
Canada, Sunnyside Seniors' Services, Kitchener,
4
Ontario, Canada, St. Joseph's Health Centre
Guelph, Guelph, Ontario, Canada
Introduction: The needs of persons living with
young onset dementia (YOD) may not be met by
community programs for older persons with
dementia. Two YOD programs in southern Ontario
were designed to meet the unique needs of this
group. This study aimed to understand: program
processes, potential benefits, participant goals,
and ways in which the program could be improved
to better serve the needs of persons living with
YOD and their care partners.
Methods: The study followed an action research
approach with mixed methods. Semi-structured
individual interviews were conducted with 12
program participants, 11 care partners, and seven
staff. Focus group interviews were conducted with
participants (six/site), and staff (seven and
five/site). Interviews were tape-recorded,
transcribed and analyzed using directed and
emergent coding. Goal Attainment Scaling (GAS)
was used to measure individual goals of
importance to participants.
Results: Results provide an understanding of
program processes, and highlighted benefits
including connecting with others around common
experiences, and active engagement in activities participants see the program as a club. Program
staff described the value of peer support in
accommodating the changing needs of participants
over time. Care partners received enhanced
respite, feeling reassured that the person with YOD
is in good hands and among peers. Participants
described positive progress on individual goals
(GAS), including socializing and learning new
strategies.
Conclusions: Two YOD programs, operating as
social clubs, provided benefits for younger persons
with dementia and their care partners. This study
identified an initial program model upon which
future research can build.
P17
It reminds me that I'm still me: Social programs
for younger persons with dementia
104
Implementation of a Virtual Ward in an
academic hospital-based family practice
centre: challenges and recommendations
1
1
Justin Gagnon , Araceli Gonzalez-Reyes , Isabelle
1
1
Vedel , Genevieve Arsenault-Lapierre , Mina
2
2
2
Ladores , Georgia Vriniotis , Vinita D'Souza ,
2
Bernardo Kremer
1
Department of Family Medicine, McGill University,
2
Montreal, Quebec, Canada, Herzl Family Practice
Centre, Jewish General Hospital, Montreal,
Quebec, Canada
CONTEXT: Transitions in care from a hospital to a
community setting for elderly patients are
especially complex. Transitional care interventions
are being widely implemented to increase
continuity and quality of care. A family medicine
based Virtual Ward was implemented in an
academic hospital-based family practice centre.
The aim was to better plan and coordinate the
transition of elderly patients to reduce emergency
department visits, hospital readmission and death
after hospital discharge.
OBJECTIVES: 1) Describe the Virtual Ward
implementation process; 2) identify challenges
faced by the interdisciplinary Virtual Ward team; 3)
identify strategies for overcoming these
challenges.
METHODS: A participatory qualitative descriptive
study. The sources of data were 50 hours of
observation and a focus group was conducted with
the members of the interdisciplinary team
(physicians, nurses, resident, social worker,
pharmacist and administrator). A hybrid qualitative
thematic analysis combining the diffusion of
innovation theory and inductive coding was
conducted.
RESULTS: Funding for a full-time nurse case
manager, the in-kind commitment of the Virtual
Ward Family Physician and the proximity of the
interdisciplinary team were conditions that favored
the implementation of the intervention. In terms of
challenges, the team identified: difficulty
establishing lines of communication between
professionals in hospital and home-care services,
inadequate financial incentive for Family Doctors
for post-discharge follow-up, and sustaining
financial support the nurse case manager.
Numerous strategies were proposed to address
the challenges they encountered.
EXPECTED CONTRIBUTIONS: Results of this
study will be used to identify strategies to enable
the application of the Virtual Ward in other settings.
P18
Exploring the relationship between different
social network structures and perceived social
support availability
Oksana Harasemiw, Verena Menec, Shahin
Shooshtari, Corey Mackenzie
Canada
Objectives: This study was designed to examine
whether different social network structures provide
different types and frequencies of social support to
the individual.
Method: Data were drawn from the baseline
questionnaire for the tracking cohort of participants
in the Canadian Longitudinal Study on Aging (n=
8782). Cluster analysis was first conducted to
group individuals ages 65 to 85 years old into
different social network clusters, based on their
structural social network characteristics (e.g.
number of family and friends, and frequency of
contact). The clusters were subsequently
examined to see whether they differed in terms of
frequency and type of social support.
Results: Six social network clusters were found,
each with distinct structural profiles. Findings
suggest that as level of social integration within a
social network declines, and individuals become
more socially isolated, overall quantity of support
declines. However, the types of social relationships
that are present within the network impact the
availability of different social support types,
including affectionate support, emotional support,
positive social interactions, and tangible support.
Conclusion: Findings indicate that social
networks in older adulthood are not homogenous
structures, but rather have considerable variation
in their patterns of social relationships.
Furthermore, while overall network size is
important for the frequency of social support
available, the diversity of the ties within the social
network influences the specific type of support
available.
P19
105
Parcours professionnel atypique et passage
à la retraite
Background: Elderly individuals in long-term care
facilities (LTCFs) are at high risk for elder abuse
(EA) and its related health consequences. Yet,
currently available EA screening and identification
tools have limitations for use in this population.
J Purenne, Y Carrière
Université de Montréal, Démographie, Canada
Au Canada, 21% des hommes et 25% des
femmes âgés de 50 ans et plus n'ont jamais
occupé un emploi pendant plus de 12 ans. Malgré
les nombreuses recherches sur le passage à la
retraite, à ce jour aucune étude n'a été menée sur
ces travailleurs. L'objectif de cette présentation est
d'identifier les différents parcours vers la retraite de
ces derniers et d'analyser les caractéristiques qui
influencent leur prise de la retraite. Les données
de l'Enquête sociale générale de 2007 sont
utilisées pour faire une analyse de séquences des
parcours d'emploi avant et après la retraite. Cette
méthode a pour avantage de pouvoir identifier des
regroupements (clusters) à travers les différentes
combinaisons de séquences possibles, ce que les
autres méthodes statistiques ne permettent pas.
Une analyse des risques concurrents entre
différents types de retraite a aussi été utilisée. Les
premiers résultats semblent indiquer que les
travailleurs qui ont un historique d'emploi atypique
se retirent plus rapidement du marché du travail et
plus souvent de façon involontaire que les retraités
qui ont eu parcours d'emploi plus linéaire. Ils sont
également plus susceptibles de retourner sur le
marché du travail pour des raisons économiques.
À l'heure où les baby-boomers arrivent à la
retraite, ce résultat a des implications importantes
pour les politiques publiques, car de nombreux
retraités auront à recourir à leur épargne pour
subvenir à leur besoin, ce qui pourrait augmenter
leur dépendance au système public de pension.
P20
Introducing the Elder Abuse Suspicion Index
for Long-Term Care (EASI-ltc): An Adaptation
of the Elder Abuse Suspicion Index©
1 ,2
1 ,3
Objectives: To modify an existing EA detection
tool, the Elder Abuse Suspicion Index (EASI), for
use in LTCFs, and to explore contextual factors
that may affect its use in LTC.
Methods: This was a mixed methods study
sequentially integrating quantitative cross-sectional
and qualitative descriptive methodologies. Tool
modification was informed by a literature review,
internet-based consultations with EA experts
across Canada, and data obtained from two
purposively selected focus groups. Efforts were
made to specifically distinguish between
institutional or systems failure, and residentdirected abuse.
Results: Analyses resulted in the development of
a nine-question tool, the EASI-ltc, designed to
raise suspicion of EA in older adults with MMSE
≥24 residing in LTCFs. Notable modifications to the
original EASI included three new questions to
further address neglect and psychological abuse,
and a context-specific preamble to orient
responders. Resident reluctance to report abuse
and a lack of defined reporting
protocols/procedures were identified as potential
barriers to successful EASI-ltc implementation.
Conclusions: It is expected that the EASI-ltc will
advance understanding of abuse experienced by
LTC residents. As an indication of suspicion
necessitates further evaluation and response,
future validation of the EASI-ltc may lead to
reliable EA prevalence data in this population. A
next step will be to develop a research protocol to
explore the practical aspects of EASI-ltc
implementation.
2
Stephanie Ballard , Mark Yaffe , Linda August ,
2 ,3
1 ,4
Deniz Cetin-Sahin , Machelle Wilchesky
1
2
Montreal, Quebec, Canada, Donald Berman
Maimonides Geriatric Centre, Montreal, Quebec,
3
Canada, St. Mary's Hospital Centre, Montreal,
4
Quebec, Canada, Centre for Clinical
Epidemiology, Lady Davis Institute for Medical
Research, Jewish General Hospital, Montreal,
Quebec , Canada
P21
Towards a Diverse Vision of
Aging: Transgender Older Adults' Experiences
of Identity Negotiation
Ashley Flanagan, Lisbeth Berbary, Sherry Dupuis
University of Waterloo, Waterloo, ON, Canada
The discrimination transgender individuals have
faced in their past does not end at age 65, rather
106
heterosexism and cisgenderism persist into later
life. These experiences are also often
compounded with ageism and age-related issues.
Out of fear of rejection, discrimination, and
harassment transgender older adults become
adept in negotiating their identity presentation as
they navigate relationships with family, friends,
healthcare providers, and the population at large.
Aging as a transgender individual appears to be a
complex juxtaposition of embracing one’s self, and
mediating one’s interactions and relationships with
others. The intention of the larger inquiry was to
call attention to the aging experiences of LGBTQ
older adults, as well as to contribute to and
celebrate the growing understanding of leisure and
diversity in aging and later life. Nine semi-structure
interviews focusing on stories of aging perceptions
and experiences were conducted with older adults
who self-identified as lesbian, gay, or transgender.
As a small component of the aforementioned
study, this presentation aims to disrupt the
homogenized view of aging by highlighting the
complexities of identity negotiation as a
transgender older adult. Through the use of
screenplay as creative analytic practice, this
presentation highlights the aging experiences of
three trans-identified women. The voices of the
women are heavily embedded throughout the
presentation – via excerpts from the original
screenplay – as we explore their stories of seeking
acceptance, identity management, and claiming
identity.
not translated to increased interest in providing
physiotherapy care for them.
METHODS: A scoping literature review was
conducted using multiple databases. Search terms
included physiotherapy, student, perception,
attitude, bias, belief, older adults, geriatrics and
related terms. Articles were retained for analysis if
physiotherapy students were the research
participants and the researchers reported findings
related to attitude toward older adults.
FINDINGS: Eleven articles were found that met
criteria. Although most studies supported that
physiotherapy students have positive attitudes
toward older adults, there were many limitations in
the studies found. Many lacked a comprehensive
theoretical framework to inform their methods, did
not clarify the constructs to be measured, or used
measurement instruments of questionable validity.
DISCUSSION & CONCLUSION: Future research
should aim to measure students' attitudes
specifically towards providing physiotherapy care
for older adults and not merely towards older
adults themselves. Theoretical frameworks that
inform methods, and development of validated
measurement tools, would advance our
understanding.
P23
P22
Marital and Parental Status as a Risk Factor for
Dementia and Alzheimer’s Disease
Is the future physiotherapy workforce prepared
for the population ageing? A scoping review of
Literature
Allegra Samaha, Yeonjung Lee
Michael Kalu, Norman Kathleen
School of Rehabilitation Therapy, Queens
University, Kingston/Ontario, Canada
PURPOSE/GOAL: There is a projected increase in
demand for physiotherapists to work with older
adults due to the increased chances of reduced
mobility in older adults. The extent to which
physiotherapy students may hold ageist attitudes
has been examined in many countries. Currently,
the attitude of physiotherapy students towards
older adults is reported as more positive than
negative, and yet few are interested in working
with older adults. The purpose of this research is to
explore why the positive attitudes of the
physiotherapy students toward older adults have
A short statement of the objectives Risk factors
contributing to the development of dementia have
been studied focusing mostly on cognitive and
physical characteristics. Currently, there is scant
research to explain difference in incidence of
dementia reliant on marital and parental status,
related to the broader topic of dementia and social
networks. The purpose of this study is to present a
review of the literature on marital and parental
status as a risk factor for dementia in terms of
social networking. In addition, gaps in the
literature and recommendation for future studies
will be identified.
Methods This study will evaluate international
research on marital and parental status as a risk
factor for dementia and summarize current findings
107
on associations between familial structures and
incidence of dementia. A comprehensive review of
literature was performed. Studies were limited to
original quantitative and qualitative research and
research included in scoping, meta-analysis,
and/or systematic review, written in English and
published in peer-reviewed journals from January
2000 through April 2016.
Results Preliminary findings suggest that being
married and having children are both protective
factors against the development of dementia.
Moreover, widowers are at a much higher risk of
developing dementia than their counterparts.
Conclusions The findings from this study will 1)
provide awareness, understanding and knowledge
of risk factors for dementia in terms of familial
structure; 2) suggest the prevention and
intervention strategies from a non-medical
perspective; and 3) identify knowledge gaps
requiring future research.
Keywords: risk factors, marital status, parental
status, literature review
higher death rate. These negative outcomes affect
the quality of care provided to persons with
dementia. Interventions to support family
caregivers exist, however, little is known about
family caregiver-related goals and the ways in
which these goals are set or assessed. Studies
that investigated family caregiver needs are limited
and, unequivocally, focused primarily on the goals
of persons with dementia. Person-centered care
can be optimized if goals of family caregivers align
with intervention outcomes. The aim of this study is
to investigate the goals set by family caregivers of
persons with dementia prior to a behavior-based
non-pharmacological intervention. The London
Ontario-based intervention included thirty family
caregivers who created individualized goals for
their needs. Key themes of family caregivers’ goals
will be identified by content analysis. The results
will provide useful knowledge and awareness of
goals set by family caregivers which will help
optimize development, use and evaluation of
behavioural intervention programs.
P25
P24
The experiences of homecare personal support
workers in a dementia focused personcentered communication intervention
Discovering goals set by family caregivers of
persons with dementia prior to a behavioural
intervention
Lauren Tordoff, Marie Y. Savundranayagam, JB
Orange, Deborah Fitzsimmons
Western University, London, Canada
1
1
Shalane Basque , Marie Savundranayagam ,
1 ,2
1
1
Angela Roberts , JB Orange , Marita Kloseck ,
3
Karen Johnson
1
2
Northwestern University, Chicago, Illinois, USA,
3
Alzheimers Society of McCormick Home, London,
Ontario, Canada
Dementia is an acquired progressive
neurodegenerative syndrome that impairs
cognitive functioning and compromises persons’
abilities to complete essential daily tasks. Globally,
47 million people live with dementia. This number
is expected to double every twenty years over the
coming century. On average, family members
spend 60 hours per week helping their relatives
who have dementia with care for activities of daily
living, monitoring changes of functioning, and
providing emotional support, among other tasks.
However, caregiving for persons with dementia is
linked with negative health outcomes including
increased levels of psychiatric symptoms,
associated depressive and anxiety disorders, and
Recent epidemiological estimates indicate 747,000
Canadians are living with dementia with cases
expected to double to 1.4 million by 2031. Most
persons with dementia rely on formal care provided
either in long-term care facilities (LTC) or in their
own home. The proportion of individuals with
dementia receiving care in LTC vs. in home will
shift dramatically in the coming decades.
Homecare for persons with dementia and their
families is viewed as a more economical, socially
acceptable, and comfortable option. By 2038, 62%
of individuals with dementia will receive formal
homecare. Personal support workers (PSWs) who
are imperative in providing dementia care are
tasked often to help persons with dementia
complete myriad self-care activities. However,
homecare PSWs often are neglected in literature
on formal caregivers. Moreover, a lack of
standardization in and inconsistency of PSW
education and training programs result in differing
caregiving skills, abilities and knowledge. PSW
curricula often contain a minimal focus on mental
health education including dementia. Education
108
programs may be failing to prepare future PSWs
adequately for dementia caregiving. This study
uses phenomenological interviewing to understand
experiences of homecare PSWs, pre- and post- a
person-centered communication intervention. The
study will examine homecare PSWs’ experiences
in communicating with home-based persons with
dementia, their experiences of formal training in
dementia care, and their experiences interacting
with a simulated patient during the planned
intervention. The results of this study will inform
future educational interventions for homecare
PSWs and will help identify their current and future
learning needs.
P26
Exploring the influence of oral health literacy
and oral health chronic disease knowledge on
older adults' oral care behaviours
1
2
Alison MacDougall , Lori Weeks , William
1
3
Montelpare , Sharon Compton
1
University of Prince Edward Island, Charlottetown,
2
PE, Canada, Dalhousie University, Halifax, NS,
3
Canada, University of Alberta, Edmonton, Alberta,
Canada
Background: Unlike previous generations, baby
boomers are keeping their own natural teeth as
they enter into older age.
Purpose: The purpose of this mixed-methods
online study was to explore the influence of oral
health literacy (OHL), and oral health chronic
disease knowledge (OHCDK) on oral care
behaviours (OCBs).
Methods: This exploratory, Internet based mixed
method study recruited a sample of 69 community
dwelling men and women aged 50 to 69 years.
Results: All participants had some natural teeth
and 72.46% had access to private dental
insurance. The mean OHL score was 13.36 and
the mean OHCDK score was 10.01. Pearson
product moment correlation co-efficient procedure
revealed a low but positive correlation between
OHL and OHCDK scores. [r = 0.31, n =69, p =
0.008]. The mean dental behaviours score was
5.60. Regression analysis determined the
significant predictor model for dental behaviours
included: (1.46) dental insurance + (0.85) age
cohort + (0.6) level of education. (F(3) = 311.87, p
= < 0.0001, R2 = 93.5%).
Qualitative analysis revealed six major themes:
Relying on Dental Professionals, Only Knowing
Part of the Story, Making the Connection, Living
with the Consequences, Practicing and Valuing
Oral Health, and Identifying Barriers to Care.
Triangulation also showed that participants had
adequate OHL, yet were lacking in OHCDK and
highlighted the influential role that dental insurance
has on OCBs.
Conclusion: Future research should focus on a
larger samples with equal numbers of men and
women to further explore what factors influence the
oral care behaviours of baby boomers.
P27
Existe-il une relation entre la douleur et
l'anxiété chez les aînés souffrant de douleur
musculo-squelettique ?
1 ,2
1 ,3
Marie-Philippe Harvey , Dominique Lorrain ,
4
1 ,2
1 ,2
Inès Daguet , Marylie Martel , Francis Houde ,
2 ,5
1 ,2
Mario Séguin , Guillaume Léonard
1
Centre de Recherche sur le Vieillissement,
Université de Sherbrooke, Sherbrooke, Canada,
2
Faculté de Médecine et des Sciences de la Santé,
3
Département de psychologie, Université de
4
Sherbrooke, Sherbrooke, Canada, Département
de Biologie Lyon 1, Université Claude Bernard
5
Lyon 1, Lyon, France, Neurochirurgie, Centre
Hospitalier Universitaire de Sherbrooke,
Sherbrooke, Canada
Introduction: Plusieurs études suggèrent qu'il
existe une relation entre la douleur et l'anxiété.
Peu d'études ont cependant évalué la relation
entre ces deux variables chez les aînés. L'objectif
de la présente étude était (1) d'évaluer la relation
entre la douleur et l'anxiété chez les aînés
souffrant de douleur chronique d'origine musculosquelettique et, (2) de déterminer si un traitement
de neurostimulation, ciblant la douleur, pouvait
réduire l'anxiété.
Méthodes: 19 aînés (âge moyen 69 ± 8 ans)
souffrant de douleur chronique ont pris part à cette
étude randomisée et à double insu. Les
participants recevaient cinq séances quotidiennes
consécutives de tDCS anodique appliqués au
109
cortex moteur primaire (2 mA, 20 minutes) ou cinq
séances de tDCS simulée. Avant et après les
traitements, l'intensité de la douleur et l'anxiété
étaient évaluées à l'aide d'échelle visuelle
analogue (ÉVA) et de l'inventaire d'anxiété de
Beck (BAI), respectivement.
Résultats: D'une part, les résultats préliminaires
indiquent qu'il existe une relation positive entre
l'intensité de la douleur et l'anxiété des aînés avant
les traitements de neurostimulation (r = 0.46 ; p <
0,05). D'autre part, la diminution de douleur
engendrée par la tDCS permet d'atténuer l'anxiété
(p < 0,05).
Conclusion: Les présents résultats suggèrent que
l'association observée entre la douleur et l'anxiété
dans la population générale est également
présente chez les aînés souffrant de douleur
chronique musculo-squelettique. De façon
intéressante, il appert que le soulagement de la
douleur, via l'utilisation d'une technique de
neurostimulation, peut contribuer à réduire
significativement l'anxiété ressentie par les aînés.
and incident dementia in older adults were eligible
for inclusion.
Results: Of 1216 potentially relevant articles, 17
met the final inclusion criteria. In older adults with
Mild Cognitive Impairment (MCI) slow gait velocity
and postural instability and gait disturbance (PIGD)
but not manual dexterity, severity of rigidity, or
severity of bradykinesia predicted dementia. In
older adults with Parkinson’s Disease manual
dexterity, severity of bradykinesia, and severity of
rigidity were predictive of dementia, but gait
velocity and PIGD were not. In most but not all
mixed cohorts of older adults global parkinsonism
and gait disturbances were associated with
incident dementia of any type while decreased gait
velocity selectively predicted Vascular Dementia.
Tremor did not predict dementia in any population.
Conclusion: Motor function decline affecting gait,
manual dexterity, bradykinesia, and rigidity may
indicate an increased risk of developing dementia.
More consistent methodology across studies in the
assessment of motor function is needed for a
meta-analysis to be conducted.
P28
Motor changes as a predictor of dementia
syndromes: A systematic review
1 ,2
1 ,2
Jacqueline Kueper , Mark Speechley , Navena
1 ,2
1 ,2
Lingum , Manuel Montero-Odasso
1
2
Gait and Brain Laboratory, London, Ontario,
Canada
Background: Cognitive and mobility decline are
interrelated processes whereby mobility decline
coincides or precedes the onset of cognitive
decline. Consequently, clinical assessment of
motor function may provide valuable information
about an older adult’s current and future cognitive
health.
Objective: To evaluate if decreased motor function
is associated with an increased risk of incident
dementia.
Methods: A systematic search of the following
electronic databases was performed: Medline,
Proquest Psychology Journal, Embase, Cinahl,
and PsycInfo. Grey literature sources were also
searched. Studies written in English that tested for
an association between baseline motor function
P29
Incidence and impact measurement of delirium
induced by ED stay (INDEED)
1 ,2
1 ,2
3 ,4
5
M Émond , P Voyer , R Daoust , M Pelletier
,2
6
1 ,2
1
1
, E Gouin , S Berthelot , V Boucher , M Giroux
,2
1 ,2
7 ,2
1 ,2
, A Laguë , M-E Lamontagne , S Lemire , J
9
1 ,2
1 ,2
Lee , M Morin , L Juneau
1
Centre de Recherche du CHU de Québec,
2
Québec, Québec, Canada, Université Laval,
3
Québec, Québec, Canada, Hôpital du SacréCoeur de Montréal, Montréal, Québec, Canada,
4
5
Canada, Centre Hospitalier Régional de
Lanaudière;, Lanaudière, Québec, Canada,
6
Centre Hospitalier Régional de Trois-Rivières,
7
Trois-Rivières, Québec, Canada, Centre
interdisciplinaire de recherche en réadaptation et
en intégration sociale, Québec, Québec, Canada,
8
Centre d'Excellence sur le Vieillissement de
9
Québec, Québec, Québec, Canada, Sunnybrook
Health Sciences Centre, Toronto, Ontario, Canada
Introduction: Delirium is a dreadful complication
in seniors' acute care. Many studies are available
on the incidence of delirium, however ED-induced
delirium is less studied. We aim to evaluate its
incidence and impact among admitted seniors with
prolonged ED stay (≥8 hours).
110
Methods: This prospective study included patients
from 4 Canadian EDs. Inclusion criteria: 1) Patients
aged ≥65; 2) ED stay ≥8 hours; 3) admitted to
hospital ward; 4) non-delirious upon arrival and
after the first 8 hours; 5) Independent/semiindependent. Patients were assessed by a
research assistant twice a day up to 24h after ward
admission. Functional and cognitive status were
assessed using validated OARS and TICS-m tools.
The CAM was used to detect incident delirium.
Univariate and multivariate analyses were
conducted to evaluate outcomes.
Results: 380 patients were included, mean age
was 76.5 (± 8.9), 50% male and 16.5% were aged
> 85 y.o.. The overall incidence of ED-induced
delirium was 8.4%. Distribution by the 4 sites was:
10%, 13.8%, 5.5% & 13.4%. Mean ED LOS varied
from 29 to 48 hours and mean hospital LOS was
increased by 6.1 days in the delirious patients
compared to non-delirious patient (p<0.05).
Increase mean hospital LOS distribution by site
was by: 6.9, 8.5, 4.3 and 5.2 days for the EDinduced delirium patients.
Conclusions: ED-induced delirium was recorded
in nearly 10 % of included seniors after an 8 hour
ED stay. An episode of delirium increases hospital
LOS by about a week and therefore could
contribute to ED overcrowding.
P30
Pubmed, CINHAL. Studies were retained if they
were 1)peer-reviewed; 2)published in English;
3)focused on non-pharmacological interventions
(specifically psychosocial interventions including
cognitive training); and 4)designed for persons with
dementia, or other related diseases, diagnosed
before the age of 65.
Results: A total of 7 articles met our inclusion
criteria and were included in the study. Of those,
four consisted in social programs involving the
community as part of the intervention, two focused
on a cognitive based intervention and one focused
on a cognitive behavioral intervention. The social
interventions improved the mood and well-being of
participants as well as provided respite for
caregivers. The cognitive interventions were
successful in improving perceived functional
outcomes and affective symptoms.
Conclusion: Every intervention reported positive
benefits for participants and their caregivers. There
is a growing need to develop, study, review, and
establish effective interventions for individuals with
YOD given the particularities of this population.
P31
Association between Emergency department
induced delirium and cognitive & functional
decline in seniors
1 ,2
Non-pharmacological interventions for
individuals with young-onset dementia
1
1 ,2
Marivic Aplaon , Aline Aboujaoudé , Isabelle
1
2 ,3
1 ,2
Gélinas , Nathalie Bier , Patricia Belchior
1
2
McGill University, Montreal, Canada, Institut
Universitaire de Gériatrie de Montréal, Montreal,
3
Canada, Université de Montréal, Montreal,
Canada
Objective: The aim of this study was to conduct a
scoping review of the literature to investigate nonpharmacological interventions for individuals with
young-onset dementia and examine their success.
Given that this disease starts at an early age,
these individuals might require different types of
support and services than those available for
individuals with late-onset dementia.
Methods: A comprehensive review of the literature
was conducted. The following databases were
included in our search: Ovid Medline, PsycINFO,
1 ,2
1 ,2
2
M Giroux , M Émond , MJ Sirois , V Boucher ,
4 ,5
6
7
2 ,1
R Daoust , E Gouin , M Pelletier , S Berthelot ,
1 ,3
1 ,2
1 ,2
P voyer , L Moore , S Lemire , ME
1 ,8
Lamontagne
1
2
Université Laval, Québec, Canada, CHU de
3
Québec, Québec, Canada, Centre d'excellence de
vieillissement du Québec, Québec, Canada,
4
Hopital du Sacré-coeur de Montréal, Montréal,
5
Canada, Université de Montréal, Montréal,
6
Canada, Centre hospitalier régional de
7
Lanaudière, Lanaudière, Canada, Centre
hospitalier régional de Trois-Rivières, Trois8
rivières, Canada, Centre interdisciplinaire
recherche réadaptation et en intégration sociale,
Québec, Canada
Background: Delirium is a common medical
complication among senior in the emergency
department (ED). Delirium is associated with
increased mortality & longer hospital stay. It is also
associated with functional & cognitive decline in
hospitalized seniors and institutionalization. No
data is currently available for ED patients. Aim: To
evaluate the association between ED-induced
111
delirium and functional & cognitive decline in
seniors at 60 days.
but de réduire les facteurs de risque responsable
des chutes chez les personnes âgées.
Method: This study is part of the ongoing
multicenter prospective cohort MIDI-INDEED
study. Patients were recruited after 8 hours in the
ED and followed up to 24h after admission. A
follow-up phone assessment was conducted 60
days later. Delirium was measured by the validated
CAM. Functional status was measured by the
validated OARS. Cognitive status was measured
using the validated TICS-M. Functional and
cognitive decline were obtained by comparing the
baseline and 60-days follow-up scores.
Méthode: Cette évaluation de programme utilise
un devis avant-après sans groupe de
comparaison. Une analyse des effets permet
d'examiner la relation de causalité entre le
programme et ses effets et une analyse logique
permet d'évaluer la pertinence du programme
selon la perspective des participants. Les données
quantitatives pré et post programme des tests
physiques (Berg, Sit-to-stand, appui unipodal) et
du test de connaissances sont comparées à l'aide
de tests de Student. Une analyse qualitative de
contenu permet d'analyser les questionnaires de
satisfaction et de suivi.
Results: 370 seniors were recruited. 280 had
follow-up data available. ED-induced delirium was
10%. There was a difference in mean functional
decline among seniors with and without:
3,04 (±2.65) vs 1,53(±3,55), pwlicoxon= 0.02.
Proportion of seniors showing a decline ≥2 points
on the OARS was significantly higher in those with
delirium (p=0,04). Seniors with delirium also
showed a significant decline in mean TICS scores:
4,04(±5,80) vs 0,88 (±6,74), pwlicoxon=0.03. There
was no significant difference in the proportions of
seniors showing a decline ≥ 3 OARS points
(p=0.06).
Résultats: à la fin du programme, un changement
positif et statistiquement significatif est observé
aux trois tests physiques et au test de
connaissances. Au suivi, six mois après la fin du
programme, la majorité des participants ont
apporté des modifications à leur environnement et
à leur comportement et la majorité d'entre eux
continue à faire de l'exercice. De plus, la
satisfaction des participants s'avère élevée.
Conclusion: ED-induced delirium seems to be
associated with poor functional and cognitive
outcomes in older patients 60 days after discharge
from the hospital.
Conclusion: Ces résultats suggèrent que la
vidéoconférence peut être utilisée pour offrir des
programmes incluant des exercices à des groupes
isolés comme les ainés vivant dans des
communautés francophones en situation
minoritaire.
P32
P33
Évaluation du programme Marche vers le futur,
un programme multifactoriel de prévention des
chutes offert par vidéoconférence
A Review of Factors Influencing Appropriate
Psychotropic Prescribing for Older Adults in
Long-Term Care Facilities
1
1
2
S. Labossière , J. Savard , D. Cardinal
1
Université d'Ottawa, Ottawa, Canada,
2
Consortium national de formation en santé, volet
Université d'Ottawa, Ottawa, Canada
Contexte: Chez les personnes âgées, les chutes
représentent un problème de santé publique
majeur. Elles ont un impact sur la personne, ses
proches, les ressources communautaires et le
système de santé.
Objectif: Évaluer le programme Marche vers le
futur, un programme offert par vidéoconférence
par le CNFS-volet Université d'Ottawa, qui a pour
1 ,2
1
Matteo Peretti , Jonathan Salsberg , Deniz Cetin2
2 ,4
1 ,3
Sahin , Ovidiu Lungu , Machelle Wilchesky
1
2
Montreal, Quebec, Canada, Centre for Research
in Aging, Donald Berman Maimonides Geriatric
3
Centre, Montreal, Quebec, Canada, Centre for
Clinical Epidemiology, Lady Davis Institute for
Medical Research, Jewish General Hospital,
4
Montreal, Quebec, Canada, Département de
Psychiatrie, Université de Montréal, Montreal,
Quebec, Canada
Background: The use of psychotropic medications
in elderly long-term care facility (LTCF) residents is
variably effective and often associated with
112
significant adverse events. High prevalence rates
of psychotropic prescribing in LTCFs in spite of this
evidence suggests that there are barriers to
appropriate psychotropic prescribing in clinical
practice. No review of the barriers and facilitators
to appropriate psychotropic prescribing in LTCFs
from the perspective of physicians currently exists.
The objective of this literature review was to
address this knowledge gap.
Methods: We searched MEDLINE, PsychINFO,
and EMBASE from inception to present. Selected
keywords included long-term care, physician*,
psychotropic*, barrier*, facilitator*, appropriate*.
Using snowball sampling, reference lists of
relevant studies were searched for additional
articles. Barriers and facilitators in included
studies were thematically analyzed.
Results: Three studies, two qualitative (focus
groups, interviews) and one mixed methods, (focus
groups, surveys) were included. Each study
addressed different classes of psychotropics
(antipsychotics, antidepressants, sedativehypnotics). Studies were conducted in Germany,
Belgium, and Norway. Five themes emerged from
the barriers: pressure for physicians to prescribe;
fear of reducing quality of life; lack of nonpharmacological alternatives for LTCFs; concerns
about negative outcomes of deprescribing; and
infrequent medication review. Clear treatment
indication was the only theme that emerged from
the facilitators.
Conclusion: Barriers to appropriate psychotropic
prescribing in LTCFs have been identified but
facilitators remain largely unknown. Despite the
central role of physicians in this process, their
perspectives are underrepresented in the
literature. An in-depth understanding of the
relevance of these findings to the Canadian
context is needed.
P34
Physical activity positively impacts cognition
and quality of life in older adults
Amanda George, Michelle Ploughman, Linda Rohr
Memorial University of Newfoundland, St. John's,
Newfoundland, Canada
Objective: Maintaining mental and physical fitness
is important throughout the lifespan. Research has
indicated that being physically active can have
benefits for both cognition and quality of life, even
in older adults. This project attempted to determine
the impact of a physical activity intervention on the
cognition and quality of life on older adults with
self-reported memory impairments. Specifically, we
asked the question, does maintaining a physically
active lifestyle aid in maintaining cognitive abilities
and a good quality of life?
Methods: Eighteen older adults (ages 65 to 79)
were recruited to complete a walking intervention,
while tracking changes in cognition and quality of
life with bi-monthly questionnaires. The
intervention consisted of attaining 150 minutes or
more of physical activity, specifically walking, per
week, which was tracked over the six-month
intervention in a self-reported logbook. An
informant (family member or friend) was also
selected by each subject to provide objective
information regarding changes over time.
Results: Being physically active, regardless of
intensity, was related to increases in individuals
cognition (p = .004) and quality of life (p = .044)
over the six-month period. Informants reported a
positive change in cognition (p = .006), but not in
quality of life.
Conclusion: Engaging in a physically active
lifestyle can positively impact an individual's mental
capabilities and life satisfaction, even in the later
stages of life.
P35
Successful cognitive aging is associated with
frailty but not individual comorbidities among
older adults with HIV
1
2
Lindsay Wallace , Maria Ferrara , Thomas
1
2
1
Brothers , Sara Garlassi , Susan Kirkland , Olga
1
2
3
Theou , Stefano Zona , David Moore , Kenneth
1
2
Rockwood , Giovanni Guaraldi
1
Dalhousie University, Halifax, NS , Canada,
2
University of Modena and Reggio Emilia, Modena
3
, Italy, University of California San Diego, San
Diego, CA, USA
Background: Aging with HIV poses unique and
complex challenges, including avoidance of
neurocognitive disorder. Our objective here is to
identify the prevalence and predictors of
successful cognitive aging (SCA) in sample of
older adults with HIV.
113
Methods: One hundred three HIV-infected
individuals aged 50 and older were recruited from
the Modena HIV Metabolic Clinic in Italy.
Participants were treated with combination
antiretroviral therapy (cART) for at least one year
and had suppressed plasma HIV viral load. SCA
was defined as the absence of neurocognitive
impairment (as defined by deficits in tasks of
episodic learning, information processing speed,
executive function, and motor skills) depression,
and functional impairment (instrumental activities
of daily living). In cross-sectional analyses odds of
SCA were assessed in relation to HIV-related
clinical data, HIV-Associated Non-AIDS (HANA)
conditions, multimorbidity (≥2 HANA conditions),
and frailty. A frailty index was calculated as the
number of deficits present out of 37 health
variables.
Results: SCA was identified in 38.8% of
participants. Despite no differences in average
chronologic age between groups, SCA participants
had significantly fewer HANA conditions, a lower
frailty index, and were less likely to have
hypertension. Additionally, hypertension (OR=0.40,
p=0.04), multimorbidity (OR=0.35, p=0.05), and
frailty (OR=0.64, p=0.04 were significantly
associated with odds of SCA.
Conclusions: Frailty is associated with the
likelihood of successful cognitive aging in people
living with HIV. This defines an opportunity to apply
knowledge from geriatric population research to
people aging with HIV to better appreciate the
complexity of their health status.
P36
The Effect of Alzheimer's disease on Oral
Health
1
2
3
Gauri Mathur , Yasmina Tehami , Navdip Bhela ,
2
Raza M. Mirza
1
Poznan University of Medical Science, Poznań,
2
Poland, University of Toronto, Toronto, Canada,
3
York University, Toronto, Canada
A growing number of older Canadians will be
diagnosed with Alzheimer's disease (AD), and as
such may be at an increased risk of oral health
issues. Although AD is recognized as a debilitating
illness with no cure, limited attention has been paid
to the implications of poor oral health for those with
AD. What is known is that Individuals with AD have
gradual deterioration of memory and motor skills
which translates to eventual poor self-care and
increased risk for oral diseases. This leads to
additional health issues, increased morbidity and
mortality and lower quality of life. A scoping review
was conducted to synthesize the literature on the
effect of AD on oral health. Examination of six
databases using sets of keywords yielded over
6000 articles. The titles and abstracts were
manually curated and 110 were included for further
review. Three independent reviews were
conducted for these abstracts using a set inclusion
criteria and those that met this criteria were fully
analyzed. The results indicate that the severity of
dementia may be related to the extent of the oral
health issues, AD patients that attend memory
clinics may have improved oral health and that
special care should be taken by all healthcare
professionals when assessing and treating AD
patients. The findings from this review highlight
that poor oral health for those with AD may have
far-reaching implications and in order to improve
future outcomes, greater research focus, practice
consideration and policy changes will be needed in
this area.
P37
Economic barriers regarding adherence to
pharmacological treatments for chronic
diseases in the Elderly covered under a public
drug insurance in Quebec
R Milan, H-M Vasiliadis
Department of Community Health Sciences,
Université de Sherbrooke, Sherbrooke, Canada
Background: The daily intake of several
medications by the elderly population creates a
challenge when it comes to maintaining adherence
to their prescriptions. Moreover, an earlier study
carried out in Quebec showed that adherence
rates to antidepressants were superior in privately
insured patients due to the lower medication copayments. The aim of this study is to assess
whether the co-payments among the elderly,
covered under a public insurance in Quebec, may
influence differently adherence to pharmacological
treatments for chronic diseases such as
antihypertensive drugs, oral antihyperglycemic
agents and antidepressants.
Methods: Data was collected from a
representative sample (N=2,811) of communitydwelling adults in Quebec aged from 65 years or
older who participated in the “Étude sur la Santé
des Aînés” survey. Medication adherence was
measured using the medication possession ratio
114
over a 3-year period. Costs paid out for drugs by
beneficiaries were found in the RAMQ database.
Other factors considered were age, gender,
education, area, annual income, presence of
chronic disease(s) and the presence of depression
and/or anxiety. Multivariate logistic regression was
used to model medication adherence as a function
of study variables.
related emergency department visits. This
investigation suggests that avoiding inappropriate
medications, avoiding high risk medications such
as narcotics and anticholinergic drugs, and the
presence of adequate social supports are
important in preventing drug-related emergency
department visits in older adults.
P39
Results: There is a differential association
between payment and adherence to medications
depending on type of chronic illness.
Limiter les pertes fonctionnelles des aînés
après un trauma mineur par la physiothérapie :
projet en cours
Conclusion: This study will help identify factors
that influence adherence to medications for chronic
physical and mental disorders and will allow
clinicians to identify vulnerable people in order to
reduce inequity in access to public health services.
P38
A Cohort Study to Identify Risk Factors for
Drug-Related Emergency Department Visits in
Older Adults
1
1 ,2
1
Shanna Trenaman , Susan Bowles , D Persaud ,
1 ,2
Melissa Andrew
1
2
Dalhousie University, Halifax, NS, Canada, Nova
Scotia Health Authority, Halifax, NS, Canada
In older adults polypharmacy and the use of
inappropriate medications are a common cause of
drug-related emergency department visits. Given
the complex interplay between social, economic
and medical factors in older adults the present
study explored a comprehensive list of potential
risk factors for drug-related emergency department
visits. Potential factors included gender; age;
comorbidities; history of falls; cognition; education;
dependence for activities of daily living; social
supports; frailty, number of medications;
medication appropriateness index; and use of
specific high risk medications. Information
collected from the Comprehensive Geriatric
Assessment during patient assessment in the
emergency department from a subset of the
geriatric internal medicine service between 2006
and 2013 was used. Backward stepwise binary
logistic regression was used to examine the
multiple potential risk factors for drug-related
emergency department visits in older adults. The
analysis showed that narcotic drug use, any
anticholinergic drug use, lack of social supports
and increased use of inappropriate medications as
identified by an increased medication
appropriateness index increased the risk of drug-
1 ,2
2 ,3
2 ,3
L Fruteau de Laclos , MJ Sirois , B Batomen ,
2 ,3
M Émond
1
Centre d’Excellence sur le Vieillissement de
2
Québec , Québec, Canada, Centre de recherche
3
du CHU de Québec, Québec, Canada, The
Canadian Emergency Team Initiative (CETI),
Québec, Canada
Objectif : Comparer le changement fonctionnel
des aînés ayant reçu ou non des services de
physiothérapie après une consultation au
département d'urgence (DU) pour une blessure
mineure.
Devis: Analyses secondaires de la cohorte CETI
(Canadian Emergency Team Initiative).
Participants : 1274 aînés autonomes ayant
consulté les DUs pour une blessure mineure en
2010-13 ont été suivis pendant 6 mois.
Mesures principales : Statut fonctionnel mesuré à
l'aide du OARS (Older American Ressources
Scale); recours ou non à la physiothérapie pendant
la période de suivi. Mesures secondaires :
données socio-économiques, statut fragile,
physique, cognitif et affectif. Des analyses de
régressions multiples ont été utilisées pour
examiner l'effet du recours à la physiothérapie sur
le statut fonctionnel en tenant compte des facteurs
confondants.
Résultats : 338 (27%) aînés ont reçu des services
de physiothérapie au cours du suivi. Après 6 mois,
les changements moyens au OARS étaient de 0,98 chez les aînés ayant eu de la physiothérapie
vs -0,99 chez les autres (p=0,99[MS1] ). Chez les
aînés ayant exprimé le besoin d'avoir de la
physiothérapie, ceux qui en ont effectivement reçu
avaient moins décliné (-0,36 vs -0.66, p=0,1) en fin
de suivi. Les pertes fonctionnelles à 6 mois des
aînés utilisant une aide à la marche au moment de
115
la blessure étaient moindre chez ceux ayant
bénéficié de physiothérapie (physio : -1,15 vs nonphysio : -2,04, p=0,05).
Conclusion : Ces résultats préliminaires indiquent
que la physiothérapie est associée à une
amélioration non-significative du statut fonctionnel
post-blessure chez certains sous-groupes d'aînés
ayant consulté les DUs.
P40
The Effects of Physical Training Cessation on
Executive Functions in Older Adults
1 ,2
1 ,2
Lynden Rodrigues , Tudor Vrincineau , Nicolas
2 ,3
2 ,4
5
Berryman , Laurent Bosquet , Sylvie Nadeau ,
5
2
2
Séléna Lauzière , Lora Lehr , Florian Bobeuf ,
2
2 ,6
Marie Jeanne Kergoat , Thien Tuong Minh Vu ,
1 ,2
Louis Bherer
1
Centre PERFORM, Concordia University,
2
Montréal, Québec, Canada, Institut Universitaire
de Gériatrie de Montréal, LESCA, Montréal,
3
Québec, Canada, Sports Studies Department,
Bishop’s University, Sherbrooke, Québec, Canada,
4
Faculté des Sciences du Sport, Laboratoire
MOVE, Université de Poitiers, Poitiers , France,
5
École de Réadaptation - Faculté de Médecine,
6
Canada, Centre hospitalier de l’Université de
Montréal, Département de Médecine, Service de
Gériatrie, Montréal, Québec, Canada
Combined strength and aerobic exercise (S+A)
and gross motor skills programs (GMS) have
shown promise in selectively improving executive
functions (EF) in older adults. However,
interruptions in training may occur resulting in
losses of training-induced physiological benefits.
So far, little is known about the effects of physical
training cessation on EF. Forty older adults
(70.5±5.51 years; 67.5% female) who had
completed an 8-week S+A or GMS program
followed by an 8-week training cessation period
were included in this study. Performances in the
Random Number Generation (RNG) test (inhibition
and working memory) in a single task (ST) and a
-1
dual-task (DT, walking at 4 km.h ) were analyzed.
Two-way ANOVAs, with repeated measures for
time (pre, post intervention and follow-up),
revealed a significant time effect for inhibition
scores. Turning Point Index (TPI - occurrence of
sequence changes from ascending to descending
numbers) improved in ST for all time comparisons
(pre to post intervention and post to follow-up)
whereas TPI performances in DT improved from
pre intervention to follow-up and from post
intervention to follow up (p < 0.05). However,
participants exhibited worse performances (p <
0.05) from pre intervention to follow-up (ST and
DT) and from post intervention to follow-up (ST) for
one working memory score (redundancy index).
Results of this study suggest that training
cessation can selectively impact EF but that
performance in inhibition does not seem to
decrease after a period of physical training
cessation.
P41
Multimorbidity and loneliness among Canadian
older adults: The mediating effect of pain
perception
Oladele Atoyebi, Andrew Wister
Simon Fraser University, Vancouver, British
Columbia, Canada
Background Multimorbidity negatively affects the
activities, lifestyle and quality of life of older
persons causing complex interactions between
physical and psychological conditions. These may
make social interaction difficult, leading to potential
feelings of loneliness. However, it is not known
how the pathways between multimorbidity and
loneliness could be modulated by the perception of
pain. This study aimed to determine if an
association exists between multimorbidity and
loneliness and whether this association is
mediated by pain perception.
Method This cross-sectional study used data
drawn from the 2008/2009 Canadian Community
Health Survey, targeting persons aged ≥80
(n=6,427). Loneliness scale was derived by
summing up responses to questions measuring
loneliness (Hughes et al., 2004), multimorbidity
was measured using an additive multimorbidity
scale and pain was assessed with the HUPDPAD
variable in CCHS. Ordinary least square
regression analysis with six hierarchical blocks was
used to estimate the relationships among
multimorbidity, loneliness and pain variables.
Results Multimorbidity expresses a statistically
significant beta coefficient with the loneliness scale
(β=0.092, p<0.001) in block 3, after controlling for
age, sex, marital status, education and income.
The inclusion of perceived pain in block 4 reduced
116
the effect of multimorbidity on loneliness to
β=0.049 (p<0.001). Inclusion of functional status in
block 5 further reduced this association to β=0.043
(p=0.001).
significantly increased, statistically and clinically, t
(16) =2.8, p= 0.006; SPPB increases were
statistically, but not clinically significant (1.15(1.67),
t(13)=2.48, p=0.014).
Conclusion In this study, multimorbidity modestly
increases the risk of loneliness among older
persons as hypothesized, while perceived pain
appears to slightly mediate this effect. Further
study is needed to help clarify these associations
using more refined measures and other subpopulations.
Conclusion Shorter duration, lower intensity
cardiovascular exercise, meeting ACSM
guidelines, produced endurance benefits for older
adults participating in Goldies2Home.
Recommended resistance exercise intensity was
not met and function score increases were not
clinically significant. Physiologically adequate
prescription for older adults in SSR is critical for
training gains.
P42
P43
The Where, When, How and What of
Rehabilitation Prescription in a Communitybased Slow-Stream Rehabilitation Program
Acute care early mobilization: an
interprofessional research project
Melody Maximos, Vanina Dal-Bello Haas
Objective Slow-stream Rehabilitation (SSR)
programs directed at increasing independence and
function are important health care continuum
components for older adults. However, SSR
exercise prescription has yet to be assessed. Our
objectives were to examine 1) SSR EX
prescription; 2) whether exercise prescription met
American College of Sport Medicine (ASCM)
guidelines for older adults; 3) physical endurance
and function outcomes.
Methods A mixed-method, prospective cohort
study of 19 older adults (X=78.85, SD=8.12)
attending Goldies2Home (Hamilton) was
conducted. Short Performance Physical Battery
(SPPB) and 6-minute walk test (6MW) were
administered at admission and discharge (week 4).
EX duration and mode were collected from the
health record and Rate of Perceived Exertion
(RPE) was used to determine intensity. Analyses
included descriptive statistics and paired t-tests.
Results Participants were prescribed15 minutes of
seated cardiovascular exercise (NuStep) and 20
repetitions of arm and leg resistance exercise, 3 to
5 days/week. Mean EX RPE (SD) was as follows:
Cardiovascular=4.88(1.07); arm =4.42(1.16);
EX=5.02(1.46). Cardiovascular exercise guidelines
were met, although at the lower end range for
duration and intensity. ACSM guidelines were not
met for resistance exercise intensity. 6MW scores
1 ,2
1 ,2
Diana Brutto , Leanna Taggio , Susan Steels
1
2
Canada
1 ,2
Despite ample available evidence of benefits of
early mobilization in acute care, hospitals in
Ontario lack early mobilization practices and
protocols (Liu et al., 2013). Systematic research
has unveiled an evidence to practice gap, which
requires review and investigation. Through an
inter-professional lens, examination of the patient's
perspective about motivation to mobilize and acute
care experience in mobilization is the first step to
bridging this gap.
Method: Six patients over the age of 65 admitted
to an acute care medical unit were interviewed by
social work and physiotherapy students in 2
phases; Phase 1: Captured feelings, motivators
and barriers related to acute care mobilization.
Phase 2: 4/6 patients interviewed about the
patient's experience of mobilization in relation to
the Registered Nurses Association of Ontario's
best practice guidelines in patient-centered care.
Results: Patients expressed feelings of frustration
about mobilization. While most recognized it's
importance in hospital, a few felt mobilization was
not their priority. Common barriers to mobilization
include dizziness, fear of falls, and pain, while
common motivators include increased
independence, staff availability, and discharge.
117
Conclusion: Inter-professional clinicians should
use information about a patient's values and
beliefs as a starting point for mobilization
treatment. Based on patient's reported barriers and
motivations to mobilize, individualized strategies
should inform treatment. In addition, clinicians
should continue to establish therapeutic,
empowering, and meaningful relationships and
goals with clients, while improving on pre-treatment
and post-treatment conversations that capture
preferences for care and feedback.
P44
Technology-Assisted Toilets: Enhancing
toileting independence in geriatric and stroke
rehabilitation
1 ,2
1
David Yachnin , Jeffrey Jutai , Hillel Finestone
1
2
Bruyère Research Institute, Ottawa, Ontario,
Canada
1 ,2
Toileting is an activity of daily living that is often
difficult to perform independently for elderly people
who are frail or have disabilities. As a result, they
may experience greatly reduced self-esteem and
improper hygiene which can cause to infection,
rashes, or skin breakdowns. Advances in toileting
technologies have the potential to accommodate
many of these concerns. Technology-assisted
toilets (TATs) are commercially available devices
that clean and dry the anal and vaginal regions
using a stream of water and a fan and are
operated using wall-mounted remote controls.
They can therefore potentially eliminate the need
for patients to challenge their balance and motor
dexterity in order to wipe themselves. This
presentation describes a program of research on
TATs located at leading geriatric and rehabilitation
care center in Ottawa.
We conducted a pilot trial in stroke rehabilitation to
assess whether TATs could provide adequate
hygiene and whether patients found the TAT easy
to use. Participants used the TAT on three
occasions for a bowel movement and answered
baseline questionnaires about their regular
toileting. The results indicated that TATs provided
sufficient hygiene on nearly all occasions. Scores
on the Psychosocial Impact of Assistive Devices
Scale (PIADS) were significantly higher when
comparing TAT trials to baseline, indicating that
patients felt more competent, confident, and
motivated to self-toilet. The findings informed the
design of an ongoing, larger study with geriatric
patients which will help us understand how
technology-assisted toileting may be integrated
with rehabilitation programs for elderly patients.
P45
A Smartphone-Based Approach to Longitudinal
Evaluation of Gait Variability and Executive
Function
1
1
Jenna Blumenthal , Mark Chignell , Tammy
2 ,1
Sieminowski
1
2
Bridgepoint Active Healthcare, Toronto, Ontario,
Canada
Walking has long been considered to be an
autonomic process involving little or no higher
cognitive input. In healthy adults, stride-to-stride
fluctuation of many gait parameters (e.g. gait
speed, stride time) is on the order of just a few
percent, testimony to the accuracy and reliability of
the fine-tuned systems that regulate locomotion.
When the systems regulating walking are disturbed
as a result of neurological disease or abnormal
aging, movement control may be impaired leading
to increased variability of several gait parameters.
Previous work has found that gait timing in healthy
adults is consistent regardless of gender or age,
suggesting that decline in gait control cannot be
attributable to aging alone.
Traditionally, gait variability has been difficult to
quantify and has been carried out in specialized
laboratory settings. Current motion analysis
systems are expensive, require trained personnel
to operate, and limit evaluation to a few strides in a
controlled setting. However, recent advances in
consumer electronics allow for the development of
a system that is cheap, unobtrusive, and easy-touse in unconstrained ambulation.
We have developed a simple smartphone-based
application, “Journey” for the evaluation of gait
variability, through a co-design process with
clinicians and rehabilitation therapists at
Bridgepoint Active Healthcare. The application has
three main features: simple measurement of
clinically relevant gait parameters, the ability to
track share, and visualize patient progress with
meaningful feedback, and the integration of a
novel auditory secondary-task game, which has
been previously demonstrated to improve
screening for mild cognitive impairment and risk of
falling.
118
P46
Prise en charge des symptômes
comportementaux et psychologiques de la
démence par des infirmières au Québec : des
résultats encourageants !
Sylvie Rey, Philippe Voyer
Université Laval, Québec (Québec), Canada
Description des objectifs : pour une première
fois au Québec, une étude a été réalisée dans le
but de décrire la prise en charge des symptômes
comportementaux et psychologiques de la
démence (SCPD) par des infirmières.
Méthode : un devis rétrospectif simple a été utilisé.
Un instrument de collecte de données a été
spécialement conçu pour cette étude. L’analyse
des données s’est effectuée avec des distributions
de fréquence, des mesures de tendance centrale
et des mesures de dispersion. Les infirmières font
partie de l’équipe de mentorat du Centre
d’excellence sur le vieillissement de Québec
(CEVQ).
Les résultats sont issus de 38 dossiers. Ils offrent
un regard complet sur la démarche clinique
réalisée par ces infirmières. Leur démarche est
constituée par l’évaluation clinique, la planification
des interventions et l’évaluation de l’efficacité des
interventions. La pratique clinique de ces
infirmières atteint un niveau de concordance élevé
(91,3 %) avec les recommandations des lignes
directrices sur les SCPD. Par ailleurs, les
interventions proposées par ces infirmières
réduisent de façon significative (64 %) la
fréquence et la gravité des SCPD. De plus, le taux
d’aînés pour lesquels les interventions ont été
efficaces s’élève à 94,7 %. Enfin, le niveau de
satisfaction des soignants (95 %) et des proches
(100 %) est élevé.
Les conclusions de cette étude soutiennent
qu’une pratique infirmière basée sur les
recommandations des lignes directrices sur les
SCPD permet d’assurer une prise en charge
optimale des SCPD par les infirmières et
d’augmenter la qualité de vie des aînés présentant
des SCPD.
P47
Living with COPD through the eyes of military
veterans residing in London, Ontario
Erisa Deda, Deborah Fitzsimmons, Marita Kloseck,
Marie Savundranayagam
University of Western Ontario, London, Canada
Objective: Chronic Obstructive Pulmonary
Disease (COPD) is a debilitating condition
characterized by a progressive decline in lung
function. COPD is particularly prevalent in military
veterans who are at twice the risk for developing
this disease due to heavy tobacco use among
military personnel. However, despite the
prevalence of this disease in this population, little
to no focus has been placed on gaining an
understanding of their experience of living with this
condition. This study will address this gap.
Methods: Using a hermeneutic phenomenological
approach, ten veterans, recruited through
Veteran’s service clubs in London, Ontario will be
invited to participate in the study. To be eligible
participants must be ≥65 years of age; a Canadian
veteran; a current/recent smoker; a resident of
London, and diagnosed with COPD. Participants
will undertake a semi-structured interview, which
will be transcribed verbatim and analyzed using
inductive thematic analysis. Continuous reflection
on emerging ideas and interpretations will be
undertaken through analysis of researcher
journaling and self-reflexive notes.
Results: This research will provide a richer
understanding of how COPD affects the day-to-day
lives of veterans diagnosed with COPD, and how
they identify, select and utilize health services to
help them with the management of their condition.
Conclusions: As few studies have focused on the
lived experience of veterans with COPD, it is
important that further research be conducted in
order to provide these individuals with a voice,
learn of their experiences with this disease, and
identify whether there are currently un-met support
needs that could be addressed.
P48
The meaning of wandering behaviour from the
perspectives of older adults with the diagnosis
of mild-moderate dementia in long-term care
homes
Adebusola Adekoya
Canada
119
Wandering is common among older adults living
with dementia in long-term care homes. Wandering
behaviour is a common reason for long-term care
placement and it is often interpreted in a way that
demeans the personhood of those who wander.
Wandering is often described as a disruptive
behaviour that needs to be controlled. However,
little is known about the meaning of wandering
from the perspectives of older adults with
dementia. It has been suggested that older adults
living with dementia maintain to some extent their
values, personality, and preferences. While we
know from research that older adults living with
dementia can answer simple questions, there has
been little done in the area of wandering. Kitwood's
Enriched Model of Dementia Care has challenged
us to focus on the person rather than the
behaviours. The purpose of this study is to give
voice to people living with dementia by exploring
the meaning of wandering from their perspectives.
Interviews will be conducted during a mutual walk
between the researcher and the participant with
questions such as, "Do you enjoy walking?" and
"How are you feeling about walking right now?" We
need a broader understanding of wandering
behaviour that goes beyond seeing it as: disruptive
to others (staff, families, other residents), a need
for movement, a past coping strategy or a
therapeutic activity, by including the perspectives
of those who wander. Older adults who wander
have not had an opportunity to add their voice.
This research is continuing and preliminary
findings will be presented.
clinique du patient.
L'objectif est d'évaluer l'évolution et l'investigation
supplémentaire pour les patients gériatriques avec
un TCCL, avec ou sans anticoagulothérapie.
Une étude de cohorte historique fut constituée à
partir des bases de données administratives de
l'Hôpital de l'Enfant-Jésus de la dernière année
(2014). Les patients de plus de 65 ans présentant
un TCCL et résidant dans la région administrative
12 et 03 furent sélectionnés. Les dossiers furent
révisés avec une grille d'analyse standardisée. Les
données clinico-administratives, les investigations,
les comorbidités et la médication furent recueillis.
Les complications furent colligées pour une
période de 90 jours. L'utilisation de l'imagerie et la
trajectoire des soins furent analysées. Des
analyses statistiques multivariées permettront
d'évaluer les issues importantes entre les trois
groupes (anticoagulé, antiplaquettaire et thérapie
combinée).
Un TCCL fut confirmé pour 93 patients (49 %).
Chaque groupe a eu respectivement, une TDM
initiale normale 88.9 %, 93 %, 76 %. Une TDM de
contrôle fut faite dans une proportion de 43 %, 16
% et 10 %. Un saignement intra-crânien retardé fut
identifié dans une proportion de 0 %, 2 %, et 0 %.
P50
Well-being through song: An examination of
singing in community dwelling older adults
Laura Thompson, Mary L. Gick
P49
Le traumatisme crânien léger avec
anticoagulation a-t-il besoin d'une
tomodensitométrie (TDM) de contrôle?
1
1
1
CG Gariépy , NL Lesage , CM Malo , PL
1
1
Lavergne , ME Émond
1
2
Université Laval, Québec, Canada, CHU de
Québec, Québec, Canada
Il fut démontré récemment que le nombre de
traumatismes importants, dont les crâniens, est en
augmentation chez la population gériatrique.
Plusieurs patients ont des comorbidités
nécessitants une anticoagulothérapie; la plupart
des guides de pratiques pour les traumatismes
crânio-cérébraux légers (TCCL) excluent les
patients avec une anticoagulothérapie. Durant la
dernière décennie, plusieurs auteurs ont suggérés
TDM de contrôle systématique, tandis que d'autres
suggèrent une TDM au besoin selon l'évolution
Leisure engagement is beneficial for well-being,
especially in older people (Kuykendall, Tay, & Ng,
2015). As a leisure activity, singing may provide
well-being benefits for older adults (Gick, 2011).
However, past studies have not offered strong
comparisons (if any) of singing to other activities;
thus, it is unclear whether singing affords additional
benefits above those associated with general
leisure activities. Furthermore, few researchers
have attempted to address potential mechanisms
by which these benefits might occur. The present
study examined changes in well-being over single
sessions of group singing as compared to musical
(band) and non-musical (bridge club) control group
activities. Older adults (Mage = 73 years, SD = 8.26)
recruited from seniors' recreation centers
completed measures of well-being before and after
singing, band, or card activities. Preliminary
findings indicate that positive affect, F (1, 82) =
13.85, p < .001, and vitality, F (1, 82) = 5.25, p <
.05, were significantly higher after one session of
120
singing as compared to one session of non-singing
activities combined. Bootstrapping analyses also
showed that increased positive affect mediated the
relationship between singing and increased vitality,
M = .25, SE = .12, 95% C.I. [.07, 0.54]. These
findings may provide valuable information about
benefits of singing and cost-effective programs to
enhance well-being in older adults.
P51
Moderators of the relationship between family
caregiver proxy ratings and person with
dementia self-ratings of quality of life
Sathya Amirthavasagam, Lynn McCleary
Brock University, St. Catharines, Ontario, Canada
Quality of life is typically regarded as an essential
measure of assessing the clinical course and
evaluating interventions for those with dementia.
Caregivers typically provide a proxy rating of
quality of life to health professionals, which the
literature has noted to be inconsistent with selfrated reports from the person with dementia
(PwD). Moreover, the literature strongly suggests
that there are symptom and psychosocial factors
that can influence proxy ratings of quality of life. As
the field of proxy ratings and dementia is relatively
novel, the current study sought to explore the level
of agreement between proxy raters and PwD’s
self-ratings of quality of life, as well as factors that
may moderate the relationship between proxy
ratings and PwD ratings. To assess agreement
between proxies and PwDs, an intraclass
correlation coefficient was calculated and a
moderator regression analysis was conducted to
explore potential moderating relationships.
Potential moderators that were explored included:
caregiver burden, caregiver age, caregiver income,
PwD IADLs/ADLs, PwD education, PwD cognitive
impairment, PwD depressive symptom severity,
PwD behavioural symptom severity, and the
relationship between caregiver and PwD. Utilizing
secondary data from 107 recruited dyads from
Calgary, Ottawa, and Edmonton, analyses
conducted found fair agreement between
caregivers and PwDs, while none of the
hypothesized factors were found to moderate the
rating relationship. Though these variables may
not moderate the PwD-proxy rating relationship
regarding quality of life, other analyses should be
undertaken to understand the capacity in which
these variables influence this rating relationship.
P52
Le littérisme en santé mentale quant aux
troubles anxieux chez les aînés
1
1 ,2
EB Beaunoyer , PL Landreville
1
2
Université Laval, Québec, Canada, Centre de
recherche du CHU de Québec-Université Laval,
Québec, Canada
Les aînés consultent peu pour leurs problèmes
d'anxiété, ce qui, selon plusieurs auteurs, serait
possiblement lié à leur manque de connaissances
au sujet des troubles anxieux. L'objectif de ce
projet est de réaliser un relevé de littérature portant
sur le littérisme en santé mentale, spécifiquement
au sujet des troubles anxieux, chez les aînés. Une
recherche d'articles a été effectuée à partir des
bases de données Pubmed et Psycnet Parmi les
sept études documentant le littérisme au sujet des
troubles anxieux, la majorité n'examine qu'un seul
aspect de ce concept, soit la reconnaissance des
troubles anxieux et comporte des échantillons
majoritairement constitués de participants âgés
entre 18 et 25 ans. De façon générale, les
participants démontrent de faibles résultats quant
à la reconnaissance d'un trouble anxieux lorsque
présenté dans une vignette et les taux de
reconnaissance varient considérablement d'une
étude à l'autre. Parmi les quelques études qui se
sont intéressés à la population âgée, les scores de
reconnaissances sont plus faibles chez les aînés
que chez les jeunes adultes. Spécifiquement, les
jeunes adultes seraient meilleurs pour identifier la
phobie spécifique et le trouble d'anxiété
généralisée. La recherche actuelle manque de
précision quant à ce que les aînés connaissent
des autres aspects des troubles anxieux tels que
les facteurs de risque et les traitements. À cet
effet, il serait pertinent d'employer une méthode de
recherche différente impliquant des mesures
quantitatives et qualitatives qui permettrait
d'obtenir des résultats plus détaillés sur ce que les
aînés connaissent spécifiquement des troubles
anxieux.
P53
Convergent Validity of the Coping Strategies
Subscale of the Stress Profile in Older Adults:
Preliminary Findings
Vivian Huang, Alexandra Fiocco
Ryerson University, Toronto, ON, Canada
The Stress Profile (SP; Nowack, 1990) is a selfreport measure that examines the various domains
of stress and its related health risks, including
121
general stress levels, health habits, social support
network, coping style, etc. Since its development, it
has been widely used in the literature to examine
the relationship between stress and its related
constructs. Although it is a commonly-used
measure, the psychometric properties of the SP
have not been validated and most of studies have
been conducted in working adult samples. Given
the moderating effect of coping styles on stress, it
is imperative to examine the coping style
subscales of the SP to ensure construct validity.
Thus, the present study examined the convergent
validity of the SP and the Cognitive Emotion
Regulation Questionnaire (CERQ; Garnefski,
Kraaij, Spinhoven, 2001) in a sample of
community-dwelling older adults. A total of 63
community-dwelling older adults (mean age =
67.24, SD = 6.70, 52.4% females) competed the
Stress Profile and the. A Pearson's correlation was
conducted to examine the convergent validity
between the coping styles subscales of the SP and
the CERQ. Small to medium relationships were
found between the SP coping style subscales and
the subscales of the CERQ. Our preliminary
analysis suggests that the Stress Profile coping
style subscale exhibited adequate to good
convergent validity with the CERQ in a group of
older adults. Given the small sample size, the
current findings should be considered with caution.
However, further data collection is still underway.
Implications and future directions are further
discussed.
P54
Through Seniors' Eyes: Age-Friendly
Communities and Quality of Life
Kayla Goulet, Sabrina Ladak, Sandy Lam, Beth
Stanley, Anna Tomczak, Susan Braedley, Renate
Ysseldyk
Carleton University, Ottawa, ON, Canada
This community-engaged study explored the
relationships between seniors' perceptions of the
age-friendliness of their city and quality of life
within two retirement communities in Ottawa,
Ontario. Building on the concept of ‘aging in place'
and the World Health Organization's eight
indicators of age-friendly cities, a mixed-methods
approach combined survey data collection (N=51)
and focus groups (N=21) to investigate agefriendliness and quality of life (QOL) "through
seniors' eyes". As expected, our survey data
revealed multiple positive relationships between
the age-friendly community indicators and QOL. In
particular, social participation and housing were
found to be the key indicators that were associated
with perceived quality of life amongst the study
participants. Moreover, social participation
continued to be the most important indicator within
the qualitative phases of the study. Family and
friends, aging in a familiar community, and
physical/information accessibility emerged as the
three major themes related to enhanced social
participation for older adults, and thus, are
imperative to enhancing quality of life. In addition,
both the survey data and focus group discussions
indicated that each of the eight age-friendly
indicators was interrelated. Therefore, allocating
resources to improve one aspect of agefriendliness may not yield substantial impact if not
coupled with acknowledgment and attention
towards the relationships among the indicators
themselves. Taken together, our findings suggest
that while quantitative measures are useful for
establishing initial associations between agefriendliness and QOL, the intricate relationships
between these factors are only discoverable by
involving seniors in the assessment in meaningful,
qualitative ways.
P55
Out of the Loop: Social Network Isolation in
Long-Term Care in Nova Scotia
1 ,2
1 ,2
Erin McAfee , Janice Keefe , Carole
3 ,4
Estabrooks
1
Mount Saint Vincent University, Halifax, Nova
2
Scotia, Canada, Nova Scotia Centre on Aging,
3
Halifax, Nova Scotia, Canada, University of
4
Alberta, Edmonton, Alberta, Canada, Translating
Research in Elder Care, Edmonton, Alberta,
Canada
Objectives: Based on the data from the TREC
project "Advice Seeking Networks in Long-Term
Care", the purpose of this study is to better
understand the nature, characteristics and
reasoning as to why some directors of care in
nursing homes are isolated from the social
network.
Research Question: What are the descriptive
characteristics of Directors of Care who are
network isolates in Nova Scotia and what factors
contribute to their isolation within the network?
How does network isolation impact on the DOCs
ability to access information and advice?
122
Theoretical Framework: The research is
imbedded in the diffusion of innovation's theoretical
framework that explains how and why new
innovations and interventions are spread
throughout a network. In this case of Social
Network Isolates, one might assume that with
limited connectivity to the network, opportunities
and experiences of spreading new innovations and
best practices will be limited.
Method: The project will utilize findings from the
Quantitative Survey for the selection of Network
Isolates (n=10), identified by visually observing the
network maps and low centrality scores. Semistructured interviews will be conducted with the
network isolates as well as observations within
isolated facilities. Interviews will address
demographic factors that may lead to network
isolation but also aim to understand the
implications of a limited social network.
Observations will help to provide contextual
information about the homes.
Outcomes: The anticipated outcomes of this
research is to understand what factors contribute
to isolation and what impact this has on access to
information regarding best practices and
innovations.
P56
Fall Prevention Strategy for a Northern Ontario
Emergency Department
Mwali Muray, Charles Bélanger
Laurentian University, Sudbury, Ontario, Canada
Patients falling in hospitals can be expensive and
harmful. Falls result in injuries, varying in severity,
and can be a serious impediment in the life of a
patient, while having negative financial
repercussions on the healthcare system. While
this problem is widely known, consistent fall risk
identification and prevention strategies continue to
lack in emergency departments (EDs).
The purpose of this study is to implement a fall
prevention strategy for a northern Ontario ED. This
study involves identifying patients at a high risk for
falling, in hospitals, tracking the incidence of falls
for patients in hospitals, and collaboration with key
stakeholders to identify strategies for fall
prevention in hospitals.
The study design consists of a one-group pretestposttest experimental design. The pretesting
component of the study was based on a
retrospective analysis of past medical records and
incident reports of patients falling in the ED.
Following this, a fall prevention strategy was
implemented. Posttest data was based on patient
outcomes following the implementation of the fall
prevention strategy. During the sample period,
5371 patients were formally assessed using the fall
risk assessment tool, with 56.5% of the sampled
patients over the age of 65 in the ED were at risk
for falls (n=3035). To conclude, in order to optimize
patient safety and quality of care, hospitals need a
consistent fall prevention strategy enabling them to
identify, assess, and prevent falls from happening
while a patient is in their institution. This strategy
should be initiated upon initial presentation to the
hospital ED.
P57
Exploring person-centered care at mealtimes
for residents with dementia in special care
units
1 ,2
2
Sarah Wu , Habib Chaudhury
1
2
Canada, Simon Fraser University, Vancouver,
British Columbia, Canada
Background: Tom Kitwood’s philosophy of
personhood has been instrumental in the culture
change movement towards person-centered
dementia care (PCC). Mealtimes are an opportune
time for meaningful social exchanges. However,
the application of Ktiwood’s positive person work
during mealtimes in care homes is not well
understood. This focused ethnographic study
explored the dining experience of residents with
dementia living in specialized care units. Kitwood’s
person-centered care elements were applied to
better understand the nature and processes of
mealtime care practices and social interaction
between staff and residents.
Methods: Data were collected by multiple
methods: participant observations, informal and
formal interviews with care staff, and examination
of relevant documents in a special care unit at a
long-term care facility in British Columbia, Canada.
Data was analyzed using analytic induction for
themes and emergent understandings.
Results: Five person-centered categories were
identified in relation to residents’ dining
123
experience: (1) Relaxed Pace/Outpacing, (2)
Respect/Disrespect, (3) Connecting/ Distancing,
(4) Empowerment/Disempowerment, and (5)
Inclusion/Ignoring. Analysis also identified the
processes in which staff understood personcentered care, and factors affecting its delivery,
namely management support, staffing ratios,
education, and policy.
P59
Conclusions: The findings advance our
understanding into the psychosocial and physical
environmental factors that affect residents’ dining
experience. They suggest that while staff practices
reflect several aspects of person-centered care, a
biomedical undercurrent and organization culture
continue to hinder the evolution in dementia care.
Objective: An aging population and increasing
rates of dementia point to the need for alternative
strategies to allow individuals to age in place. The
purpose of this multiple case study is to
understand, from an insider’s perspective, the role
and influence of music in the lives of individuals
with dementia who are aging in place. The
following three questions guide this exploration:
How is music integrated into the day-to-day lives of
individuals with dementia aging in place? What
does music mean to someone with dementia and
if/how has this changed, over time? How do
individuals with dementia perceive the influence of
music on their health and wellbeing?
P58
Influence of music therapy on residents with
dementia in residential care facilities
Madeleine Bourdages, Habib Chaudhury
Empirical evidence on the influence of music
therapy for persons with dementia in residential
care homes is fairly limited. Residents with
dementia often experience a low quality of life in
care homes 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. Evidence suggests
the psychosocial needs of residents with dementia
are particularly unmet in care homes. This
qualitative study explored the influence of group
music therapy sessions on engagement, social
interaction and enjoyment in residents with
dementia living in a special care unit of a
residential care facility in Vancouver, B.C. Data
was collected over a 12-week period, with 15 hours
of focused ethnographic observations in each
week. Ethnographic observations were carried out
before, during, and after music therapy sessions,
as well as during other activities and when no
planned activities were taking place on the unit.
Interviews with staff, family, and music therapists
complemented the observations, and together,
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 of this study provide
substantive insights on the role of music therapy
on improving the quality of life in residents with
dementia and have practice implications for music
therapy programming in residential care facilities.
Music Lessons: Exploring the Role and
Meaning Among Community-Dwelling Older
Adults with Dementia
Melanie Elliott, Paula Gardner
Method: Critical qualitative research was
conducted through semi-structured interviews,
observations, and videos. All three participants
were in the early stages of dementia, living in the
community (not in an institution), residing in
Ontario, using music in their lives in a routine
capacity, and not enrolled in music therapy.
Results: Results are framed using an adapted
version of the Psychosocial Model of Music in
Dementia and speak to how music is seen to affect
meaning, personhood, and relationships of
individuals with dementia in the aging in place
environment. The connection between these
factors and the overall health and wellbeing of
these individuals are discussed.
Conclusion: This research makes an important
contribution to the field by focusing on individuals
who are aging in place and emphasizing the
importance for further exploration of innovative
strategies that support community-dwelling older
adults with dementia.
P60
The Impact of Visiting Dog Programs on
Seniors’ Social Support: Comparing Group and
Individual Conditions
1
1
1
Lindsay Burton , Colin Reid , Alan Davidson ,
2
1
James Gillett , Cristina Caperchione
124
1
University of British Columbia Okanagan,
2
Kelowna, Canada, McMaster University, Hamilton,
Canada
Jovana Sibalija, Marie Savundranayagam, JB
Orange, Marita Kloseck
Introduction: Social support (SS) is an important
determinant of senior health. Dogs are an
underutilized modality for seniors’ SS promotion,
and dog visitation programs are emerging to
address this underutilization. Dogs impact SS in
two ways, as a provider of SS (direct) or as a
facilitator of SS (indirect).
Family caregivers are invaluable to the healthcare
system because their unpaid support enables older
adults to remain at home. However, caregiving by
family members to older adults is associated with
negative health outcomes including depression.
Poor family caregiver health, such as depression,
often means an inability to provide care which, in
turn, affects the care received by their older adult
relatives with the chronic illness. This scenario
means increased risk of institutionalization for older
adults. Pearlin’s Stress Process Model
conceptualizes caregiving as a chronic stress
experience influenced by stressors related to
caregiving demands including low social support
and restricted social activities. The Activity
Restriction (AR) Model of Depressed Affect
hypothesizes that the amount of lowered
participation in regular activities impacts
depressive symptoms. Previous studies showing
AR as a mediator of depressive symptoms in
family caregivers used small samples of nonCanadian participants. This study, based on
integrating the Pearlin and the AR model, aims to
use population-level data from the Canadian
Longitudinal Study on Aging to investigate
relationships among social support, social
participation, and depression in family caregivers
and non-caregivers. Analysis of variance will be
used to assess differences in mean scores of
social support, social participation and depression
between caregivers and non-caregivers. Path
analysis also will be used to investigate
relationships between the social variables and
depression. Results from this study will help inform
how health and social services can better support
family caregivers in their roles while also
addressing their mental health needs.
Purpose: To replicate real world interventions to
determine whether visiting dog programs positively
impact SS and whether there are differences
between individual and group conditions.
Methodology: A six-week intervention exposed
eight participants’ to a dog and its handler during
thirty-minute sessions. Group and individual
conditions were compared to explore differences in
program implementation. Quantitative
measurements of SS were taken at baseline, post
intervention, and six-weeks post. Semi-structured
interviews were taken throughout the intervention
along with field notes. Six-weeks following the
intervention a focus group was held to determine
short-term effects. Quantitative data were analyzed
using repeated measure ANOVA and qualitative
data were analyzed using interpretive description.
Results: Repeated measures ANOVA were not
significant. The main effect in the individual
condition was facilitation of interaction between
participant and handler. Participants in the group
condition were able to form a lasting bond because
of their shared experience with the visiting dog.
Reminiscence was an important component of the
visitation program.
Conclusion: The visiting dog program produced
positive influence on the participants’ perceived
social support. This study lends further evidence to
the indirect effect of dog companionship, in a
visitation setting, even after the dog is no longer
present.
P61
The impact of social support and social
participation on depression in Canadian family
caregivers
P62
Evaluating e:learning training material on
ethics for use in long-term care environments
1 ,2
2
Jennifer Estey , Clive Baldwin
1
University of New Brunswick, Fredericton, NB,
2
Canada, St Thomas University, Fredericton, NB,
Canada
This project focuses on the question: "To what
extent does e:learning enhance ethical reasoning
among long-term care (LTC) staff?" A
comprehensive literature review and a survey
125
conducted in 2014 on New Brunswick nursing
homes, indicated staff members lack training in,
and resources for addressing ethical issues they
encounter in practice. E:learning is frequently used
in LTC, but there is little such provision regarding
ethics. As a result, a three-month, standalone
e:learning training program is being developed
based on data previously gathered from staff
discussing experiences of ethical issues in LTC.
The training has ten modules which explores the
topic of ethics. Focus groups and interviews will be
conducted to explore what changes, if any, in
participants' ethical reasoning can be identified
following engagement with the e:learning
materials, the strengths and weaknesses of
e:learning in ethics training, and staff perceptions
regarding e:learning in relation to developing
ethical practice. Interview and focus group data will
be compared with the previous interviews and
focus group data to determine whether participants
have enhanced ethical awareness indicated by the
application of skills from the training through the
recognition of ethical issues, the use of ethical
concepts, more ethically-nuanced language,
the use of principles, the consideration of
alternative frameworks in discussing ethical issues,
and more nuanced and robust justifications used in
ethical decision-making. Residents and staff
members of LTC will benefit as ethical issues may
be addressed consistently thus enhancing the
quality of care provided and staff may feel better
prepared to approach and resolve ethical issues,
thus reducing moral distress.
P63
Considering age, gender and sexual
orientation: The blurring of insider/outsider
boundaries
Patrick Aubert
Objectives: As a researcher considering the
effects that gender and sexual minority identity
have on the aging process, my position as insider
or outsider has tremendous epistemological
implications. My gender, my sexuality, and my age
influence and inform my beliefs and values, which,
in turn, determine my research interests and how
these are conceptualized. My goal is thus to reach
across a multiplicity of differences to find, at their
intersections, the interplay of privilege and
oppression.
Methods: In preparation for conducting my
qualitative research study, I have adopted a
reflexive constructivist stance to my interpretation
and summary of the existing literature and its
implications for my research design.
Findings: The process of questioning the
dominant discourse undermines and destabilizes
my preconceived self-identity creating uncertainty
about the categories I have applied to myself, thus
complicating the applicability and challenging the
very notion of insider/outsider labels. Since the
expression of age, gender, and sexuality are all
embodied, I can achieve an accurate
representation of the lived experience of those who
identity as gender and sexual minorities only by
reflecting upon the social status that I achieve
through my age, gender, and sexual orientation
and the ways in which I embody and express these
categories.
Conclusion: A reflexive consideration of my
position as insider/outsider both self-perceived and
perceived by study participants, will illuminate the
fluidity of these labels and permit a shared, albeit
incomplete, temporal, and local reflection on the
meaning of aging as a gender and sexual minority.
P64
Applying the gendered lens of Masculinity in
education regarding men and aging
Annie Boucher
Huntington University, Sudbury Ontario, Canada
The concepts of gender, masculinity and
hegemonic masculinity must be applied in
education, practice, and policy making. They
provide an essential lens for understanding older
men who were socialized at a different time, and
help students understand the gendered nature of
their interactions and impact of age. They also help
to explain gaps in the literature on men, aging and
health. Instead, men are most often forgotten or
invisible in research on aging, and thus, their
specific needs are neglected in curriculum, practice
and policy. Much more is known from a feminist
perspective about the health and experience of
women, creating gendered health inequities and
disadvantages for men.
The presentation applies these concepts in
education about men and aging. Learner attitudes
and media influences are assessed. The gendered
health experiences are distinguished. Role
transitions, stress and aging are explored. Special
126
topics address: marginalized identities, cultural
groups (Aboriginal men, immigrant men, Baby
Boomers), Aging in Place and Aging without Place
(homeless and incarcerated men). The course
meets a significant gap in education.
All gerontology courses must be assessed to
determine if a gendered view is applied to
understanding the specific experiences and needs
of men. Doing so is imperative to fostering
sensitivity toward aging men and fostering equity in
education, practice and policies (212 words)
P65
Ageism in Nursing Educational Programs: A
Review of the Literature
Paula Black
University of Manitoba , Winnipeg, MB , Canada
Background/Objectives: It is evident that Canada
has a rapidly aging population. Due to this aging
population, the need for care to be provided to
older adults will rise. Nurses play a pivotal role in
the care of older adults across many care settings.
However, recruiting newly graduated nurses into
gerontological nursing has been challenging. The
literature indicates that nursing students rate
gerontological nursing as their least preferred
specialty post graduation. Consequently, it has
been argued that elements of ageism are
embedded within nursing educational programs
and have contributed to the negative attitudes and
perceptions that nursing students’ harbor towards
this field. The objective of this review is to identify
elements of ageism within nursing educational
programs and propose interventions to encourage
newly graduated nurses to pursue a career in
gerontological nursing.
Methods: A comprehensive review of the literature
was conducted in order to identify elements of
ageism apparent within nursing educational
programs.
Results: Six overarching themes that contribute to
the development of ageism were identified from
the literature. These themes include: absence of a
standalone gerontological nursing course, course
timing, nursing educators that lack gerontological
expertise, absence of content on healthy aging,
dichotomy of care versus cure, and impoverished
clinical practice environments.
Conclusions: Elements of ageism are clearly
evident within nursing educational programs.
However, all elements identified within this review
are modifiable. Although negative attitudes and
perceptions may not change automatically the
proposed interventions may help inspire nursing
students to consider the value in caring for older
adults.
P66
Associations between cardiovascular disease
risk factors and executive function in the
NutCog Study
1
2
Guylaine Ferland , Pierre-Hugues Carmicheal ,
1
3
Sylvie Belleville , Alexandra J Fiocco , Carol
4
2
1
Greenwood , Danielle Laurin , Bryna Shatenstein ,
1
5
Marie-Jeanne Kergoat , José A Morais , Pierrette
6
Gaudreau
1
Centre de recherche, Institut universitaire de
gériatrie de Montréal, Montreal, QC, Canada,
2
Centre d’excellence sur le vieillissement de
Québec au Centre de recherche du CHU de
3
Québec, Québec, QC, Canada, Department of
Psychology, Ryerson University, Toronto, ON,
4
Canada, Rotman Research Institute, Baycrest,
5
Toronto, ON, Canada, Division of Geriatrics,
McGill University, Montreal, QC, Canada,
6
Laboratory of Neuroendocrinology of Aging,
Centre Hospitalier de l’Université de Montreal
Research Center, Montreal, QC, Canada
Introduction: There is growing evidence for a role
of cardiovascular disease risk factors (CVDRF) in
the development of cognitive deficits during aging.
Observational studies have shown that elevated
plasma homocysteine (Hcy) and indicators of lipid
metabolism are potentially modifiable risk factors
for cognitive aging. Executive functions (EF) which
refer to the brain components involved in the
planning and control of complex tasks is one
domain affected by aging.
Objective: Explore the associations between
circulating CVDRF markers and EF in communitydwelling elderly individuals. Methods: Plasma Hcy
and serum indicators of lipid metabolism and EF
were assessed in 159 men and 193 women (mean
age = 77.3 y, SD=3.9) from the NutCog Study, a
sub-study of the Quebec Longitudinal Study on
Nutrition and Aging. EF were assessed using
components of the Rey Complex-Figure copying,
the Stroop test, the Browne Peterson procedure,
and the (WAIS-III) Digit Symbol-Coding subtest.
Associations between circulating markers and EF
were assessed at recruitment and two years later
using regression models.
127
Results: Increased plasma levels of Hcy
(p=0.0005) and serum triglycerides (p=0.0263)
were associated with lower EF at both time points
whilst higher levels of serum high density of
lipoproteins (HDL) were marginally associated (p =
0.0617) with better performances.
Conclusion: These results add to the hypothesis
of a link between cardiovascular health and
cognition in aging. The fact that CVDRF are
modifiable through diet and exercise suggest that
EF could be ameliorated in the elderly through
lifestyle changes. Funded by the Réseau
Québécois de recherche sur le vieillissement.
understand the processes healthcare teams use in
order to incorporate older adults and their families
perspectives.
P68
Comparison of APRV and SIMV on cardiac
index and heart rate of elderly people after
coronary artery bypass graft
Samaneh Zakeri, Javad Malekzadeh, Shahram
Amini
Mashhad University of Medical Sciences,
Mashhad, Iran
P67
Older Adults and Their Families’ Perspectives
about Collaboration with Healthcare
Professionals
1
2
Sherry Dahlke , Kim Steil , Rosalie Freund1
3 ,1
1
Heritage , Ann Comeau , Adrian Wagg , Marnie
1
1
Colborne , Susan Labonte
1
2
Glenrose Hospital, Edmonton, AB, Canada,
3
Edmonton Southside Primary Care Network,
Edmonton, AB, Canada
Objectives: The aim of this exploratory study was
to gain an understanding of older adults and their
families’ experiences and perceptions of
interdisciplinary healthcare teams.
Method: Interviews were conducted with ten
families in which an older family member had
encountered interdisciplinary healthcare teams.
Data were analyzed using interpretive descriptive
methods.
Results: Findings revealed that families’
perceptions of healthcare teams were influenced
by how healthcare teams communicated with them
and by the type of care they saw demonstrated
with their older adult family member. Respect for
families’ role in the older adult’s care was
communicated through the language that was
used in explaining what was going on, what could
be expected, and if something had gone wrong,
what happened, and why.
Conclusions: The processes that interdisciplinary
teams use to communicate and incorporate older
adults and their families’ perspectives are not well
understood. More research is needed to
Background: The elderly often suffer from
ischemic heart disease. Coronary artery bypass
surgery is used in the treatment of these diseases.
After surgery, respiratory failure is inevitable.
Because oxygenation and survival of all body
tissues, including the brain is dependent on the
activity of the heart and lungs, the invasive
ventilation in patients with ventilator on. APRV is a
ventilation mode that used the positive pressure for
a long time, and at moments for ventilation, the
pressure is released.
Aim: Comparison of APRV and SIMV on cardiac
index and heart rate of elderly people after
coronary artery bypass graft
Method: This clinical trial study was conducted
with the participation of 40 patients undergoing
CABG in ImamReza hospital of Mashhad, in Dec
2014. Patients were randomly divided into two
groups. SIMV was applied in a group for half an
hour and APRV was applied in the other group for
half an hour. The variables were measured for all
patients. Data analysis was performed by t-test.
Result: mean of cardiac index and heart rate no
significant change (P>0.05).
Conclusion: APRV does not create disorder in the
elderly hemodynamics and on the other hand,
improvement of oxygenation in this mode is
confirmed.
P69
Exploring variability in Cognitive and Physical
Responses Following a Dance/Movement
Therapy Program
128
1 ,2
1 ,2
Florian Bobeuf , Alida Esmail , David
2 ,3
2 ,3
2
Predovan , Antony Karelis , Sébastien Grenier
,3
2
2
, Minh Vu , Juan-Manuel Villalpando , Louis
1 ,2
Bherer
1
PERFORM Centre and Psychology department,
2
Concordia University, Montréal, Canada, Centre
de Recherche de l’Institut Universitaire de Gériatrie
3
de Montréal, Montréal, Canada, Université du
4
Québec à Montréal, Montréal, Canada, Université
de Montréal, Montréal, Canada
Regular physical activity can lead to
cognitive/physical benefits. Some studies suggest
that these benefits are observed after traditional
intervention programs specifically challenging
cardiovascular and strength training, but recent
studies also proposed that dance can have a
favourable impact on cognition. Dance/movement
therapy (D/MT) is the therapeutic use of movement
through the integration of physical and emotional
aspects in promoting harmonization of bodily and
mental dimensions. The present study proposes a
comprehensive evaluation of the effects of a D/MT
program tailored to the specific needs of the
elderly people, compared with a traditional
exercise intervention program. Following the
evaluation of the inclusion/exclusion criteria,
participants performed tests measuring cognitive
abilities (MoCA, executive function) and physical
(cardiovascular function, body composition,
functional abilities). Participants were randomized
into 3 groups: waiting list, cardiovascular exercise
supervised by kinesiologists and D/MT with
certified dance therapists. The interventions
consisted of a 12-week program (1h, 3
times/week). The same battery of tests was
repeated in post-intervention (ClinicalTrialsNCT02455258). Although the analysis shows
overall improvement of cognitive/physical
parameters with the 2 types of interventions, D/MT
seems to have a smaller effect on the variables of
interest (1-wayAnova, post-hoc). Moreover, data
variability was equivalent between training groups
for most of the variables (Levene tests). D/MT
generally has a beneficial effect on
cognitive/physical parameters in elderly people,
and could therefore be a relevant alternative to a
traditional response exercise. Unfortunately, as
with traditional intervention programs, D/MT has
the same kind of variability in the individual
responses on the main outcomes.
P70
controls having progressed to MCI/AD within a
decade
1
1 ,2
Olivier Potvin , Simon Duchesne
1
Institut universitaire en santé mentale de Québec,
2
Québec, QC, Canada, Département de radiologie
et médecine nucléaire, Université Laval, Québec,
QC, Canada
Objective: We recently produced normative values
for Freesurfer-extracted subcortical regional
volumes in cognitively healthy adults, taking into
account age, sex, intracranial volume, MRI magnet
strength as well as manufacturer. Using these
normative values, we compared volumes at
baseline for cognitively healthy controls (CON) in
the ADNI study who went on to develop either
clinical Alzheimer's disease (CON-AD) or mild
cognitive impairment (CON-MCI).
Method: We used 319 cognitively healthy
participants from ADNI with at least a 2-year
follow-up. Twenty developed probable AD (age:
75.9±4.2; years to diagnosis: 6.0±2.4, range: 1.99.2), 54 progressed to MCI (77.1±5.4; 4.2±2.6, 0.510.1) and 319 remained cognitively healthy (CONCON; 74.5±5.9; maximum follow-up years:
4.0±2.6, range: 0.5-10.3). Volume Z scores were
calculated according to our normative formulas. A
Cox proportional hazards model predicting
progression to MCI/AD was built using age, sex,
hippocampi and total subcortical volumes, and
cognitive measures (ADAS-cog, RAVLT delayed
recall, MMSE) as predictors. Backward selection
was used to keep only significant predictors.
Results: CON-AD, but not CON-MCI, had
significantly (p < .01) lower baseline normative Z
score for both left and right hippocampi, as well as
subcortical volumes respectively, compared to
CON-CON. Age, ADAS-cog, RAVLT, and left
hippocampus Z score were selected as significant
predictors and a left hippocampal Z score of -1 was
associated with a 1.39 (1.12-1.74) increased risk of
developing MCI/AD.
Conclusions: These results outline the small, but
significant, magnitude of hippocampal atrophy in
cognitively healthy individuals that will progress to
AD up to 10 years before diagnosis.
P71
Pseudo-longitudinal analysis of normed
hippocampal trajectories in cognitively healthy
129
Improving Seniors' Care Transitions and
Patient and Caregiver Experience: The
PATHway to Aging Well Project - Second Phase
1
2
Veronique Boscart , Maryanne Brown
1
Conestoga College Institute of Technology and
Advanced Learning, Kitchener, Ontario, Canada,
2
Energy Intuitive, Wellness Within: Healing Energy
Centre, Brighton, Ontario, Canada
Objectives: The PATHway to Aging Well Project
(PATH) was developed to improve care and
transitions for seniors and caregivers through
access, advocacy and continuity of quality care in
partnership with the Northumberland Hills Hospital
(NHH) and the Northumberland community. The
second phase of the study focused on exploring
seniors' and caregivers' experiences and
perceptions of PATH.
Methods: Twenty-two seniors and ten family/friend
caregivers participated in individual semistructured interviews. Qualitative data was
analyzed using a situational analysis technique
and organized under three main categories:
successes, implementation factors, and
recommendation.
Results: Participants felt that a key success of
PATH was the availability and helpfulness of the
transition coaches. Increased awareness of
participants' previous and current health concerns,
available services and resources, and care
planning were other perceived accomplishments.
PATH also acted as a support system for
participants in the following ways: 1) establishing
connections with fellow seniors and caregivers; 2)
providing a sense of independence and control
(i.e., empowerment) by advocating their own care
needs; and 3) offering a sense of comfort in times
of need (i.e. care transitions). Lastly, PATH
improved access within the healthcare system
through greater availability of health information
and saving time.
Conclusion: Culture change within the health care
system was identified as the first step to further
optimizing transitional care. This shift requires
active participation of all groups, including further
education and training to increase knowledge,
awareness and participation in PATH. Finally,
services (resource allocation, flexibility and
accessibility of tools) should be provided according
to seniors' needs.
P72
Alzheimer's disease and other related
dementias in Canada: A focus on living well
with dementia
Veronique Boscart
Conestoga College Institute of Technology and
Advanced Learning, Kitchener, Ontario, Canada
Objectives: To provide adequate knowledge
regarding Alzheimer's disease and other related
dementias (ADRD) in order to decrease and
demolish stigmas associated with dementia,
playing a significant part in creating further barriers
to the access and delivery of high quality care and
services.
Methods: Canadian Gerontological Nursing
Association and Registered Nurses' Association of
Ontario delivered a joint submission that provided
background and 12 recommendations on five key
areas to Dementia care in Canada: health system
resources, education for health professionals,
housing, caregivers, and integration of health and
social services.
Results: 1) Health professionals, including
registered nurses (RNs) and nurse practitioners
(NPs) must work together to support people with
dementia. 2) RNs, NPs, and unregulated providers
must have opportunities to enrich their knowledge
skills and competencies to care for persons with
dementia. 3) Fostering living well with dementia
means efforts should be made to support access
to appropriate home and community supports and
assistance for care partners. 4) Being aware that
compared to caregivers of older adults who
retained cognitive abilities, caregivers of persons
with dementia are more likely to experience
chronic health problems, depression, and social
isolation. 5) A shift is needed in health policy to a
broader, integrated model of health and social
services.
Conclusion: There is a need developing
accessible care models for people with ADRDs,
which accommodate various levels of care needs
and abilities, and resembles living at home.
Recommendations from the Standing Senate
Committee on Social Affairs, Science and
Technology will be considered for the final report.
P73
130
Implementation of the Aging, Community and
Health Research Unit (ACHRU) - Community
Partnership Program for Diabetes for Older
Adults with Multimorbidity: A Hybrid
Effectiveness-Implementation Study
1
1
encouraging care partners to attend home visits
and group sessions.
2
Maureen Markle-Reid , Jenny Ploeg , Kim Fraser ,
1
1
Kathryn Fisher , Amy Bartholomew , Noori Akhtar1
1
2
Danesh , Amiram Gafni , Andrea Grunier , Sandra
3
1
Hirst , Sharon Kaasalainen , Carlos Rojas4
2
1
Fernandez , Cheryl Sadowski , Lehana Thabane ,
2
5
Jean Triscott , Ross Upshur
1
McMaster University, Hamilton, ON, Canada,
2
3
4
5
Objectives: To examine the implementation of
the ACHRU-Community Partnership Program for
Diabetes, for older adults (> 65 years) with
multimorbidity and Type 2 Diabetes Mellitus
(T2DM).
Methods: A hybrid effectiveness-implementation
design was used. The intervention was a 6-month
interprofessional nurse-led program that was
delivered in four Ontario communities by
Registered Nurses and Registered Dietitians from
Diabetes Education Centres and fitness leaders
and peer support volunteers from the YMCA or a
community organization. Provider views on
acceptability, feasibility, and implementation
barriers and facilitators were explored using two
focus groups at each of the four sites, as well as
field notes from monthly outreach meetings and
site teleconferences involving providers and
members of the research team. The acceptability
of the intervention by participants was measured
by engagement rate (percentage of completers
who had at least one home visit or group session)
and completion rate.
Results: The program was perceived to be
feasible and highly acceptable for older adult
participants and providers. The participant
engagement rate was high (98% for home visits
and 92% for group sessions) as was the
completion rate (91%). Facilitators to
implementation included: tailoring the number and
structure of home visits; providing more training
and resources for the intervention team; providing
opportunities for study sites to connect with each
other; ensuring smaller group programs; and
Conclusions: The findings support the feasibility
of implementing this intervention, with some
modifications, for older adults with multimorbidity in
community settings.
P74
Feasibility of the Kinect Tai Chi for use with
older adults as an alternative to group Tai Chi
1
1
Eleni Stroulia , Lili Liu , Victor Fernández
1
1
1
Cervantes , Elly Park , Benjamin Hunter , Stephen
1
1
1
Arychuk , William Kwan , Kent Rasmussen ,
1
1
2
Charles Rozsa , Mark Tupala , Yukie Goto
1
Unversity of Alberta, Edmonton Alberta, Canada,
2
Sapporo Medical University, Sapporo, Japan
Background: Tai Chi exercise is believed to
positively affect physical (e.g., gait, balance,
stability) and mental health (e.g., deep breathing,
relaxation, concentration). Extensive research
continues to look at the benefits of Tai Chi for older
adults including improved balance and strength.
Yet, barriers to participating in group Tai Chi may
exist, including accessibility and transportation
challenges, and scarcity of programs tailored for
seniors. This study aims at evaluating the
feasibility of a Kinect-based Tai Chi system (KTaiChi) as an alternative.
Method: Using a serious-games methodology, we
developed the K-TaiChi system that guides older
adults through postures and movements,
recognizes features of their movement, provides
visual feedback on how to improve, and rewards
them when they perform well. As this is a feasibility
study, participants will be community-residing
adults, 60 years or older, recruited through local
community organizations. Ten participants will use
K-TaiChi (3 times a week, for 6 weeks). A focus
group will be conducted post intervention to obtain
the participants' feedback on the system's
effectiveness and usability.
Results: The findings will help us to determine if
K-TaiChi is ready for use by older adults with
chronic conditions, and based on the users'
feedback we can prepare for large-scale
deployment in collaboration with industrial
partners.
131
Conclusion: K-TaiChi may be used by older
adults, residing in facility care or in their own
homes, who have mobility or transportation
restrictions that prevent them from participating in
traditional group Tai Chi.
Successful ideas are being spread and scaled
across the organization with plans on future
huddles with targeted focus areas.
P75
A research agenda to improve oral health in
long-term care homes
Innovation Huddles as a Mechanism to Engage
Staff in Long-Term Care and Supportive Living
Navjot Virk
The Brenda Strafford Foundation, Calgary, Alberta,
Canada
Background: Engaging staff to identify
opportunities for improvement helps foster
innovation and improve processes of care.
Innovation huddles were implemented to elicit
feedback and innovative ideas from staff in a
continuing care environment
Objective: To implement a mechanism to engage
staff to identify innovative ideas
Methods: Innovation huddles were conducted with
staff from all shifts and disciplines (i.e. nursing,
maintenance, dietary, recreation, laundry staff etc.)
to identify opportunities for improvement. The
huddles consisted of 20-25 minute facilitated
conversations directed at answering two main
questions 1) What are your top 3 pressing
challenges and concerns? 2) What innovative
ideas or solutions do you have to overcome these
barriers? After a process of review with leadership,
decisions of all ideas were communicated back to
staff. Successful ideas are being implemented and
championed at the frontline using knowledge
translation principles.
Results: To date 67 innovation huddles were
conducted in three 3 facilities with over 283 staff.
The main improvement ideas generated focusing
on: resident engagement, palliative care, dining
experience, communication and work environment.
Preliminary results include positive qualitative
feedback from staff and initial success of initiatives
rolled out as a result of the huddles. Empowering
staff to choose ideas of interest helped with future
implementation and sustainability of initiatives.
Conclusions: Implementing a mechanism for
empowering staff to identify questions and
improvement opportunities of their choice has
helped enhance the drive to advance change.
P76
1
2
1
Minn Yoon , Michael MacEntee , Matthias Hoben ,
3
3
Mary-Lou Van der Horst , Michael Sharratt , Hilary
3
1
Dunn , Carla Ickert
1
2
3
Canada, Schlegel-UW Research, Waterloo, ON,
Canada
Objective: Oral health (OH) and OH care are
neglected and sub-standard in long-term care
(LTC). Poor OH increases the risk of pneumonia,
compromises general health through infections
and malnutrition, and threatens self-esteem, social
well-being and quality of life. Gaps exist in our
ability to translate OH care best practices for frail
people. An international interprofessional team
(researchers, decision makers and front-line care
providers) with extensive knowledge about oral
healthcare and aging gathered for a 1.5 day Think
Tank to explore this gap and develop a research
agenda addressing it.
Methods: Before the event, a survey of
international experts and community stakeholders
identified key determinants of poor OH in LTC.
During the session, participants conducted a
cause-effect analysis and priority-setting process
to generate potential target areas for research.
Results: Poor OH can be attributed to
inadequacies in four major areas: assessment,
prevention, treatment and communication. Root
causes of these break down into five Ps –
providers; patients (residents); provisions;
procedures; and physical environment.
Three key areas to focus OH research are to
understand:
1.
preferences and priorities of stakeholders
across time
2.
context and consequences of oral care
3.
communication pathways to address
individual needs
Conclusions: Root causes of poor OH highlight
where knowledge translation interventions can be
132
targeted to support identified research priorities.
Drawing on international experts and knowledge
users, a strong foundation to implement an OH
research agenda to improve OH for LTC residents
in Canada has been created.
P77
A Clinically Viable Approach for Improving
Detection of Fall Risk
1 ,2
2
Sandra Hundza , Debra Sheets , Drew
1
3
4
Commandeur , Stuart MacDonald , Cheryl Beach ,
5
1
Andrew Mitz , Marc KLimstra
1
Exercise Science, University of Victoria, Victoria,
2
BC, Canada, Institute on Aging & LifeLong Health,
3
University of Victoria, Victoria, BC, Canada, Dept.
of Psychology, University of Victoria, Victoria, BC,
4
Canada, Canadian Institute for Health Information,
5
CIHI, Canada, Laboratory of Neuropsychology,
National Institute of Mental Health, NIH, USA
Over 33% of community-dwelling older adults
experience one or more falls each year causing
debilitating and often life-threatening outcomes.
Early accurate and clinically viable identification of
at-risk individuals is essential for targeting
interventions to decrease the likelihood of falls.
Recent findings have shown gait parameters to be
potentially more sensitive and specific for detecting
fall risk than other indicators. To be clinically viable
in fall risk prediction, gait data must be acquired
with affordable, portable technology and with
limited walking duration required. In the current
study, 41 community-dwelling older adults (25 nonfallers and 16 fallers) were recruited and
retrospectively classified as fallers or non-fallers.
Each participant completed walking trials with and
without cognitive load while gait parameters were
measured. We sought to determine the minimum
number of steps required and whether these steps
need to be consecutive (i.e. without turning) to
provide predictive fall risk data using both the
GaitRite Mat and Kinect system. Preliminary
univariate data suggests that 2 passes of 5-6
strides are required with the GaitRite Mat to
provide data differentiating fallers from non-fallers
during the cognitively loaded condition for 8 gait
metrics comprising step length, stride length, base
of support, stride width. stride velocity, velocity and
single support% and swing %. We will explore the
potential improved predictively of a weighted
composite relative to any single indicator. This
analysis will be repeated with the Kinect data.
Aging with schizophrenia: what do nurses need
to know?
Brittany Tyerman, Tanya Park, Sherry Dahlke
Edmonton, Alberta, Canada
The purpose of this systematic literature review
Honors Project was to discover what is known in
the literature about people with schizophrenia who
are aging.
People aging with schizophrenia are
underrepresented, unacknowledged, and hidden
from society. Healthcare systems have been
accused of discrimination towards aging adults
with mental illness as their needs are complex and
do not fit established plans of care. Schizophrenia
and aging each present individual challenges, so
experiencing both can be especially difficult. Little
is known about the experiences of people aging
with schizophrenia, and even less is known about
how healthcare professionals build capacity within
this unique population.
Method Results This systematic literature review
Honors Project was guided by the following
questions. What is known about people with
schizophrenia who are aging; what are the specific
healthcare problems for this population; what is
known about how healthcare professionals support
this population; what are the gaps in current
research; and what are recommendations for
future nursing practice? The results will guide
further research initiatives that focus on knowledge
translation.
Conclusions The traditional medical focus of
treatment for people with schizophrenia along with
the health challenges associated with aging,
dominates current literature. Focusing on positive
experiences and building the capacity of people
aging with schizophrenia needs to be given
attention by health care professionals. Building the
capacity of student nurses through increased
knowledge in these areas will lead to improved
advocacy and nursing practices.
P79
Health literacy and health-related quality of life
in elderly diabetic clients: the mediating role of
treatment regimen adherence
1 ,2
P78
2
2
Hadi kooshiar , Maryam Shorvazi , zahra Dalir ,
2
Masoud Hosseini
133
1
University of Western Ontario, London/Ontario,
2
Canada, Mashhad University of Medical Sciences,
Mashhad/Khorasan, Iran
Purpose: The aim of this study was to examine the
mediating role of treatment regimen adherence
between health literacy and health-related quality
of life (HRQoL) in elderly patients with type 2
diabetes mellitus (T2DM).
Method: In this cross-sectional study, multi-stage
cluster method sampling was used to recruit 300
elderly people aged 60 years in age and over with
T2DM who were referred to health centers in
Mashhad, Iran. The abbreviated version of the
Test of Functional Health Literacy in Adults (STOFHLA ), the Swedish health-related quality of
life (SWED-QUAL) instrument, Morisky Medication
Adherence Scale (MMAS), the Diet and Exercise
Adherence Questionnaire instrument included.
Results: The mean age of the respondents was
64.92 years. Females represented 65.7% of the
total respondents. In addition, the mean and
standard deviation of the respondents' health
literacy scores were 52.8213.25. The prevalence
rates of the inadequate, marginal, and adequate
health literacy of the respondents were 70%,
14.7%, and 15.3%, respectively. The result of
Baron and Kenny's procedure and Sobel's test
showed there were significant mediation roles of
medicine adherence (p = 0.00, Sobel's Z = 2.28)
and diet and exercise adherence (p = 0.00, Sobel's
Z = 1.87) between health literacy and (HRQoL).
Conclusion: To increase the quality of life in
elderly diabetes patients in addition to health
literacy, some mediating factors were found
between health literacy and (HRQoL), such as
medicine adherence and diet and exercise
adherence.
P80
L'effet cumulatif et combiné des facteurs de style
de vie a été exploré dans le domaine des maladies
cardio-vasculaires, le cancer, le diabète et de la
démence. D'où l'intérêt grandissant la dernière
décennie vers des interventions qui agissent
simultanément sur de multiples comportements.
La présente recherche développement vise à
provoquer le changement de multiples
comportements favorisant la santé cognitive
(CMCFSC) des adultes de plus de 50 ans. Notre
modèle conceptuel de CMCFSC à l'aide d'un
environnement TIC personnalisé s'appuie sur
Scaffolding Theory of Aging and Cognition STACR (Reuter-Lorenz & Park, 2014), sur la Théorie de
l'autorégulation (Karoly, 1993) et sur l'Internet
Intervention Model IIM (Ritterband et al., 2009). Il
fournit les outils et les variables nécessaires à la
conception et au développement de
l'environnement TIC personnalisé, ainsi qu'à
l'évaluation de ce dernier lors de la mise à l'essai.
Résultats attendus : La présentation donnera un
bref aperçu de l'application du modèle lors de la
conception du prototype de l'environnement TIC
personnalisé et les défis présents à ce jour.
Conclusion : L'environnement TIC personnalisé
pour CMCFSC des adultes de plus de 50 ans
recherche à créer un effet de synergie et de
coaction qui peut survenir chez les personnes qui
prennent des mesures efficaces sur un
comportement cible pour les rendre beaucoup plus
susceptibles de prendre des mesures efficaces sur
un second comportement (Johnson et al., 2008). Il
vise à atteindre une plus grande efficacité sur la
santé des adultes âgés qui sont susceptibles
d'avoir des conditions de santé concomitantes.
P81
Development and Evaluation of a
Comprehensive Diabetes Management
Program in Long Term Care
1
Un modèle conceptuel pour le changement de
multiples comportements favorisant la santé
cognitive (CMCFSC) des adultes de plus de 50
ans à l'aide d'un environnement TIC
personnalisé intégrant les théories IIM, STAC-R
et la théorie de l'autorégulation
NK Kichkina, MR Romero
Université Laval, Quebec, Canada
2
Andrew Steele , Denis O'Donnell , Chris
5
5
3
Brockington , Simon Jay , Susan Cymbaluk ,
4
2
3 ,1
Vianna Pana , Hrishikesh Navareb , Shawn Riel
1
2
In Initiative Inc., Markham, Canada, Medical
3
Pharmacies Group Ltd., Markham, Canada, OMNI
4
Healthcare, Peterborough, Canada, Lakeridge
5
Health, Oshawa, Canada, School of Pharmacy,
University of Waterloo, Waterloo, Canada
Diabetes is an increasingly prevalent disease in
long term care (LTC) among frail elderly, with a
rise of 74% from 2003 to 2013 and is associated
134
with several comorbidities and functional
impairment. LTC practice guidelines are lacking
due to a paucity of studies in this population and a
care gap remains. A comprehensive diabetes
program was developed by an inter-professional
health care team and introduced in 16 LTC
facilities in Ontario, Canada. The following is a
subgroup analysis among 827 residents in 8 LTC
facilities conducted after two years (June 2013June 2015) of this continuous quality improvement
initiative.
(p=0.001) for the gait speed test, and the lowest
was of 0.041 (p=0.089) for the handgrip strength
test. The sensitivity and specifity for all the tests
was similar with low values.
CONCLUSION The misconception and fail to
effectively diagnose has adverse outcomes for the
patient. Whenever it is possible objective
measurements should be used. Otherwise when
using subjective measurements this should be
clearly specified and pitfalls of using them
extensively discussed.
P82
Comparison of Subjective and Objective
Measurements of Physical Performance: A
Secondary Analysis of the Mexican Health and
Aging Study
5
1
Mariana Gonzalez-Lara , Pamela Tella-Vega ,
1
Mario Ulises Pérez-Zepeda , Julio Fernández2
3 ,4
Villa , Matteo Cesari
1
Geriatric and Epidemiologic Research
Department, Mexican Institute of Geriatrics,
2
Mexico City, Mexico, Metropolitan Autonomous
3
University, Mexico City, Mexico, Université de
Toulouse University III Paul Sabatier, Toulouse,
4
France, Gérontopôle, Centre Hospitalier
Universitaire de Toulouse, Toulouse, France,
5
National Autonomous University of Mexico,
Mexico City, Mexico
OBJECTIVE To find is there any difference
between the proportion of subjects categorized as
frail using physical performance tests or other
measures mainly based in question, and if present,
the magnitude of them.
METHOD Design: 11-year follow up longitudinal
analysis of a cohort of Mexican older adults
Setting: First wave of 2001 and third wave of 2012
of the Mexican Health and Aging Study, a cohort
study
Participants: Adults of 60-year or older with selfreported and physical performance test.
Measurments: Gait speed and handgrip strength
were measured with standardized protocols, the
cut-off values to classify as weak or slow an older
adult were estimated as originally done by Fried.
For handgrip strength two self-reported were used.
The balance test was done taking the time an older
adult could hold on one foot, the final score was
the average of the two foots.
P83
Postponing aging-associated diseases by
technical and physiological interventions
Ülo Kristjuhan
Tallinn University of Technology, Tallinn, Estonia
Objectives: Study of efficiency of nonpharmacological interventions in postponing agingassociated diseases.
Methods: From 1965 to 2000, we carried out
physiological and ergonomic studies in industry
(2147 persons). The studies were carried out in
Finland, Sweden, Japan, Great Britain, Russia and
Moldova, in workshops where environmental
conditions were mostly satisfactory, corresponding
to international standards. The studied groups
included 30-50 male and female workers. Most
studies were carried out three times during the shift
in the course of a few weeks. On the basis of
these studies, we made hundreds of individual and
group level recommendations similar to health
promotion, to managers’ various enterprises and to
workers: changes in machine construction,
optimum work-rest schedules, complexes of
physical exercises, devices to decrease too
intensive bodily activity, lifestyle etc. Most
enterprises and workers got more than 30
recommendations. We paid much attention to early
symptoms in different regions in the body in
working out these recommendations. Many years
later we assessed the effect of interventions.
Results: After interventions, fatigue intensity was
markedly lower in the end of the work-shift.
Cardiovascular diseases and musculoskeletal
disorders appeared up to 20 years later as a result
of proposed interventions. Consequently, human
aging processes are markedly malleable.
RESULTS From a total of 845 older adults
included the highest kappa statistic was of 0.186
135
Conclusions: Aging-associated diseases are
possible markedly to postpone using technical and
physiological approaches that is very important
individually and on state level.
P84
Emotion regulation strategies determine
psychological wellbeing but do not associate
with executive function in late life
Alexandra Fiocco, Vivian Huang, Shruti Vyas, Mitra
Farzaneh
Ryerson University, Toronto, Canada
Previous studies suggest that use of adaptive
emotion regulation (ER) strategies is associated
with wellbeing in young and older adults. However,
some ER strategies, such as cognitive reappraisal,
require a significant amount of cognitive control. As
such, age related changes in executive function
may decrease the ability to engage in adaptive
emotion regulation strategies in late life. The
objective of this study was to examine the
association between emotion regulation, executive
function and psychological wellbeing in community
dwelling older adults. A total of 64 men and women
(Mean age = 67.24, SD=6.7) completed a battery
of cognitive tests that tap into executive function
and questionnaires that measure ER, depressive
symptoms, perceived stress and quality of life
(QoL). Independent step-wise linear regression
models were conducted to examine whether ER
predicts psychological wellbeing and executive
function. Age and gender were entered into step 1
of each model and nine ER subscales were
entered into step 2. Results suggest that ER
significantly predicts psychological wellbeing. More
specifically, increased rumination predicted
increased depressive symptoms (b= .74, p=.006),
increased perceived stress (b=.91, p=.001) and
decreased overall QoL (b= -1.00, p=.032). Further,
positive reappraisal consistently predicted
decreased depression (b=-1.44, p=.002), lower
perceived stress (b=-1.43, p=0.002) and increased
QoL (b=2.57, p=.001). ER did not predict executive
function; however positive reappraisal (b=2.82,
p=.001) and refocus planning (b=-3.14, p=.002)
significantly predicted percentage of perseveration
error. These findings confirm that adaptive ER
strategies are associated with enhanced
psychological wellbeing in late life, but may not
associated with executive function performance.
P85
Worries about Maintaining Independence of
Rural/Remote Older Adults: Opportunities for
Technology Development
1
1
1
Megan E O'Connell , Ben Gould , Andrea Scerbe ,
1
1
2
Debra Morgan , James Carter , Carrie Bourassa ,
3
4
Kristin Jacklin , Wayne Warry
1
University of Saskatchewan, Saskatoon, SK,
2
Canada, First Nations University of Canada,
3
Regina, SK, Canada, Northern Ontario School of
4
Medicine, Sudbury, ON, Canada, Laurentian
University, Sudbury, ON, Canada
One purpose of AGE-WELL's RRITE:
Rural/Remote Indigenous Technology needs
Exploration is to inform creation of AGE-WELL
technologies that are relevant to the rural/remote
user, information critical to help overcome barriers
to adoption of technologies by this unique
population. For the current study, user needs of
rural/remote dwelling older adults were explored by
brief interview with 621 adults, aged 60 years and
older. The sample was recruited from randomly
selected telephone numbers (landlines and cell
phones) listed for persons residing outside
metropolitan areas of Saskatchewan, and the
sample was predominantly rural/remote. Of the
sample, 463 rural/remote seniors (M age = 71.6;
SD = 8.4; range 60-102 years) responded to an
open-ended question regarding their ‘worries'
about maintaining independence as they advanced
in age, and themes of reported worry were
analyzed (with NVIVO for support). Almost one
third of the sample (31%) denied any worries
associated with aging, but 23% of reported worries
were related aging in the context of geographic
isolation and lack of accessible services. Additional
worries were characterized as general anxiety
about independence, taking care of their home,
and moving into assisted or residential living
(18%). Of the remaining categories of reported
worries: 11% were related to physical declines in
advanced aging; 8% finances; 5% neurological or
mental health conditions; 3% physical mobility
restrictions, and 2% were characterized as ‘other.'
These data suggest technology that mitigates
geographic isolation and increases accessibility of
services will be critical for rural/remote seniors, and
provides further support for development of
assistive technologies.
P86
Ethical issues in information and
communication technologies adoption by
136
aging persons with cognitive impairments and
their caregivers: a systematic review
1
1
Hajer Chalghoumi , Rawad Mcheimech , Virginie
1
1
2
Cobigo , Jeffrey Jutai , Johanna Lake
1
University of Ottawa, Ottawa, ON, Canada,
2
Centre for Addiction and Mental Health, Toronto,
ON, Canada
BACKGROUND: Although Information and
Communication Technologies (ICT) appear to be
promising tools to promote self-determination and
social inclusion for aging persons with cognitive
impairments, their use raises a host of ethical
issues. Ethical issues are observed when the risks
and benefits of ICT use are unclear or
controversial. Because they may not have the
required abilities to balance the pros and cons of
technology use, aging persons with cognitive
impairments are more likely to encounter these
challenges. This study aims to explore ethical
factors that facilitate or hinder access and adoption
of ICT by aging persons with cognitive impairments
and their caregivers.
METHOD: A systematic review was conducted in
order to report on ethical issues concerning ICT
development and adoption by persons with
cognitive impairments and their caregivers.
RESULTS: Six hundreds thirty eight articles were
retrieved, 72 of which met the inclusion criteria.
Findings of the systematic review highlight that
while ethical issues of ICT adoption by aging
persons with cognitive impairments are a reality,
they are rarely addressed in previous studies.
Some of these issues are related to surveillance
and tagging, and their impact on invasion of
privacy. Others are linked to accessibility at its 3
levels: physical access, interface access and
cognitive access.
CONCLUSION: Future research should consider
ethical issues from the beginning of and
throughout the process of technology development
and research.
P87
Behavioural Management in Dementia using
Innovative Devices and Systems
1
1
1
Mark Chignell , Andrea Wilkinson , Thomas He ,
2
3
Farzad Nejatimoharrami , Oleksii Shevchenko
1
2
University of Toronto, Toronto, Canada, IT
University of Copenhagen, Copenhagen,
3
Denmark, University of Alberta, Edmonton,
Canada
After reviewing the scientific literature, Spira and
Edelstein (2006) concluded that there is evidence
“that warrants optimism regarding the application
of behavioral principles to the management of
agitation among older adults with dementia.”
Token economies are a type of behavioural
management that has been used in schizophrenia
(e.g., Dixon at al., 2009) and dementia (e.g.,
Mishara, 1978).
One barrier to the use of token economies in
dementia is the effort involved in running them.
Since caregiver burden is already high it is hard to
justify the introduction of a technique that requires
caregivers to continuously monitor behaviours.
Thus we are looking at ways to automate
behavioural management so as to improve
behaviours, without increasing caregiver burden.
In this presentation we describe two systems that
we have developed for efficient management of
behaviour in dementia. The first system is a
computer-controlled hardware device that
dispenses nickels (tokens). We chose nickels as a
primary reinforcer because money tends to retain
perceived value late into the progression of
dementia. Nickels are a convenient size and are
manufactured to precise tolerances. The second
system is a combination of sensors and software
that controls dispensing of nickels (which can also
be used as tokens) based on performance of
desired behaviours. The software also allows
caregivers to track behaviour over time and to set
individual goals based on targeted behaviours. We
will discuss the usability of the system and present
use cases that demonstrate the value of the
system in managing behavior in dementia.
P88
Let’s Connect - digital games for people living
with dementia
1
1
1
Paul Gural , Karen Cotnam , Teresa Shearer ,
2
2 ,3
Erica Dove , Arlene Astell
1
Oshawa Seniors Citizen Centres, Oshawa, ON,
2
Canada, Ontario Shores Centre for Mental Health
3
Sciences, Whitby, ON, Canada, University of
Sheffield, Sheffield, S. Yorkshire, UK
Objective To introduce digital games to people
with dementia in a Specialized Day Program and
137
develop a support package for families to provide
these games at home.
Method Phase 1 - a selection of digital games was
chosen that are available on different tablet
devices (Android, Windows and Apple). Phase 2 Sixteen clients attending a Specialized Day
Programme for Seniors were recruited along with
nine volunteers to coach the older adults. In the
first eight weeks a total of 55 one-to-one sessions
were conducted. Phase 3 – the aim was to provide
a workshop for families to learn how to use the
tablets and games.
Results The older adults were able to play games
on the tablets supported by the volunteer coaches.
Volunteers were successfully trained to provide
responsive coaching that reflected the strengths
and interests of the older adults. Families attending
the workshop were able to see their relatives with
dementia engaged in playing games on the tablets
and were interested in trying these at home.
Conclusions Older adults living with significant
cognitive impairment can be supported to learn to
play digital games on tablet computers. It very
quickly emerged that everyone has their own
preferences, supporting the case for
personalisation. For these benefits to carry over to
the home, families need support in selecting tablet
devices, choosing digital games and downloading
them. Training for volunteers and families can be
adopted by other organisations supporting
individuals living with dementia.
P89
Safety of older pedestrians: Issues and
strategies to address them
Robert Dewar, Carole-Lynne Le Navenec
University of Calgary, Calgary, Alberta, Canada
Walking across the street, in parking lots, on
sidewalks and in buildings can be hazardous for
older adults. Various factors contribute to these
hazards, including limited mobility, reduced vision,
cognitive deficits, and poor balance, as well as
environmental conditions such as poor lighting,
winter conditions and poorly built walkways and
stairs. This presentation will include:
(a) evidence from the literature regarding each of
these issues, as well as related factors such as
pedestrian walking speeds, distraction and
impairment
(b) roadway design and traffic calming as related to
pedestrian safety
(c) discussion of several countermeasures to
improve pedestrian safety in winter and in the
three above-mentioned contexts.
P90
Perceived discrimination and civic engagement
of immigrant older adults in Canada
Hongemei Tong, Yeonjung Lee
Civic engagement involves civic and political
activities intended to benefit the public. Among
older adults, civic engagement has been linked to
the promotion of self-esteem, wellbeing, life
meaning and satisfaction. A range of sociodemographic and contextual factors shape civic
engagement experiences among older adults. Yet,
the connection between civic engagement and
discrimination is lack. When compared to
Canadian-born older adults, immigrant older adults
have a higher risk of be discriminated due to their
age, race, ethnicity, and language. Thus, this study
aimed to answer the research question “What is
the association between perceived discrimination
and civic engagement among immigrant older
adults in Canada?” Secondary quantitative data
analysis of 2013 General Social Survey (GSS)
data was used. Civic engagement was presented
by volunteering, donation, voting in federal,
provincial, municipal or local elections, participation
in political activities, and organizational
membership or participation. Perceived
discrimination was measured by a question
whether older adults is a victim of discrimination in
the past five years. Binary analysis and logistic
regression were used. Bivariate analysis showed
that 20% of immigrant older adults reported being
victims of discrimination. Logistic regression
showed when socio-demographic variables,
physical and mental health variables were
controlled, perceived discrimination is negatively
associated with the odds of engagement in
volunteering, organizational membership or
participation, and participation in political activities.
The findings illustrate the significance of
addressing discrimination in increasing older
immigrants’ civic engagement in Canada. Antidiscrimination programmes should be provided to
increase their civic engagement.
P91
138
People Living with Dementia and the Law:
Stakeholder Perspectives
Rebekah Churchyard, Arlene Astell
Ontario Shores Centre for Mental Health Sciences,
Durham, Ontario, Canada
Objective. As the population ages, the number of
people living with dementia is growing. One
consequence is an increase in police contact with
people living with dementia, ranging from missing
persons to allegations of serious crimes. The
implications of this rise for people living with
dementia and law enforcement as well as the wider
criminal justice system, requires further
understanding.
Methods. The Region of Durham in Ontario,
Canada was taken as an illustrative case example,
set within the Canadian national context plus
available international data. Informational
interviews (in-person, by phone and Skype) were
conducted with 29 local, national and international
experts (lawyers, police officers, researchers,
managers).
Results. The preliminary analysis revealed 3557
calls for the Durham Regional Police Services
(DRPS) for older adults (65+) in 2013 and 208
incidents resulting in 2052 recorded points of
contact with the Seniors Response Coordinator
(during Sept 2014-March 2015), roughly 11
contacts per day. An estimated 5-6 cases per year
involve a person living with dementia facing
mandatory charges. Outcomes included several
different arrangements, with some individuals
accessing many points of the legal and social care
systems, including acute or psychiatric
hospitalization and homeless shelters.
1 ,2
2
Christopher Poulos , Roslyn Poulos
1
2
HammondCare, Sydney, NSW, Australia, The
University of NSW, Sydney, NSW, Australia
Objectives: ‘Reablement' and ‘restorative care' are
becoming pervasive terms in the community care
lexicon, internationally and within Australia. This
paper aims to: describe the genesis and
development of ‘reablement' in Australian
government community aged policy; critically
evaluate the potential benefits of reablement
approaches for consumers and funders; and,
discuss the implications for providers.
Method: A review of the academic and grey
literature on the evolution of ‘reablement' and
‘restorative care' has been undertaken; as well as
an analysis of the response of HammondCare, a
large not-for-profit aged care provider, to the new
policy environment.
Results: ‘Reablement' is described as a
philosophical approach underpinning community
care provision as well as a targeted, time-limited
intervention. In ongoing care, reablement is often
described as ‘doing with', rather than ‘doing for', a
person. There remains a lack of clarity about how
reablement can be delivered cost-effectively.
Failure to identify and manage underlying health
conditions, through inadequate coordination
between service providers and primary care, could
adversely impact an older person's ability to
respond to reablement strategies. Consumer
directed models of care have allowed service
providers opportunities to offer flexibly delivered
reablement interventions. ‘Reablement' does not
offer the same comprehensive approach to
addressing functional decline as does traditional
rehabilitation.
Conclusion. These findings highlight a growing
need for specialized responses for people living
with dementia who intersect with the criminal
justice system. There is also a need for
community-based research exploring the pathways
people living with dementia take through the
criminal justice system, including their
accommodation and the role of other service
providers, e.g health, social care, etc.
Conclusions: While advocated by many as a
means of increasing independence and reducing
longer term care costs and reliance on residential
care, reablement strategies will likely be most
effective when the comprehensive health and
wellness needs of older people are addressed
within the reablement approach.
P92
Development of a Tracheostomy Ambassador
Program in a Geriatric Health Facility
‘Reablement as the new black' - the changing
focus of community care provision in Australia
P93
139
1
1
1
Gina Dolezel , Susan Calabrese , Carman Lee
1
2
Baycrest, Toronto, Canada, West Park, Toronto,
Canada
Baycrest Hospital serves a large number of
Complex Continuing Care Clients with a current
40% ratio of our clients having a tracheostomy.
Prior to implementation of our Tracheostomy
Ambassadors Program, there were limited
resources to support clients and nurses through
ensuring routine tracheotomy tube changes. In
exploring the issue, it was noted that the changing
and maintenance of tracheostomy tubes are well
within the scope of practice of the Registered
Nurse. In collaboration with Westpark, we
launched an innovative Tracheostomy
Ambassador Program, led by registered nurses
and the Advance Practice Nurse. We developed a
competency based training program in order for
patient tracheostomy tubes to be changed right at
the patient's bedside. Having a RN Team lead this
initiative has improved our tracheostomy care
outcome including cost effectiveness and client
reported experiences, as well as increased our
decannulation rates. Infection rates are currently
being evaluated.
P94
Enhancing Lives with in-Home Personalized
Music
1
1
1
Catherine Chater , Gloria Kay , Joy Klopp ,
2
1
1
Sabrina McCurbin , Sandra McKay , Kathy Sidhu
1
VHA Home Healthcare, Toronto, Ontario, Canada,
2
Alzheimer Society of Toronto, Toronto, Ontario,
Canada
Dementia is a significant cause of disability among
older Canadians and forecasts predict a two-fold
increase in prevalence within 20 years, with the
majority of care to be provided in home-based
1
settings . Innovative, evidence-based tools that
strengthen the capacity of homecare providers and
informal care-partners to provide support for
individuals living at home with dementia is
becoming of increasing importance within
1
Canada's health system . Client-centered music,
delivered through a personal audio player, is one
such tool with demonstrated effectiveness in
improving cognition, communication and quality of
life for persons living with dementia, while reducing
the occurrence of the behavioural/psychological
2
symptoms of dementia .
A review of available evidence (primarily from
residential care), as well as ideas sparked by pointof-care service providers, inspired an initiative to
respond to the feedback of clients' care-partners,
and their voiced desire for in-home activation for
their loved ones without involved cost, travel or
administration. VHA Home HealthCare partnered
with the Alzheimer Society of Toronto to provide
clients with iPods containing personalized music.
Our objective was to evaluate the
feasibility/effectiveness of the program delivery,
and to assess stakeholder's satisfaction with inhome program implementation. 120 personal
support workers were oriented to the iPod
initiative and invited to engage their clients with the
program over a 3-month pilot period. Key-informant
interviews were established to collect data on user
experience. Early results suggest this to be a
viable service-delivery model with potential to
expand utilization across the organization and
within the homecare sector.
P95
Development of a meaningful staff
development resource as a participatory
activity in continuing care
1
2
Sharla King , Steven Friesen , Sandra Woodhead
3
Lyons
1
2
Bethany Care Society, Calgary, AB, Canada,
3
Insititute for Continuing Care Education &
Research, Edmonton, AB, Canada
Objectives: This paper will describe the process
used to develop a toolkit to support the
development and sustainability of learning circles
in continuing care settings.
Methods: As part of the end-of-grant KT for the
study, "From Cooperative Learning Strategies to
Quality Continuing Care (CC) Workplaces" or
Learning Circle (LC) project, the Research Team
developed a user-friendly toolkit using a
collaborative, participatory approach. The toolkit
helps CC sites establish and sustain LCs as a
means of effective workplace learning and support
for clinical practice changes. The toolkit
development was based in theory and research
results and then validated through a cyclical
process with site LC representatives. The
Research Team recognized that ‘real life’ and
theory don’t always agree and it was important to
140
get the practical and realistic perspective of the
providers.
Results: Based on existing theories of adult
learning and on the results of the project, an online
toolkit was developed. It contains specific sections
for facilitators, site and organizational sponsors.
The Research Team ‘workshopped’ the draft with
site representatives and revised based on the
knowledge and learning site participants had
gained during the project. Site representatives and
non-study stakeholders were asked to review the
toolkit online for final comments.
Conclusions: Using a participatory process to
guide the development of the toolkit resulted in a
more effective knowledge translation tool for the
continuing care sector. Housing it It is housed
within a community of practice for education &
research in CC allows for further participatory
development.
P96
Health impacts of caregiving in Canada: an
analysis of the 2012 General Social Survey
Simone Powell, Natasha Kuran
Public Health Agency of Canada, Ottawa, Canada
Objective: Analyse national-level General Social
Survey data to determine the impact of caregiving
on the health status of care providers.
Method: Participants were drawn from the crosssectional study Canadian General Social Survey
which consisted of 23,909 participants, of which
7082 indicated they provided care to an individual
with a chronic disease, disability, or aging-related
issue. Analyses were undertaken to compare the
self-reported health impacts that participants
attributed to caregiving with overall health status.
Descriptive statistics, including chi-square tests
were performed, and logistic regression was used
to derive odds ratio with adjustment for other
relevant risk factor data.
Results: Providing care was found to have
detrimental effects on healthy behaviours
(smoking, alcohol use, eating habits, and physical
activity). This impact was enhanced among those
caregivers who were less than 65 years of age.
Those who indicated that their physical and mental
health status was impacted by caregiving also
reported overall poorer quality of life. These
effects were greater for mental rather than physical
health, and were greater in women when
compared to men.
Conclusion: Our analyses reveal that there are
inconsistencies when assessing the impacts of
providing care when participants are asked
whether caregiving impacts their health, when
compared to providing responses about overall
health. It is also evident from these analyses that
caregiving affects the health status and healthy
behaviours of individuals providing care,
particularly in those less than 65 years of age.
P97
Improving the Last Stages of Life for LGBT
Seniors: Implications for Research, Policy &
Practice
1 ,2
1
Arne Stinchcombe , Kathy Kortes-Miller ,
3
Kimberley Wilson
1
Lakehead University, Thunder Bay, Ontario,
2
Canada, University of Ottawa, Ottawa, Ontario,
3
Canada, University of Guelph, Guelph, Ontario,
Canada
In December 2015, the Law Commission of
Ontario (LCO) issued a Call for Research Papers
related to its project, “Improving the Last Stage of
Life.” As one of the seven multidisciplinary teams
funded to undertake research on complex issues
of law and policy relating to care in the last stages
of life, this presentation focuses on the
perspectives of lesbian, gay, bisexual and
transgender (LGBT) older adults.
Recognizing that while Canada’s population is
aging, so too are our LGBT communities. Much of
the current evidence indicates health disparities
among LGBT older adults relative to their
heterosexual peers. Furthermore LGBT older
adults are less likely to have children, to have
children who may act as caregivers and are more
likely to live alone and socially isolated. To
prevent further marginalization of aging LGBT
individuals, considering of the potential barriers in
accessing care is necessary to ensure policy
reform is inclusive and responsive to the needs of
the growing population of LGBT older adults. This
presentation will feature findings from pilot
research on the lived experience of older LGBT
individuals and their caregivers within the
healthcare system in Ontario as well as highlight
their concerns associated with the last stages of
life. Integrating evidence from literature and focus
141
groups with LGBT individuals aged 60 and older
across Ontario, this presentation will describe key
findings presented to the Law Commission of
Ontario and offer recommendations for future
research, practice, and policy that is responsive to
and values the experiences of LGBT older adults.
of transition to RC. This information is valuable for
understanding psychosocial influences on wellbeing and improving preventive supports for
community-dwelling older adults.
P98
Family Caregivers' Experiences With
Caregiving-Related Technology
Changes in social participation and loneliness
are associated with risk of transition from
home to residential care
1
1
1
Julie Gorenko , Paul Brewster , Brent Gali , Cheryl
4
1
2
Beach , Sandra. R. Hundza , Jeff Poss , Carl V.
3
5
1
Asche , Andrew R. Mitz , Debra Sheets , Stuart
1
W.S. MacDonald
1
2
3
University of Illinois, College of Medicine at
4
Peoria, Peoria, IL, USA, Canadian Institute of
Health Information, Victoria, BC, Canada,
5
Laboratory of Neuropsychology, National Institute
of Mental Health, National Institutes of Health,
Bethesda, MD, USA
Varying social participation and loneliness have
been linked, but little research has focused on the
relationship between these variables in home care
and the risk of transition into residential care (RC).
These variables were captured in the Resident
Assessment Instrument – Home Care (RAI-HC),
which was administered to an Ontario cohort and
derived from the Canadian Institute for Health
Information database. The study sample
(n=356,104) was comprised of individuals aged 65
years and older that were receiving home care and
had at least two RAI-HC assessments during the
9-year follow-up period. Social participation was
measured by a reported change of engagement in
social activities since the last assessment, and
loneliness was assessed by a participant’s selfreported feelings. The outcome measure was
transition to RC, which coincided with the end of
available assessment data. Results from
multivariate logistic regression analyses indicated
that those reporting an increase in social
participation were less likely to transition to RC
(OR = 0.64, p < .01), with elevated loneliness
linked to increased transition risk (OR = 1.14, p <
.01). The interaction between loneliness and social
participation was also significantly predictive of
transition to RC (p < .0001). These findings
underscore the importance of quality social
interactions for an aging population, as they may
decrease the likelihood of loneliness as well as risk
P99
1 ,2
1 ,2
3 ,2
R. Dalle , W.B. Mortenson , F. Routhier , L.
4 ,2
5 ,2
4 ,2
6 ,2
Demers , A. Wister , C. Auger , J. Fast , P.
4 ,2
3 ,2
3 ,2
Rushton , M. Beaudoin , J. Lettre , D.
7 ,2
Mallette
1
2
Canada, AGE-WELL, Toronto, ON, Canada,
3
Université Laval, Quebec City, QC, Canada,
4
Université de Montréal, Montreal, QC, Canada,
5
Simon Fraser University, Burnaby, BC, Canada,
6
7
Patterson Medical Canada Inc., Mississauga, ON,
Canada
Objectives: Family caregivers use technology for
many reasons: to help care recipient perform daily
activities and assist with care provision, to monitor
safety and to find out information/ to learn new
skills. In light of limited knowledge in this area, a
study was conducted to identify caregivers’
experiences with caregiving related technologies.
Method: This ongoing project draws on data from
a larger national study that will include 60
caregivers of older adults. This mixed-methods
study uses semi-structured qualitative interviews,
as the primary means of data collection. The first
interview identifies their needs and solutions they
currently use, and the second interview explores
technological solutions they may be unaware of or
could use in the future. A constructionist approach
to thematic analysis is being used for data
analysis.
Results: Our analysis of data from the first 16
participants, identified three preliminary themes: 1)
“Does the benefit out-weigh the cost?” explores the
challenges caregivers face setting up new
technologies and training care recipient 2), “You
can lead a horse to water” describes care recipient
resistance to obtaining and adopting new
technologies; and 3) “You don’t know what you
don’t know” reveals limited knowledge about
technologies that currently exist and how to find
and fund them.
142
Conclusions: Findings from this study emphasize
the ambivalence that caregivers experience with
technologies related to caregiving and how their
introduction may cause unintended consequences.
Technology developers and providers need to be
aware that among family caregivers perceived
long-term benefits needs to be carefully balanced
with short-term costs.
P100
Athletic Identity and Retirement
Michelle Silver
Objectives: To examine perspectives on
retirement, athletic identity, and factors that
promote exercise participation among retired
athletes.
Method: In-depth interviews were conducted with
former Olympians from 10 different sports following
a life story approach that focused on transition
points.
Results: The retired elite athletics in this study
found retirement to be a difficult transition, both
physically and mentally. All participants faced
numerous barriers to exercise participation,
including pain and injury. Each participant
established a retirement identity that necessitated
a divorce from their athletic identity and a complete
reorientation in their attitudes about health and
exercise.
Conclusions: This study highlights the importance
of developing multidimensional, dynamic
programming that fosters later life athletic identity
in a way that helps individuals develop social
connections and integrates fun with achievement.
P101
How can Qualitative and Geospatial Methods
be Combined to Study Aging and
Neighbourhoods? A Scoping Review
Carri Hand, Suzanne Huot, Debbie Laliberte
Rudman, Sachindri Wijekoon
University of Western Ontario, London, ON,
Canada
Neighbourhood contexts can support and pose
barriers to health, participation and inclusion for
older adults, via the built environment, attitudes
about aging, and policy, among others. In-depth
information about such person-place transactions
is lacking. Combining geospatial and qualitative
methods is one promising approach to more fully
explore older adults’ experiences in their
neighbourhoods. This scoping review aimed to
synthesize the extent and nature of research with
older adults that combined qualitative and
participatory geospatial methods (i.e. the
participant was actively involved in data collection).
We searched eight academic databases (CINAHL,
EMBASE, Georefs, Geobase, Sociological
Abstracts, Scopus, Social Science Citation Index,
and SocINDEX) using search terms related to
geospatial methods and qualitative methods and
older adults. We identified 1474 unique articles.
Seventeen articles met the selection criteria
(published from 1995-2015 in English, involved
older adults, and used a qualitative method
combined with a participatory geospatial method).
All selected articles were published from 20102015 in Australia, Belgium, Canada, the
Netherlands, and the United States of America.
Common study methods included go-along
interviews, photovoice followed by focus groups,
and global positioning system data collection
followed by interviews. Most studies lacked an
explicit methodological approach and involved
limited analysis of geospatial data. Further
development of these methods is recommended
including using more rigorous methods and more
extensive integration of data during
analysis. Approaches that combine geospatial and
qualitative methods hold promise for exploring
person-place transactions to provide crucial
knowledge that can support older adults’ health,
participation and inclusion.
P102
Language and Communication Barriers
Experienced by Culturally and Linguistically
Diverse (CALD) South Asian Individuals with
Dementia and their Family Caregivers in
Accessing and Navigating the Canadian Health
Care System
Sehrish Haider, Joseph Orange
Background: Older adults from culturally and
linguistically diverse (CALD) background constitute
a significant portion of Canada’s population. As the
prevalence of dementia increases in Canada, the
proportion of individuals with dementia from CALD
143
communities also rises. Older adults from CALD
backgrounds with dementia face numerous
barriers accessing and navigating Canada’s health
care system. These barriers include, among
others, difficulty using and understanding
Canada’s two official languages, a lack of
knowledge and understanding of the health care
system, and cultural issues related to
understanding dementia and responding to the
needs of those with dementia.
Hypotheses and/or Objectives: The objective of
the study is to identify CALD-related
communication and language barriers related to
dementia and dementia care, and to create
awareness about them.
Proposed Methods: Participants include family
caregivers to individuals with dementia belonging
to the South Asian community. Semi-structured
open-ended interviews will be conducted using
focused ethnography. The interviews are designed
to determine what language and communication
barriers participants encounter while accessing
and navigating the Canadian health care system,
and how these may limit their access and
navigation.
Future Applications/Directions: Results from this
study will help (1) determine the types of language
and communication barriers that affect access and
navigation, (2) identify how the these barriers
influence healthcare access and navigation, and
(3) increase awareness about these barriers. The
anticipated findings will advance the development
of strategies to minimize these barriers and will
help promote increased accessibility of healthcare
for older adults with dementia from CALD South
Asian populations in Canada.
P103
Long Term Care Stakeholder Perspectives on a
Participatory Occupational Health and Safety
Program
1
1 ,2
Teresa D'Elia , Dwayne Van Eerd , Era Mae
1
1 ,3
Ferron , Ben Amick
1
Institute for Work & Health, Toronto, ON, Canada,
2
School of Public Health and Health Systems,
3
School of Public Health and Social Work, Florida
International University, Miami, FL, USA
Objectives: Musculoskeletal disorders (MSD) and
slips, trips, and falls (STF) are a major source of
workplace injuries. In Ontario, MSD account for
45% and STF account for 18% of all lost-time
claims in the healthcare sector. Our objective was
to integrate stakeholder experiences related to
implementing a participatory ergonomics program
in Long Term Care (LTC) settings.
Methods: The project builds on a recently
completed pilot intervention of the Employee
Participation in Change (EPIC) program, in three
LTC homes. Interviews were conducted with
Program Champions (n=3) and an interactive
stakeholder workshop (n=13) was held. Transcripts
were analyzed for emerging themes. Workshop
focus group data centred on strategies for
knowledge sharing and program
recommendations.
Results: Program champions, site administrators
and worker representatives led discussions about
their experiences with EPIC implementation. EPIC
has been sustained and incorporated into existing
health and safety procedures at all sites.
Improvements in communication about safety were
noted in all cases. Funding to implement changes
remains a challenge in LTC homes. Suggestions
included reducing program training and paperwork.
Key barriers included the time for implementation
due to daily workloads. Participants noted that
sharing solutions across sites would have been
useful earlier. A key facilitator to success included
the role of ergonomics consultants.
Conclusions: Program stakeholders, including
front line staff representatives, took part in an
interactive workshop to inform improvements in
program delivery and research evaluation of a
participatory intervention in LTC. Frontline staff
continue to use EPIC hazard identification tools
and practices. “Raised awareness” from EPIC has
persisted.
P104
Low-Income Immigrant Seniors - Housing
Struggles Affect Their Health
Louanne Keenan
University of Alberta, Edmonton, Alberta, Canada
Multicultural health brokers (MCHB's) are
members of immigrant communities; they have
trusting relationships with the natural leaders,
144
immigrant seniors and families. Our team worked
alongside MCHB's to capture photos and
accompanying narratives with low-income
immigrant senior's concerning their perceptions of
how senior's housing struggles affect their health.
Involving vulnerable seniors allowed them the
freedom to demonstrate their spatial mobility,
interactions, and participation within their
neighborhoods: but they also found the experience
frightening and invasive. The MCHB's were
sensitive to the immigrant seniors' issues: PTSD
from years in refugee camps; fear of reprisals from
the landlords; and shame because of their poor
living conditions. Lofty goals of recruiting 36
participants who were living in
inadequate/precarious housing changed to realistic
participation by 12 seniors: 2 representatives from
Serbia, Iran, and Iraq; 3 from China and Korea
respectively. Their ages ranged from 60 to 92. Two
focus groups were conducted with the brokers and
3 low-income immigrant seniors to review the
photos and narratives for the selected photos. The
sessions were transcribed verbatim, coded and
grouped into categories, which resulted in three
major themes: i) Substandard Living Conditions; ii)
Resiliency; and iii) Shifting Spaces - Instability,
Changing Health, and Loneliness. MCHB's and
selected seniors participated in editing and copresenting a workshop for stakeholders that are
involved with senior housing initiatives. These
resilient seniors demonstrated that independence
is strongly valued - they arrive with limited
resources but they do not want to be a burden on
their children, their church, or their new country.
P105
Successful Aging: Considering non-biomedical
constructs
Lisa Carver, Diane Buchanan
Queen's University, Kingston, Ontario, Canada
Objective: The term successful aging continues to
be applied in a variety of contexts and without
consistency in terms of included constructs.
Although previous reviews highlight the
multidimensionality of successful aging few have
focused, as was done here, exclusively on nonbiomedical factors.
Methods: A scoping review was done using the
Ovid Medline database. Peer-reviewed Englishlanguage articles published between 2006 and
2015 that offered a model or, at minimum, an
operational definition of successful aging and
involved research with older adults were chosen.
Results: Seventy-two articles were reviewed.
Thirty-five articles met the inclusion criteria. The
most common non-biomedical constructs
associated with successful aging included
resilience, engagement, optimism and/or positive
attitude, spirituality, self-efficacy and
gerotranscendence.
Conclusion: Successful aging is a complex
process best described using a multi-dimensional
model. Given that the majority of elders will
experience illness and/or disease during the
lifecourse, it is vital that public health initiatives that
promote successful aging employ non-biomedical
constructs thereby facilitating the inclusion of
elders living with disease and/or disability.
P106
Volunteering and Aging in Place; A potent
synergy in healthy ageing
Alexandria Pakkala, Krishnan Venkataraman
Huntington University, Sudbury, Ontario, Canada
Volunteering activities have been demonstrated to
benefit both individuals and their respective
communities in promoting the growth of social
capital, increasing connectedness and preventing
social isolation. For older adults, volunteering also
allows for generativity, thereby enhancing the
richness of their lived experience. From a financial
perspective, volunteering in Canada contributes
the financial equivalent of 1.1 million full-time jobs
a year. Aging in place is important for most older
adults, with demonstrated evidence of better
overall well-being. In our study, we wished to
investigate whether active volunteering by older
adults in the community enabled them to age in
place more successfully. This qualitative study
analyzes the impressions of six older volunteers in
the City of Greater Sudbury to identify themes that
were either common or distinct to each participant.
P107
“It’s whimsy now”: Feeding oneself after a
lifetime of feeding others
1
2
Elisabeth Vesnaver , Heather H. Keller , Olga
1
3
Sutherland , Julie L. Locher
1
University of Guelph, Guelph, Ontario, Canada,
2
145
3
Canada, University of Alabama at Birmingham,
Birmingham, Alabama, Canada
Widowhood is an expected, disruptive event for
older married women’s food behaviours, foodrelated activities, and, consequently, diet. For
women, feeding is a highly complex construct that
is interwoven with the gendered expectations of
feeding responsibilities and caring for one’s family.
In widowhood, women lose or are relieved of the
meal-preparer and caregiver roles, which may alter
meanings associated with eating and food-related
activities. This paper explores how older women’s
experience with the gendered nature of foodwork
and feeding responsibilities affects food behaviour
in widowhood. Qualitative methods based on
constructivist grounded theory were used.
Interviews were conducted with 15 women living
alone in the community, aged 71 to 86 years, and
widowed six months to 15 years. All participants
described feeling obligated to meeting the
nutritional needs of their families and most were
responsible for the foodwork in their homes. Their
experience of this obligation to others impacted
personal eating and food behaviours in
widowhood. Women who were very focused on the
nutritional care of their families to the exclusion of
their own needs, had difficulty acknowledging and
accepting their needs and preferences as valid.
Other women were relieved to be free of the
burden of responsibility to others and easily
focused on their own needs. Encouraging women
to acknowledge and understand their food
preparer identities and develop new identities
based on current nutritional needs and preferences
and to align their behaviours accordingly may help
support women through this life transition.
P108
graduate programs were identified using AGHE
directories, student resource sites, and general
web searches, and interviews were conducted with
22/40 eligible Canadian and American universities.
The sample included all eligible Canadian
universities (n=8) and also 14 American
universities. Interviews were conducted by Skype,
telephone, or through an e-mailed questionnaire.
Supplementary data was also collected from
information available online. Our analysis covered
a number of areas such as target students,
culminating experience, work experience,
curriculum, marketing methods, etc. Certain
commonalities emerged among the graduate
programs, including: the diversity of students;
emphasis on interdisciplinary education; offering of
internship/practicum; shift from thesis to coursebased education; and research methods as a core
requirement. While there was significant diversity
among the Canadian programs, some interesting
differences emerged between Canadian and
American graduate programs in regards to
coursework, practicum/internship requirements,
and applied learning and professional development
components. While it was observed that American
universities have embraced applied education as
the way forward, Canadian universities will need to
decide what shifts need to be made in order to
meet the demands of the rapidly changing
Canadian context.
P109
L'utilisation de la question de Bergman-Paris
pour dépister les troubles cognitifs et l'atteinte
fonctionnelle chez les personnes âgées à
l'urgence
1
Gerontology Graduate Education in Canada: A
Review and Comparative Analysis
Laura Kadowaki, Andrew Wister, Barbara Mitchell
Simon Fraser University, British Columbia, Canada
Currently Canada is preparing for a massive and
rapid aging of the Canadian population which it is
expected will result in an increased demand for
students with advanced training in gerontology.
Limited research has been conducted on the state
of gerontology education in Canada, and this
paper provides a review of gerontology graduate
education in Canada and also comparative
analysis of Canadian and American gerontology
graduate programs. English language gerontology
2 ,1
3
Antoine Laguë , Marcel Émond , Raoul Daoust ,
2 ,1
4
Simon Berthelot , Mathieu Pelletier , Émilie
5
1
1
Gouin , Philippe Voyer , Valérie Boucher
1
2
Université Laval, Québec, Canada, CH de
3
Québec, Québec, Canada, Hôpital Sacré-Coeur,
4
Montréal, Canada, Centre Hospitalier régional de
5
Lanaudière, Joliette, Canada, Centre Hospitalier
régional de Trois-Rivière , Trois-Rivière, Canada
INTRODUCTION : Les atteintes cognitives chez
les patients âgés se présentant à l'urgence
passent souvent inaperçues. Il est impossible pour
les professionnels débordés d'effectuer une
évaluation cognitive complète pour tous les
patients. La Question de Bergman-Paris (QBP),
utilisée dans les cliniques de mémoire, pourrait
146
être un outil rapide pour cibler les patients ayant
besoin d'une évaluation plus poussée.
MÉTHODES : Ce projet est une sous-étude du
projet MIDI-INDEED, une étude prospective
multicentrique. Critères d'inclusion : ≥65 ans,
autonome ou semi-autonome, séjour de > 8 h à
l'urgence, demande d'admission et ne pas avoir
développé de délirium. Les patients étaient
évalués à l'urgence et 60 jours plus tard à l'aide
d'outils validés (TICS-m OARS, CAM). Lorsqu'un
proche était disponible, la QBP lui était demandée.
Une réponse négative suggère une atteinte
cognitive et/ou fonctionnelle. Des analyses
univariées et multivariées ont été effectuées.
RÉSULTATS : 167 réponses à la QBP sont
disponibles (126 non (75,5%) et 41 oui (24,5%)).
32.8% des personnes du groupe « non » ont un
TICS-m <31 comparativement à 14,3% pour le
groupe « oui » (p=0,2). Le score moyen de OARS
pour le groupe « non » est de 25,1 (3,9) et de 27,1
(1,3) pour le groupe « oui ». Le nombre de délirium
dans le groupe négatif est de 24 (18%)
comparativement à 2 (5%) pour le groupe positif.
CONCLUSION : La QBP pourrait être un outil
intéressant pour dépister les troubles cognitifs et
l'atteinte fonctionnelle. Une validation dans une
plus grande population est nécessaire.
P110
Adoption of new communication technology by
older adults: The teachers' perspective
Rebecca Judges, Clayo Laanemets, Anita Stern,
Ron Baecker
There are many barriers older adults’
communication technology use, so it is crucial to
improve our teaching methods for successful
adoption. 10 older adults were paired with 10
volunteer teachers to use an iPad communication
app called InTouch. The volunteers taught the
older adults how to use the app and supported
their learning at weekly sessions. Interviews with
the volunteer teachers took place at the beginning
and end of the study. While volunteers’
expectations were generally optimistic, pessimism
at the beginning of the study was accompanied by
less support from the volunteer throughout the
study and lower app proficiency exhibited by the
older adult participant. Volunteers discussed
teaching methods that worked particularly well,
including having the senior take short written notes
in their own words, practice and repetition, and
teaching skills in small chunks. Teacher
characteristics were also important, such as
providing encouragement and positive
reinforcement, being patient, and making sure the
senior feels equal to the teacher. Challenges were
reported due to some participants’ technology
anxiety, low motivation, and existing social
difficulties. When possible, the volunteers used the
reported successful teaching methods and social
skills to overcome these challenges. Volunteers
also overwhelmingly supported the idea using this
tool in health care settings and with personal
support workers. The results of this study have
implications for implementation in health care
settings, for formal teacher training in older adultfocused technology programs, and for the casual
teacher who is interested in supporting their older
family members and friends’ technology use.
P111
Development of a Decision Box to support
shared decision making with caregivers of
cognitively impaired seniors: a rapid literature
review of interventions
1 ,2
1
1
M.A. Lawani , V. Carnovale , A. Michaud , M.
2 ,4
1 ,3
1 ,3
2 ,5
Morin , F. Légaré , H. Witteman , P. Voyer ,
2 ,6
7
8
E. Kröger , C. Rodriguez , B. Martineau , B.
1
1 ,2
Valéra , A.M.C. Giguère
1
Laval University Department of family medicine
and emergency medicine, Quebec, Canada,
2
Quebec Excellence Center on Aging, Research
Centre of the CHU de Quebec, Quebec, Canada,
3
Research Centre of the CHU de Quebec, Quebec,
4
Canada, Laval University Department of medicine,
5
Quebec, Canada, Laval University Faculty of
6
Nursing, Quebec, Canada, Laval University
7
Faculty of Pharmacy, Quebec, Canada, McGill
University Department of Family medic, Montreal,
8
Canada, Sherbrooke university Department of
Family medicine and Emergency medicine,
Sherbrooke, Canada
Introduction: Choosing how best to reduce
caregiver burden emerged as a key unmet
decisional need in a Delphi survey of key
stakeholders about seniors with cognitive
impairment (CI).
147
Objectives: To quickly synthesize the evidence
needed to develop a Decision Box on interventions
to reduce caregiver burden.
Methods: We first identified secondary sources of
literature reporting interventions to reduce
caregiver burden: scientific summaries, clinical
practice guidelines, systematic reviews. After
extracting data from these sources, we conducted
a second search of primary studies to fill gaps in
the evidence. For inclusion, we prioritized
systematic reviews, followed by randomized
controlled trials (RCT), then other study designs.
We extracted study designs, sample sizes and the
probabilities of experiencing benefits/harms for
each intervention. A single reviewer conducted
literature search, study selection, extraction, and
quality assessment using the GRADE approach.
We converted all probabilities to absolute risk
reductions (ARR). This synthesis of evidence was
included in a Decision box, which was then
validated by three experts.
Results: From an initial list of 2916 citations, we
retained 14 reviews, two RCTs, and seven nonRCTs. We found reductions in caregiver burden
with psychoeducation (ARR=25%), meditation
(ARR=20%), cognitive-behavioral therapy
(ARR=18%), respite care (ARR=15%), support
groups (ARR=11%), and case management
(ARR=4%). Cognitive restructuring did not reduce
burden. Harms reported included worries and
anxiety potentially generated by interventions and
time required to participate in them.
Conclusion: Caregivers may benefit from this
Decision Box to make an informed choice about
whether or not to engage in interventions to reduce
their burden.
P112
Self-management in Community Dwelling Older
Adults with Multiple Chronic Conditions: A
Concept Analysis
Anna Garnett, Jenny Ploeg, Maureen Markle-Reid,
Patricia Strachan
Purpose. To analyze the concept of selfmanagement as it relates to community-living older
adults with multiple chronic conditions (MCC).
Background. The proportion of older adults living
with MCC is increasing globally. Chronic
conditions including cardiovascular disease,
diabetes and arthritis are influenced by modifiable
risk factors and health habits such as diet and
exercise. Self-management programs can be
important in affecting change in these modifiable
risk factors. Operationalizing the concept of selfmanagement to its full potential in the older adult
population with MCC will inform community nursing
practice and policies aimed at helping this
population to remain in their homes.
Design. Concept analysis
Data Sources. The search of electronic databases
included practice guidelines, journal articles and
hand searching of references. The review focused
on sources published between 2000-2016. Thirty
articles met inclusion criteria.
Methods. Walker and Avant’s methodology for
conducting a concept analysis guided this review.
Results. The concept of self-management in
community-living older adults with MCC includes
the attributes: financial self-sufficiency, available
social supports, psychological and emotional
responsiveness to MCC, ability and opportunity to
engage with the health system, and active
participation in chronic disease management; key
antecedents include: motivation, physical
capabilities to self-care, and health literacy; key
consequences include: improved psychological
outcomes, disease management outcomes, and
enhanced functional well-being.
Conclusions. In its application to communitydwelling older adults with MCC, the scope of
earlier definitions of self-management should be
adapted to address the unique context of this
population such as social isolation, limited financial
supports and potentially complex psychological
needs.
P113
“…And then of course we will involve the
community”: Lessons on meaningful
engagement of older adults in innovation
ecosystems
1
2
Heather McNeil , Josephine McMurray , Kerry
1
1
3
Byrne , Kelly Grindrod , Annette McKinnon , Paul
1
Stolee
148
1
2
University of Waterloo, Waterloo, Canada, Wilfrid
3
Laurier University, Waterloo, Canada, Canadian
Arthritis Patient Alliance, CAPA, Canada
Introduction: Health innovation offers potential
benefits for the well-being of older adults and
caregivers. Regional Innovation Ecosystems
(RIEs), involving a “triple helix” of industry,
government and academic stakeholders, have
been proposed to support development and
commercialization of new technologies and other
innovations. We sought to understand whether
older adults and caregivers contribute their
perspectives to RIEs, and how their role could be
enhanced.
Methods: Three-phase integrated mixed-methods
study, emphasizing stakeholder engagement:
Phase one - a scoping review on user engagement
in RIEs. Phase two – individual/focus group
interviews with older adults and caregivers (n=15),
and with representatives from university,
government, and industry (n=20). Following Kane
and Trochim’s (2007) Concept Mapping
methodology, phase three integrated themes into a
framework of priorities for engaging older adults
and caregivers.
Results: There is little meaningful involvement of
older adults and caregivers in RIEs. Enhancing
their involvement will require a recognition of the
need for diversity of older adult and caregiver
representation, consideration of barriers such as
system constraints and traditional partnerships,
and recognition of multiple roles that older adults
could play in health innovation.
Conclusion: Greater involvement of older adults
and caregivers in health innovation can result in
new technologies and processes that are more
likely to meet their needs and preferences. This
study identified directions and strategies for their
enhanced involvement in regional ecosystems for
health innovation. We are continuing to
collaborate with stakeholders from this project to
develop Canadian RIEs that can support the health
and well-being of older adults and caregivers.
1
2
Mario Pérez-Zepeda , María-Victoria Zunzunegui ,
2
3
Emmanuelle Belanger , Susan Phillips , Alban
4
5
Ylli , Jack Guralnik
1
Instituto Nacional de Geriatría, México, Mexico,
2
Université de Montréal, Quebec, Canada,
3
4
Queen´s University, Ontario, Canada, University
5
of Tirana, Tirana, Albania, University of Maryland,
Maryland, USA
Background. Few data exist that describe how
specific chronic diseases or multimorbidity are
responsible for physical decline in older adults.
Aim. To describe the association of individual
diseases and multimorbidity with physical
performance in older adults.
Methods. This was a secondary analysis of the
first and second waves of the International Mobility
in Aging Study. Older adults between 65 and 74
years old without cognitive impairment were
recruited in 2012 and followed-up in 2014. The
Short Physical Performance Battery was used, and
a score ≤8 was considered as low physical
performance. For the follow-up, older adults were
further categorized into incident/persistent low
physical performance and normal physical
performance groups. Individual chronic diseases
and multimorbidity were the independent
variables. Multimorbidity was categorized as
follows: 0-1 chronic diseases, no multimorbidity; 23 chronic diseases, low multimorbidity; and ≥ 4
chronic diseases, high multimorbidity. Logistic
regression was performed to examine the
associations between physical performance,
individual chronic diseases, and multimorbidity
using unadjusted and adjusted models.
Results. Of 1,785 older adults examined in 2012,
the prevalence of low physical performance was
21.4% (n=382). Regarding multimorbidity, 45.3%
of the total sample had no multimorbidity, 44.4%
had 2-3 low multimorbidity, and 10.2% had ≥4 high
multimorbidity. Low physical performance was
consistently associated with multimorbidity (except
Manizales); the highest adjusted odds ratio for high
multimorbidity was in Kingston (OR 4.68, 95% CI
1.48-14.8; p=0.008).
P114
Multimorbidity and Physical Performance,
Comparison Between Different Older Adult
Populations: Results from the International
Mobility in Aging Study
Discussion. An increasing need exists to include
multimorbidity in the assessment and intervention
of older adults.
P115
149
The Influence of Attrition and Adherence in
Falls Prevention Exercise for Communitydwelling Older Adults: A Systematic Review
and Meta-analysis
1
1
Oluwaseyi Osho , Susan Armijo-Olivo ,
2
Oluwatoyosi Owoeye
1
2
University of Calgary, Calgary, Alberta, Canada
Background Regular participation in exercise
program has been reported to lower fall risk.
However, adherence and attrition to exercise
program is a challenge in the community-dwelling
older adults. Knowledge of how adherence and
attrition levels in fall prevention exercise program
affect effect size can assist researchers in
developing experimental designs and can aid
clinicians in determining the feasibility of exercise
as an intervention for fall prevention in older adults.
Objective A review of evidence on how adherence
and attrition levels as well as intention to treat
analysis affect effect size of falls prevention
exercise programs in community-dwelling older
adults.
Method A systematic review and meta-analysis of
randomized controlled trial on falls prevention
exercise for older adults who were ambulatory,
community-dwelling older adults aged 65+ years
and did not have dementia. A total of 2,113
articles published between 2005 and January 2016
from six databases were retrieved.
Results Fifteen eligible studies, were reviewed.
Falls prevention exercise programs with adherence
level >70% showed a significant large effect size;
the overall effect; Z= 2.95 (p=0.003), risk
difference= -0.12, 95%CI [-0.20, -0.04], I² = 0%,
Tau² = 0.00; Chi² = 1.10, df = 2 (p = 0.58). Attrition
levels examined did not show any particular trends
on effect sizes.
Conclusion Researchers and clinicians may
consider adherence >70% in participants to be
able to observe true effect of a fall prevention
exercise program. Future studies should properly
report fallers and attrition to enable quality
evidence on the influence of attrition on falls
prevention exercise program.
P116
Artificial neural network and falls in
community-dwellers: a new approach to
identify the risk of recurrent falling?
Anastasiia Kabeshova, Olivier Beauchet
McGill University, Montreal, Québec, Canada
Background. Identification of the risk of recurrent
falls is complex in older adults. The aim of this
study was to examine the efficiency of three
artificial neural networks (ANNs: multilayer
perceptron [MLP], modified MLP and
neuroevolution of augmenting topologies [NEAT])
for the classification of recurrent fallers and nonrecurrent fallers using a set of clinical
characteristics corresponding to risk factors of falls
measured among community-dwelling older adults.
Methods. Based on a cross-sectional design,
3,289 community-dwelling volunteers aged 65 and
older were recruited. Age, gender, body mass
index (BMI), number of drugs daily taken, use of
psychoactive drugs, diphosphonate, calcium,
vitamin D supplements and walking aid, fear of
falling, distance vision score, Timed Up&Go (TUG)
score, lower-limb proprioception, handgrip
strength, depressive symptoms, cognitive
disorders and history of falls were recorded.
Participants were separated into 2 groups based
on the number of falls occurred over the past year:
≤ 1 fall and ≥ 2 falls. In addition, total population
was separated into training and testing subgroups
for ANNs analyzes.
Results. Among 3,289 participants, 18.9% (n=622)
were recurrent fallers. NEAT using 15 clinical
characteristics showed the best efficiency for
recurrent fallers identification: sensitivity (80.42%),
specificity (92.54%), positive predictive value
(84.38), negative predictive value (90.34),
accuracy (88.39) and Cohen’s kappa (0.74)
compared to MLP and modified MLP.
Conclusions. NEAT using a set of 15 clinical
characteristics was an efficient ANN for the
identification of recurrent fallers in older
community-dwellers.
P117
Implementing a Process of Risk-Stratified Care
Coordination for Older Adults in Primary Care
1
1
1 ,3
Jacobi Elliott , Paul Stolee , George Heckman ,
2 ,3
1
Veronique Boscart , Lora Giangregorio
1
150
2
Conestoga College, Kitchener, ON, Canada,
Schlegel-UW Research Institute for Aging,
3
BACKGROUND Primary health care may be the
best place within the health system to coordinate
care for older persons, but at present is poorly
equipped to do so. Recent reviews found that an
effective primary care model for complex patients
requires appropriate targeting, engagement of
patients and caregivers, and coordination with
other services. This project aimed to understand
the perceptions and experiences of providers,
patients and caregivers with implementation of
processes to achieve these aims.
METHODS The Chronic Care Model and a multilevel framework for implementation of health
innovations guided this study. Data collection and
analysis followed a developmental evaluation
approach. Data were collected using observations,
individual interviews, a risk-stratification tool and
tracking forms. Six patients, two family caregivers,
and 13 providers were purposefully sampled from
three primary care settings (rural and urban).
RESULTS Following implementation of a risk
screening tool and online referral mechanism, 560
patients were screened for level of risk, with care
coordinated based on level of need. Although the
screening and referral process took additional time
in a busy practice context, health care providers,
patients and caregivers identified many benefits.
These included early identification of service need,
greater awareness of community services
available, and improved relationships between
patients and providers.
CONCLUSION A process of risk-stratified care
coordination offers potential benefits for older
patients, caregivers and providers. However,
taking the time to have meaningful conversations
with patients was a challenge, and organizational
structures and funding models may need to be
modified to support fuller implementation.
P118
Psychosocial Needs within Nursing Homes:
Perspectives of Residents and their Family
Members
Julie Erickson, Malcolm Doupe, Corey Mackenzie
Background: There is a notable lack of research
identifying the psychological and social needs of
nursing home (NH) residents with dementia,
especially from the perspectives of residents and
their families. The objectives of this mixed methods
study were to (1) develop and validate a list of
psychosocial needs specific to NH residents with
dementia and (2) determine which needs on this
list are most important based on the reports of
family members.
Method: We used a comprehensive literature
review and one focus group with NH residents to
generate an initial list of psychosocial needs
informed by theory, research, and the experience
of residents. We then conducted three iterations of
a Delphi survey with n = 34 family members of NH
residents with dementia in Winnipeg to garner
consensus on the most important psychosocial
needs. For items to be included in each Delphi
iteration they must have been rated by at least
70% of respondents as being ‘important’ or
‘essential’ for residents’ mental health.
Results: A list of 16 psychosocial needs emerged
following the focus group and Delphi survey. The
needs were clustered into five categories of choice,
personal effectiveness, social connection,
pleasure, and self-acceptance. Comments from
family members underscored the importance of
opportunities for residents to exert control
whenever feasible as well as having warm and
responsive interactions with staff.
Discussion: By enhancing our understanding of
the psychosocial needs of NH residents, facilities
are better situated to provide care. Further
research examining psychosocial interventions for
NH settings is needed.
P119
Gender differences in the effect of lifetime
traumatic events on PTSD and quality of life
1 ,2
Catherine Lamoureux-Lamarche , Helen-Maria
1 ,2
Vasiliadis
1
Université de Sherbrooke, Longueuil, Canada,
2
Centre de Recherche - Hôpital Charles-Le Moyne,
Longueuil, Canada
Objectives : The aim of this study was to
determine the presence of gender differences in
the effect of lifetime traumatic events experienced
on PTSD and quality of life (QOL).
151
Method : Data retained came from a survey (20112013), which included 1,811 older adults (≥65
years) recruited in primary care clinics in the
province of Quebec. Lifetime traumatic events
were based on a list of 14 events. PTSD was
assessed using the Impact of Event ScaleRevised. QOL was measured with the EQ-5D-3L
and the Satisfaction With Life Scale (SWLS).
Multivariate logistic and linear regressions were
used to assess the impact of traumatic events on
PTSD and QOL.
Results: Results showed that for women, violence
(OR: 3,534) and the illness of a close person (OR:
2,119) were associated with the presence of
PTSD. For men, none of the traumatic events were
significantly associated with PTSD. A lower score
on the EQ-5D-3L was associated with the
experience of violence (β=-0,031), sexual abuse
(β=-0,043) and a natural disaster (β=-0,046) for
women. For men, violence (β=-0,044) was
associated with a lower QOL measured by the EQ5D-3L. For the SWLS, the experience of violence
(β=-5,603) and sexual abuse (β=-5,701) was
associated with lower QOL for women. For men,
the presence of a life-threatening disease (β=4,601) and sexual abuse (β=-6,442) was
associated with lower QOL measured by the
SWLS.
Conclusion: There are gender differences in the
traumatic events associated with PTSD and QOL.
Physicians should be aware of these differences
when diagnosed patients.
Cox regressions to identify variables we grouped
into categories of demographics, physical function,
cognition, disease, and self-complaints. A final
model combined the best predictors from each
category.
Results:This study included 1,112 participants
(62.6% female, 68.3% white) with a mean followup of 4.53 years (range:1 – 19 years). A total of 90
(8%) participants converted to aMCI. Average
follow-up time to aMCI was 5.1 years (SD = 3.5).
Characteristics at baseline showed that converters
were significantly older (mean = 79.6, SD = 5.9 vs.
mean = 77.7, SD = 5.2) and less educated (mean
= 12.8, SD = 3.1 vs mean = 13.6, SD = 3.6) than
non-converters. The final model included
protective factors (education: HR = 0.94, 95%CI =
1.05 – 1.14; gait velocity: HR = 0.98, 95%CI = 0.97
– 0.92; word-list recall: HR = 0.82, 95%CI = 0.73 –
0.93) and risk factors (age: HR = 1.09, 95%CI =
1.05 – 1.14; stroke: HR = 2.42, 95%CI = 1.38 –
4.46; memory complaints: HR = 2.53, 95%CI =
1.08 –5.59). We included these variables to
calculate risk scores.
Conclusion:Findings suggest that aMCI
converters present with a clinical profile closely
linked to Alzheimer’s disease, and one that is
easily assessed in primary care.
P121
Enabling Health Technology Innovation and
Adoption for Canadian Older Adults
1
P120
The risk profile of incident amnestic mild
cognitive impairment in community-dwelling
older adults
Andrea Zammit, Mindy Katz, Richard Lipton,
Charles Hall, Carol Derby
Albert Einstein College of Medicine, New York,
USA
Objectives:Our objectives were to identify a set of
variables that predict incident aMCI, and to
develop aMCI risk scores to help clinicians target
individuals at risk.
Methods:The Einstein Aging Study is a
longitudinal, community-based study of 70+ year
olds residing in Bronx County, NY. We fit separate
1
1
Maggie MacNeil , Melissa Koch , Ayse Kuspinar ,
2
1
Don Juzwishin , Paul Stolee
1
University of Waterloo , Waterloo, ON, Canada,
2
Alberta Health Services , Edmonton, AB, Canada
Objectives: Technological innovation offers many
potential benefits for the health of older persons,
but innovators often find it challenging to navigate
healthcare policy and regulatory systems in
multiple Canadian jurisdictions. This study
analyzes a set of interviews with policymakers and
stakeholders in the field of health innovation policy
in Canada on what is working well, and what
barriers exist to enabling health technologies for
older adults.
Methods: This study is part of Aging Gracefully
Across Environments Using Technology for
Wellness, Engagement and Long Life (AGEWELL), a Canadian Network of Centres of
152
Excellence. A scoping review of peer-reviewed and
grey literature using health and technology-related
databases was conducted. Literature review
findings were complemented by approximately 25
semi-structured interviews with[SP1]policy-makers,
and other stakeholders. Interviews were
transcribed and analyzed inductively using line-byline coding completed by two independent
researchers using NVivo11.
Results: Opportunities and challenges reflecting
different stages of the innovation process were
identified: research and development, regulation,
health technology assessment, and
commercialization/reimbursement. To facilitate
these processes, innovators are encouraged to
communicate early in the development process
with health system decision-makers, to engage
them as partners in evidence generation and as
potential payers.
Conclusions: This research has yielded insights
into how policy-makers and other stakeholders
view the innovation process for health technologies
pertinent to older adults. These results reveal an
opportunity for enhanced collaboration among
clinicians, innovators and health care systems to
facilitate faster adoption of health technologies for
older adults.
enhanced in relational ways that align with culture
change principles. This paper draws on data from
a two-year participatory action research study that
brought residents, family members, and staff
together within a LTC home to explore meanings
of resident wellness and develop a wellness
framework that could guide practice decisions.
Data from multiple sources suggest four key
markers of wellness including: a well home, well
relationships, personal well-being, and activities for
living well. What our shared reflective descriptions
revealed was two-fold: (1) resident wellness
demands a relational approach to care; and (2)
conceptualisations of resident wellness serve to
scaffold care practices towards the manifestation
of culture change values in LTC homes. Linking
the four interconnected areas of well LTC home
experiences with relational theory, this paper
provides practical examples to demonstrate how a
focus on wellness can forward culture change in
LTC, relationally enhance wellness, and enrich the
lives of all in LTC homes.
P123
Les TIC comme outil de transfert de
connaissance vers le client et ses proches :
réflexion sur les impacts potentiels d'une
approche centrée sur le client
1 ,2
P122
Relationally speaking: Focusing on wellness to
forward culture change journeys in Canadian
LTC homes
2 ,3
1 ,2
Kimberly Lopez , Sherry Dupuis
1
2
Partnerships in Dementia Care Alliance, Waterloo,
3
ON, Canada, Aging, Health, and Well-being
Interdisciplinary Program, University of Waterloo,
The culture change movement in long-term care
(LTC) homes is steadily gaining momentum across
Canada. The movement focuses on transforming
the medical/institutional culture within LTC settings
to one that embraces relational caring principles
and supports living life to the fullest. Instead of
viewing LTC homes as places of death and dying,
a relational approach nurtures living and wellness.
Thus, understanding wellness from residents’
perspectives is important, not only for shedding
light on what is needed to support resident
wellness, but also for providing insight into how the
wellness of entire LTC home communities can be
1 ,2
3 ,4
V Chenel , C Auger , M Guay
1
École de réadaptation, Faculté de médecine,
2
Université de Montréal, Montréal, Canada, Centre
de recherche interdisciplinaire en réadaptation du
Montréal métropolitain (CRIR), Montréal, Canada,
3
École de réadaptation, Faculté de médecine et
des sciences de la santé, Université de
4
Sherbrooke, Sherbrooke, Canada, Centre de
recherche sur le vieillissement de Sherbrooke
(CDRV), Sherbrooke, Canada
Les modèles hiérarchisant les niveaux d'expertise
en santé illustrent souvent le partage des rôles et
des savoirs au sein de l'équipe par une pyramide,
où les niveaux supérieurs possèdent des rôles et
des savoirs plus approfondis. En contexte de
rareté des ressources, des pressions s'exerçant
entre ces frontières mènent au transfert de rôles et
de savoirs assumés par un groupe vers un autre
ne possédant pas d'acquis équivalents (formation
ou autonomie professionnelle). Cette
hiérarchisation de l'expertise se concentre
généralement sur le potentiel d'action des
intervenants et s'attarde peu au client et à ses
proches. Or, l'augmentation des demandes de
consultation reliées au maintien à domicile des
153
aînés invite à une réorganisation de la disponibilité
de l'information chez cette clientèle. Les
technologies de l'information et de la
communication ouvrent de nouvelles perspectives
de transfert des connaissances et de nouveaux
moyens d'intervention (aides à la décision,
systèmes experts). Ces possibilités suggèrent de
revoir la représentation de l'expertise afin d'y
intégrer ces acteurs. L'objectif de cette réflexion
est d'explorer les impacts potentiels de l'intégration
des aînés et de leurs proches dans la pyramide
hiérarchique de l'expertise en santé. L'approche
centrée sur l'expertise du spécialiste est
décortiquée afin d'en extraire les caractéristiques
principales. Ces caractéristiques sont ensuite
comparées à celles d'une approche centrée sur le
client afin d'en faire émerger les impacts potentiels
sur les interventions en santé. Ces pistes de
réflexion contribueront à élaborer des approches
de transfert de connaissances impliquant
davantage le client et ses proches dans les
processus décisionnels.
P124
Social Isolation and Loneliness in Chinese
Older Adults: A Scoping Review for AgeFriendly Community Planning
1
1
1
M. Anum Syed , Lynn McDonald , Corinne Smirle ,
1
1
2 ,3
Karen Lau , Raza Mirza , Sander Hitzig
1
Institute for Life Course & Aging-Factor-Inwentash
Faculty of Social Work, University of Toronto,
2
Toronto, Canada, St-John’s Rehab Research
Program, Sunnybrook Research Institute,
Sunnybrook Health Sciences Centre, Toronto,
3
Canada, York University, Faculty of Health,
School of Kinesiology and Health Science,
4
Toronto, Canada, University Health Network,
Toronto Rehabilitation Institute, Toronto, Canada
Objective: Social isolation and loneliness is a
health and social problem in Chinese older adults
but there is a lack of consensus on what
contributes to social disconnectedness in this
population. To address this gap, a scoping review
was conducted to summarize what is known about
loneliness and social isolation in Chinese older
adults living in western societies.
Methods: Using a scoping review methodology,
both the peer-reviewed (Ageline, CINAHL, Social
Sciences Abstracts, MedLine, PsychINFO, ASSIA,
Canadian Research Index, Social Services
Abstracts, Sociological Abstracts, Social Work
Abstracts, and JSTOR) and grey literature
(Proquest Theses and Dissertations databases,
Canadian Public Policy Collection, Canadian
Health Research Collection, NIH, OpenGrey) was
searched. Two independent reviewers selected
relevant abstracts for inclusion, which were then
categorized by using the World Health
Organization (WHO)'s Age-Friendly Communities
(AFC) framework.
Results: Six hundred and eighty seven abstracts
were identified, with 19 studies meeting the
inclusion criteria. In terms of AFC dimensions,
social participation themes were salient in the
literature (n = 15 studies) whereas civic
participation and employment (n=2) and
transportation (n=2) dimensions were limited.
Across studies, a lack of positive social support
and social networks was the most significant risk
factor.
Conclusions: Additional research is needed to
identify risk factors contributing to social isolation
and loneliness in older Chinese adults in order to
develop effective interventions. The results
suggest that social network structures, Chinese
dialect-speaking health professionals and
knowledge of Chinese cultural values are
important considerations for informing policy and
practice responses aimed at this issue.
P125
Aging without place in hidden homelessness:
Stories of older northern Ontario women
Annie Boucher
Laurentian University, Sudbury Ontario, Canada
Homelessness is recognized as a crisis in Canada,
yet little is known about the experience of older
adults ageing in hidden homelessness. Persons
who are homeless experience accelerated ageing
and become elders at by the age 45 - 50. A
narrative inquiry study was conducted to
understand the life stories of older women who had
experienced hidden homelessness within the past
year in one city in northern Ontario. They were
asked about the meanings they attribute to home,
homelessness, life challenges and health. A dual
theoretical lens of post-colonial feminism and TwoEyed Seeing was selected. Serial interviews were
conducted with nine women ages 50 and over,
who had experienced hidden homelessness within
the past year. Data were analyzed using a Voice
Centered Relational Approach resulting in poems
describing their experiences and the meanings
154
they had. Thematic analysis identified common
perceptions and the complex interactions among
gender, northern place, and health. Their ‘silent
scream' captures the overall meaning of living in
hidden homelessness. Their stories of aging
without place, in hidden homelessness, are
captured by "I Poems" and themes including:
‘silent scream,' ‘hanging by a thread,' and 'finding
me.' Their strengths in response to poverty and
health challenges demonstrate resilience. The
findings have implications for inter-disciplinary
practice, future research, and policy development
(222 words).
southern Labrador’s natural and cultural
landscapes for diverse leisure and subsistence
activities as a key contributor to well-being as they
aged.
Conclusions: This research draws attention to the
importance of the natural environment and
traditional subsistence practices in aiding southern
Inuit people to age well. Based on these findings
there is a need to develop culturally-safe supports
and services which allow southern Inuit people to
age in place.
P127
P126
Spaces, places, and transitions: Southern
Labrador Inuit perspectives of aging well
1 ,2
Jessica Pace
1
McMaster University, Hamilton, Ontario, Canada,
2
Gilbrea Centre for Studies in Aging, Hamilton,
Ontario, Canada
Objectives: Historical, social and political
determinants put Indigenous people at high risk for
experiencing poor health as they age. These
challenges can be accentuated in remote
communities with limited healthcare services. This
community-based, participatory Photovoice project
seeks to understand southern Labrador Inuit
perceptions of transitions into aging and dementia
with the key goal of illuminating issues related to
prevention, help-seeking and services use in this
setting.
Successful Aging Meets Romance:
Examination of Older Adults’ SelfRepresentation in Online Dating Profiles
1
2
Mineko Wada , Ben Mortenson , Laura Hurd
2
Clarke
1
Gerontology Research Centre - Simon Fraser
2
University , Vancouver, BC, Canada, The
Canada
Objective: This study examines how relevant
Rowe and Kahn’s (1997) three criteria of
successful aging—(1) low probability of disease
and disability, (2) high functioning, and (3) active
life engagement—were to older adults’ selfportrayals in online dating profiles. In addition, it
explores how self-representations vary by older
adults’ age, gender, race/ethnicity, and intersecting
categories of these.
Method: Southern Inuit older adults and caregivers
in southern Labrador were provided with digital
cameras and asked to take photographs to portray
their understandings of aging well, dementia, and
caregiving. Participants were encouraged to
document aging-related strengths and challenges
in their community. Resultant photographs were
used to evoke stories and experiences from each
participant during in-depth, semi-structured
interviews.
Method: In this cross-sectional study, 320 online
dating profiles of older adults (aged 60+) were
randomly selected from Plenty of Fish, stratified
based on the adults’ age, gender, and ethnicity
("Asian," "Black," "Caucasian," and "Native
American" as per the categories used on the site).
We coded the profiles based on Rowe and Kahn’s
criteria. Logistic regression analyses determined
whether age, gender, and race/ethnicity predicted
how the adults presented themselves.
Results: Participant photographs depicted highly
nuanced representations of southern Inuit lived
experiences of aging, including the salience of
place, culture, family and community. Participants
identified challenges associated with the
remoteness of their community in terms of access
to healthcare and services. However, they
expressed a strong desire to age in place, citing
the importance of continued engagement with
Results: Few profiles referred to Rowe and Kahn’s
first two criteria. However, the third criterion was
identified in many profiles. Native Americans were
significantly less likely than other racial/ethnic
groups to highlight the first and second criteria.
Younger age predicted presentation of the first
criterion. Women’s presentation of the third
criterion remained significantly high with age.
155
Conclusions: The findings suggest that Rowe and
Kahn’s first two criteria of successful aging may
either be unimportant to older adults when seeking
partners, or reflect that those criteria are
unachievable. The relatively high proportions of
profiles that referred to the third criterion may attest
to the higher rates of activity among older adults or
the importance given to social engagement in
Western culture.
Conclusions: The use of statistical tests to assess
baseline imbalances in epidemiologic studies can
mislead rather than inform. This is cause for
concern given that findings based on this
inappropriate practice may result in motivating
further research or in making policy decisions.
Reporting guidelines for epidemiologic studies
need to be updated to discourage baseline testing
and emphasize the selection of adjustment
variables at the design stage.
P128
P129
Pitfalls of testing for baseline imbalances in
epidemiologic studies
1 ,2
3
1 ,2
Nadia Sourial , Tibor Schuster , Isabelle Vedel
1
2
Montreal, Quebec, Canada, Lady Davis Institute,
Jewish General Hospital, Montreal, Quebec,
3
Canada, Murdoch Childrens Research Institute,
Royal Children’s Hospital, Melbourne, Victoria,
Australia
Context: Statistical tests are often conducted in
epidemiologic studies to assess imbalances in
baseline characteristics between intervention and
control groups. Characteristics found to be
significantly imbalanced are then included in the
adjusted statistical models. Although this practice
is pervasive, it has been shown to lead to biased
study results. Guidelines for epidemiologic studies
have yet to address this issue.
Objectives: To shed light on the potential biases
caused by baseline testing and provide
recommendations for future guidelines.
Methods: Review of current practices and
guidelines in epidemiologic studies specific to
testing baseline imbalances.
Findings: This review found that adjusting models
based on observed baseline differences found to
be statistically significant can introduce rather than
remove bias. This can occur when variables that
are imbalanced at baseline - but are not
associated with the outcome - are introduced into
the statistical models. Conversely, not adjusting
the models for baseline variables which appear
balanced could create a bias if they are strong
prognostic factors. Experts recommend that
adjustment variables should be chosen at the
design stage of the study based on available
evidence of known prognostic factors.
Impacts of technology (adoption) on
successful aging within the Social context
1 ,2
Mina Sedaghatjou
1
Simon Fraser University, Vancouver, Canada,
2
Douglas College, Vancouver, Canada
Studies showed that technology is an enabler that
keeps older adults active and engage in the
society and their daily online and offline activities,
create and maintain social networks or build
community of interests, especially if they are less
mobile and unable to leave their home normally.
However, there are number of hurdles that seniors
face to adopt new technologies such as physical
difficulties (e.g.: disability, handicap, chronic
disease); developmental disabilities (i.e: sensory
lose and impairments); sceptical attitudes and
device ownership habits (Smith 2014). In addition,
financial resource and affordability, training about
usefulness of technology and earlier life
experience (e.g., education and work experiences)
may relate to technology adoption impacts, and
more importantly the mechanism of using
technology on successful aging is unclear yet
(Devaraj, 2008). So, in this study we adopt
“Activity theory” of Havighurst (1961) to investigate
impacts of using technology on successful aging in
general; and to identify successful strategies that
accelerate the adoption and reduce barriers of
using technologies that improve the ability of older
adults to remain in the social community. For this
“explanatory mix method” study mentally and
physically healthy older adults aged 55 and older
participate to avoid bio-physco meddler variable.
P130
Mistreatment and Bullying experienced by
older adults: a systematic literature review
1 ,2
1 ,2
C.P. Pelletier , M.B. Beaulieu
1
University of Sherbrooke, Sherbrooke, Québec,
156
2
Canada, Research Chair on Mistreatment of Older
3
Adults, Sherbrooke, Québec, Canada, Research
Centre on Aging, CIUSSS de l'Estrie-CHUS,
Sherbrooke, Québec, Canada
Goal: This paper aims to present the results of a
systematic review looking at older adults
experience of assistance (received or not) after
they realized being mistreated or bullied.
Method: Systematic review of English literature
(2011-2016) on hinderers and facilitators to
reporting mistreatment or bullying. In process:
systemic review of French literature. Steps: 1)
keywords identification (a) English:
denunciation/denouncement/reporting/disclosure/r
evelation; abuse/violence/
mistreatment/neglect/bullying/ageisme;
elder/older/aged/senior/older people; b) French :
personnes aînées/personnes
âgées/aînés/vieux/vieillards;
signalement/dénonciation/révélation;
maltraitance/négligence/violence/intimidation/sévic
es; 2) Inclusion (data collection must include older
adults voices) and exclusion criteria (hinderers or
facilitators from professionals, public policy or legal
point of view); 3) selection of computerised data
banks; 4) Inventory of relevant titles according to
keywords; 5) Inter-judge validation on abstracts; 6)
analysis of articles.
Results: English data banks: total (n) = 2514 and
final(n) = 15 articles. Progress: English data banks
work is almost completed while in French data
banks, we are at step 4. The majority of deleted
articles don't addressing mistreatment or bullying
from an older adults point of view.
Discussion/ conclusion: Many authors and
experts identify hinderers or facilitators for older
adults but seldom are the studies presenting
voices of older adults on the issue. This finding
justifies a doctoral thesis focussing on these
voices.
P131
A critical integrative review of the social
determinants of health in multimorbidity
Melissa Northwood, Jenny Ploeg, Maureen MarkleReid, Diana Sherifali
Objectives: Multimorbidity (MM) is most commonly
defined as the presence of two or more physical or
mental health conditions where one is not more
central than others. This definition does not
consider the influence of social, educational,
cultural, and economic circumstances on the
experience of having MM. The purpose of this
integrative review is to examine how these social
determinants of health have been considered as
dimensions of MM.
Methods: An integrative review methodology was
used with a critical feminist framework
(intersectionality) as the theoretical driver. The
review steps included: (a) literature search of a
variety of computerized databases from 2000 to
2015; (b) quality appraisal; (c) qualitative data
analysis processes of data extraction, coding, and
theme development; and (d) synthesis.
Results: Twenty-one documents were included: 2
reviews; 13 quantitative studies; 4 qualitative
studies; and 2 grey literature reports. Overall, very
little attention was paid to social determinants.
Age, sex, education, and socioeconomic status
were most commonly considered but only as
proportional descriptions of the samples, not as
modifiers of MM. Diversity within these categories
was not explored (for example, older women of
different cultural groups).
Conclusions: The dominant conceptualization of
MM does not consider differences among older
adults, such as ethnicity, race, and geography.
Consequently, health care practice, research and
policy evidenced from this literature could
inadvertently disadvantage those most burdened
with MM by ignoring care implications for different
groups. Future research is necessary to identify
the variations amongst older adults with MM
beyond disease presence.
P132
What is known about technologies to detect
falls? A scoping review
1 ,2
3
3 ,4
N Lapierre , N Neubauer , A Miguel-Cruz , A
3 ,4
3
1 ,2
Rios Rincon , L Liu , J Rousseau
1
2
Canada, Centre de recherche de l'Institut
Universitaire de gériatrie de Montréal, Montréal,
3
Québec, Canada, University of Alberta,
4
Edmonton, Alberta, Canada, Universidad del
Rosario, Bogotá, Colombia
157
Objective. With the demographic aging, falls have
become a major health issue: 30% of the elderly
fall each year, which leads to disastrous
consequences (e.g. loss of independence)(WHO,
2015). Scholars and industry have developed
technologies, but no review reports them
exhaustively. This study aims to examine the
extent and the type of technologies developed to
detect falls.
Methods. The scoping review followed Daudt et al.
(2013)methodology. Three databases were
searched (Medline, CINAHL and Embase).
Included sources were peer-review articles,
conference papers, and books along with
documents from the grey literature written either in
English, French or Spanish published from 2006 to
2016. Documents about low tech assistive
technologies related to fall (e.g.: walkers) were
excluded. A grid was developed for data
extraction.
Results. A total of 2023 references were found;
then, to select documents selection criteria were
applied. The types of technologies reported could
be classified into three categories: 1) fixed
systems, 2) wearable devices and 3) ambient
technologies. Many studies about prototypes and
the technical aspects of the technology, mainly
experiments in laboratories, were found. Few
scientific literature reported studies in the “real
settings” with the “real users” (e.g. the elderly in
home setting).
Conclusion. Few technologies have been tested
with older adults at risk of falls in real-life
situations. Thus, the readiness of these
technologies still needs to be tested. Research on
technology needs to be more oriented on userbased environment in order to validate
technologies and identify the impact of these
technologies in older adults’ lives.
Objective: Examine associations between selfreported urinary incontinence and pelvic organ
prolapse with physical performance in elderly
women from a multisite study.
Methods: Cross-sectional study of 870 older
women (65-74 years-old) from (Kingston and St.
Hyacinthe) Canada, (Tirana) Albania, (Natal) Brazil
and (Manizales) Colombia. Current pelvic organ
prolapse (yes or no) and episodes of urinary
incontinence in the past week (none, once or more
than once) were collected through a self-reported
questionnaire. The Short Physical Performance
Battery was used to objectively measure physical
performance. Adjusting for age, education, parity,
and study site, we used linear regression models
to examine the association of pelvic organ
prolapse and urinary incontinence to SPPB.
Results: 23.1% of the sample reported urinary
incontinence in the past week (10.6% just one
episode/week, 12.5% more than once/week) and
8.7% reported pelvic organ prolapse. Compared to
the women who reported more than one weekly
episode of urinary incontinence, those reporting no
urine loss or just one episode had higher mean
SPPB scores (β=0.87, p<0.01; β=0.83, p=0.<0.01,
respectively), indicating better physical
performance. Those with pelvic prolapse had lower
mean SPPB scores than those without prolapse (0.45, p=0.07). Notably, those reporting that the
prolapse bothered them considerably performed
dramatically worse on the SPPB (-1.85, p<0.01).
Conclusion: Urinary incontinence and pelvic
organ prolapse are associated to worse objective
measures of physical performance in older women.
These conditions may influence women's ability to
complete the physical performance tests, with
implications for their abilities to complete other
tasks important to daily functioning.
P134
P133
Physical performance is associated to urinary
incontinence and pelvic organ prolapse in
older adult women: Analysis from the
International Mobility in Aging Study (IMIAS)
1
1
Ingrid Azevedo , Saionara Câmara , Mayle
1
1
2
Moreira , Luana Cortez , Nicole Rosendaal ,
2
Catherine Pirkle
1
Universidade Federal do Rio Grande do Norte,
2
Natal, Rio Grande do Norte, Brazil, University of
Hawai'i, Honolulu, Hawai'i, USA
Are Inappropriate Social Behaviours of
Persons with Alzheimer's Disease Associated
with Caregivers' Health-related Quality of Life?
1
1
Mingying Fang , Mark Oremus , Jean-Eric
2
2
Tarride , Parminder Raina
1
2
To examine whether inappropriate social
behaviours of persons with Alzheimer’s disease
158
(PwAD) are associated with the health-related
quality of life (HRQoL) of caregivers.
We administered the EQ-5D-3L and its visual
analogue scale (VAS) to the primary informal
caregivers of 216 persons with mild or moderate
AD. The caregivers completed the Dementia
Behaviour Disturbance Scale and rated the extent
to which PwAD exhibited each of 10 inappropriate
social behaviours (‘never’ to ‘all of the time’).
Behaviours included actions such as verbal
abuse, screaming for no reason, and crying or
laughing inappropriately. We transformed EQ-5D3L responses into health utility scores using
Canadian preference weights. In separate
multivariable Ordinary Least Squares regression
models, we regressed these scores and the VAS
on the presence or absence of each behaviour,
caregiver age and gender, and PwAD disease
severity.
Complete data were available for 213 caregivers
(mean age 64.5 years, 139 [65%] female, 145
[68%] spousal; 171 [80%] caring for PwAD with
mild disease). Two PwAD behaviours significantly
affected caregivers’ HRQoL. Mean health utility
scores were lower when PwAD dressed
inappropriately (mean reduction = -0.036 [95% CI
= -0.067 to -0.004]); mean VAS scores were lower
when PwAD screamed for no reason (mean
reduction = -9.025 [95% CI = -16.848 to -1.202]).
Most inappropriate behaviours were not associated
with caregivers’ HRQoL. Some caregivers may
have adapted to the behaviours, many behaviours
may have been absent because most PwAD had
mild disease, and the measures of HRQoL may
have been insensitive to small changes in
behavioural frequency.
A Discharge Link Meeting to Improve
Transitional Care for Stroke Survivors
1
Methods: We describe implementation of the
model in a health region in Southern Ontario.
Evaluation feedback was obtained from hospital
and community providers to understand their
experience with the program and its impact on
transitional care and inter-provider communication.
Results: DLMs were initiated at five acute and
rehabilitation hospitals, and involved a community
therapist who meets with the stroke survivor and
hospital team prior to hospital discharge. Patient
goals and the plan of care are reviewed at the
meeting. The same community therapist then visits
the patient at home within 48 hours of discharge.
Evaluation results suggest that a DLM supports a
successful transition from hospital to home by
removing duplication in assessments and new care
plans. The new practice also improved
communication and trust between hospital and
community providers.
Conclusions: The DLM is a promising transition
management model. Future research should
assess the feasibility of the model in other settings,
and its impact on experiences and outcomes of
stroke survivors.
P136
General Health Perception Can Be Used to Plan
Health Services For Vulnerable Seniors
Sabrina M Figueiredo, Alicia Rosenzveig, Jose A.
Morais, Nancy E. Mayo
McGill University, Montreal, QC, Canada
P135
1
hospital to home are a Canadian stroke care best
practice aimed at improved continuity of care,
patient experience, and outcomes. As part of a
regional community stroke rehabilitation program,
we implemented and evaluated a Discharge Link
Meeting (DLM) to improve transitions from hospital
to home.
1
Paul Stolee , George Heckman , Arsalan Afzal ,
2
Dana Khan
1
2
Waterloo Wellington Community Care Access
Centre, Waterloo, Canada
Background: Communication between healthcare
providers is often a challenge for older stroke
survivors transitioning across care settings.
Supported and coordinated patient transitions from
Objectives: to estimate whether self-reported
health can be used as an indicator of service
needs among seniors.
Methods: Cross-sectional survey. Age and sex
adjusted logistic regression was used to estimate
the link between functional status indicators and
fair or poor self-reported health. Backward stepwise logistic regression was performed to identify
the best predictive model of service needs.
Positive predictive value (PPV), sensitivity and
159
specificity were calculated to identify whether
health perception could be used to identify people
in need of physical rehabilitation services.
Results: 142 seniors agreed to answer the survey
yielding a response rate of 73%. Among the
respondents (mean age 79±7; 60% women), 40%
rated their health as fair or poor. Seniors
perceiving their health as fair or poor had higher
odds of reporting impairments, activity limitations,
and participation restrictions (OR ranging from 2.37
95%CI 1.03-5-45 to 12.22 95%CI 2.68-55.78) in
comparison to those perceiving their health as
good or better. The most significant predictors of
service needs were community ambulation,
household tasks, fatigue, and pain with 92%
sensitivity and a maximum adjusted R-squared of
0.65. Self-rated health used as single-item showed
a positive predictive value (PPV) of 1, sensitivity of
52%, and specificity of 100%.
Conclusion: Our results indicate that all seniors
reporting fair or poor health have indicators of
need for further rehabilitation services. This
question may be an alternate way of querying
about need as many older persons are afraid to
report disability because of fear of further
institutionalization.
P137
The Roles of Home Health Aides in Preventing
Pressure Ulcers among the Elderly Receiving
Home Care: A Scoping Literature Review
Munira Sultana, Aleksandra Zecevic, Lorie Donelle
Objective: The purpose of this literature review
was to explore the role of home health aides
(HHAs) in pressure ulcers (PUs) prevention among
the elderly receiving home care.
Method: A scoping review was conducted
following a methodological framework described by
Levac and colleagues (2010). Key words search of
11 databases produced 616 relevant sources.
After removing duplicates, adding hand searches,
and applying inclusion and exclusion criteria, 12
sources were selected for review. They included
two government reports, two international best
practice guidelines, one text book and seven peerreviewed journal articles. The documents were
charted and analyzed using a descriptive summary
analysis and qualitative content analysis.
Result: The majority (eight) of the sources were
from US and Canada and were published after
2010.Three were systematic reviews and one was
performance measurement report. Four themes
emerged as follows: education and training of
HHAs; nature of relationship between HHAs,
patient and family; the assistive role of HHAs; and
beliefs of HHAs about their role in PUs prevention.
Overall, it was recognized the HHAs do have a role
in an inter-disciplinary health care team, but there
was no clarity on specifics of their involvement,
particularly in Canadian health care context.
Conclusion: This scoping literature review
identified the need to clarify the HHAs role in a
health care team providing PUs prevention in
home care. The OCAR (Observation, Coach,
Assist and Report) framework proposed by Giosa
and colleagues in 2015 could be recommended for
integration and optimization of HHAs role in PU
prevention.
P138
Screening of cognitive disorders in aging via
smart homes: A literature review
1
2
2
ML Lavoie , ML Lussier , MM Morakabati , GP
2
1
1
3
Paquette , JM Macoir , CH Hudon , MG Guay , LT
3
3
3
4
Talbot , HP Pigot , SG Giroux , CC Consel , SA
5
3
6
7
Adam , DL Lorrain , FL Langlois , BG Gilbert , HI
6
2
Imbeault , NB Bier
1
2
Université Laval, Québec, Canada, Université de
3
Montréal, Montréal, Canada, Université de
4
Sherbrooke, Sherbrooke, Canada, Université de
5
Bordeaux, Bordeaux, France, Université de Liège,
6
Liège, Belgium, CSSS-Institut universitaire de
gériatrie de Sherbrooke, Sherbrooke, Canada,
7
Montréal, Canada
Introduction: The aging of the world population is
a reality that is likely to be accompanied by a
substantial increase in elderly with dementia. New
tools will have to be developed to screen quickly
cognitive disorders and allow early intervention. In
this context, smart home has many attractive
advantages, including taking continuous
measurements in the living environment of the
elderly.
Objective: The aim of this study is to investigate
the effectiveness of smart homes for early
screening of cognitive disorders in the elderly.
160
Methods: The databases Medline, EMBASE,
CINAHL, PsycINFO, Proquest and Web of Science
were screened as well as the grey literature.
Results: Seven studies of two different
experimental designs were included in the present
review: time series (n=6) and cross-sectional
(n=1). These have used, among other things,
motion sensors for taking measures of various
indicators of cognitive disorders, such as walking
speed and performance in the activities of daily
living. Various indicators of cognitive disorders
allowed to highlight statistically significant
differences between elderly with and without mild
cognitive impairment.
Discussion: Despite technologic limitations, the
smart home has an interesting potential for early
screening of cognitive disorders in the elderly.
Other studies will be needed to explore the clinical
relevance of smart environments.
P139
Implantation d'un programme de promotion de
la santé offert par des pairs dans des
résidences pour aînés : Résultats préliminaires
1 ,2
2
Agathe Lorthios-Guilledroit , Johanne Filiatrault
,3
4 ,5
, Lucie Richard
1
École de santé publique, Université de Montréal,
2
Montréal, Canada, Centre de recherche de
l'Institut universitaire de gériatrie de Montréal,
3
Montréal, Canada, École de réadaptation, Faculté
de médecine, Université de Montréal, Montréal,
4
Canada, Faculté des sciences infirmières,
5
Université de Montréal, Montréal, Canada, Institut
de recherche en santé publique de l'Université de
Montréal, Montréal, Canada
Contexte: Le recours à des pairs pour animer des
programmes de promotion de la santé des aînés
(PPSA) s'avère prometteur. Or, les conditions
optimales de l'implantation des PPSA sont peu
connues. Des travaux théoriques suggèrent que
les déterminants de l'implantation comprennent
des facteurs liés au programme, aux participants,
aux intervenants et au contexte
organisationnel/communautaire. Cette étude de
cas vise à valider empiriquement un modèle
théorique des déterminants de l'implantation du
programme Vivre en Équilibre, un PPSA animé par
des pairs lié à la prévention des chutes.
Méthode: L'étude implique six résidences pour
aînés sises dans trois territoires du Québec. La
fidélité d'implantation et la réponse des participants
sont évaluées à l'aide de journaux de bord et de
grilles d'observation. Les déterminants de
l'implantation sont documentés au moyen
d'entrevues menées auprès de participants (n=24),
des animateurs (n=6) et des répondants des
résidences (n=6).
Résultats: L'analyse préliminaire des résultats
dans deux résidences révèle que le programme a
été implanté fidèlement et que la réponse des
participants a été positive. De façon générale, les
déterminants du succès d'implantation sont
cohérents avec le modèle théorique guidant
l'étude. La qualité des interactions entre les
personnes impliquées dans l'implantation du
programme émerge toutefois des données
empiriques comme un facteur additionnel à
considérer dans le modèle explicatif.
Conclusion: Les résultats de cette étude
contribueront à la validation du modèle théorique,
voire, à sa bonification dans le contexte des PPSA.
Cette étude contribuera au développement des
connaissances sur les conditions optimales
d'implantation des PPSA offerts par des pairs.
P140
What do we know about technologies for
wandering? A scoping review
1
2
Noelannah Neubaur , Nolwenn Lapierre , Adriana
1 ,3
1 ,3
M. Rios-Rincon , Antonio Miguel-Cruz ,
2
1
Jacqueline Rousseau , Lili Liu
1
2
3
Universidad del Rosario, Bogotá, Colombia
Objectives: Wandering is a common behavior
among older adults with dementia. More than 60%
of these individuals wonder and become lost
(Alzheimer’s Association, 2016). Technological
interventions may help in the management of
wandering, however, no review has examined
what types of technologies are being used to
reduce the risks of wandering. The purpose of this
scoping review was to examine the range and
extent of technologies used to manage wandering
behavior in persons with dementia.
Method: Articles were identified through searches
of four electronic databases, and were included if
161
they addressed: wandering in older adults and
technology use in home or supportive care
environments for older adults living with dementia
regardless of whether the technology was
embedded in the building structure or was worn on
a person. Technologies could be lower or higher
complexity, and supported independence and
considered adverse outcomes associated with
wandering. A grey literature search through google
was also explored.
Methods: Luminance intensity (Lux) and color
temperature (Kelvin) preferences were assessed
using the LuxIQ in 40 patients (ages 67-96) with
low vision (VA 20/30-20/458). Participants were
asked to adjust the intensity to the level they would
find most comfortable while reading, whereby color
temperature was fixed. They then had to adjust the
color temperature to their preferred level. Finally,
they had to re-verify the intensity level. The entire
procedure was repeated 30 minutes later.
Results: 29 articles met the selection criteria.
Technological interventions ranged from
commercial home alarm and monitoring products
to mobile locator devices. Benefits included
reductions in caregiving burden and increased
independence and safety of persons with
dementia.
Results: Using Bland-Altman plots, the 95% limits
of agreement (LoA) of inter-test difference scores
were calculated. For luminance intensity, the LoAs
were -1864 to 1605, -597 to 857 and -416 to 437
Lux for AMD, Glaucoma and other diagnostic
categories, respectively. For colour temperature,
the LoAs were -907 to 1278, -632 to 632 and -228
to 594 Kelvin, respectively.
Conclusion: The scoping review revealed four
themes: (1) there is a general acceptance that
technologies can reduce risks of wandering, (2)
ethical issues need to be addressed, (3)
technologies should be affordable and available,
and (4) research is needed to identify technologies
with high levels of evidence for effectiveness and
usability.
Conclusions: Test re-test variability is similar
across the 3 diagnostic groups, indicating that the
test is suitable for all patients. However, the size of
the variability warrants further investigation to
determine if controlled ambient illumination can
improve the variability ranges.
P142
P141
Wearable technology in detecting caregiver
stress in informal caregivers of older adults
with dementia
The LuxIQ: Test re-test reliability of a
standardized lighting assessment in older
adults with low vision
1
1
2
1
1 ,3
MC Lorenzini , L St-Amour , W Seiple , J Jarry ,
1 ,3
W Wittich
1
School of Optometry , University of Montreal,
2
Montreal, QC, Canada, Lighthouse Guild, New
3
York, NY, USA, Centre de recherche
interdisciplinaire en réadaptation du Montréal
métropolitain, Montreal, QC, Canada
Purpose: Optimal lighting is an essential
component of reading rehabilitation for older adults
with age-related vision loss. The LuxIQ
assessment tool provides a new opportunity for
systematic evaluation of lighting needs; however,
to date, this tool has not been evaluated for its
ability to provide consistent and repeatable data.
The goal of this study was to compare test re-test
variability for luminance and color temperature
preferences according to three diagnostic
categories of age-related eye diseases.
1
K Madara Marasinghe , John Hirdes , Sandra
2
2
McKay , Kathy Sidhu
1
2
University of Waterloo, Waterloo, Canada, VHA
Home Healthcare, Toronto, Canada
Introduction: Family caregivers are critical to the
health and support of older people living at home.
While Canadians are willing take on the informal
caregiver role, caregiving duties have
consequences that affect caregivers' work and
health.1 Recent advances in information
technology provide opportunities to recognize
stressful activities and roles so that best strategies
to reduce caregiver stress and enhance caregivers'
quality of life can be identified. The aim of the
study is to detect caregiver stress using wearable
devices among informal caregivers of older adults
with dementia.
Methods: Participants include 30 dyads of informal
caregivers and care recipients with dementia. Each
caregiver and care recipient with mild, moderate or
162
severe dementia are provided with a wearable
device and their activity levels are monitored for a
period of one week. Three types of data will be
collected: (1) clinical signs of dementia by using
the interRAI Home Care (HC) assessment; (2)
caregiver distress levels by using the interRAI
caregiver survey; and (3) activity data collected
with the wearable devices such as steps taken
during the day, heart rate and sleep disturbance.
Results: Data collected by the interRAI HC,
interRAI caregiver survey and wearable devices
will be linked and analyzed to identify trends in
activity levels of the informal caregiver and care
recipient to examine any associations between
patterns of movement and caregiver stress.
Conclusion: Conclusion is to be provided after the
study has been completed.
P143
Senior Toronto Oncology Panel - Research
participation for older adults with cancer and
family members/caregiver
1
Results: The majority of the older adults and their
caregivers have never participated in research
before. The majority are willing to be a research
team member and be involved in all steps of
research if it could benefit them or future patients
and caregivers. Flexibility in time and location,
accessibility to computer technology, transportation
support, material translation and short training
sessions, as well as peer support are some of the
important factors to take into consideration when
having them on the research team.
Conclusion: our study showed that older adults
are very willing to participate and be research team
members but have often not been invited. The
social aspect of being on a team is important and
teams should take that into account.
References
1.Cranswick K, Dosman D. Eldercare: What we
know today: Statistics Canada, 2008.
1
Method: Public meetings and focus groups were
conducted to explore research priorities and to
discuss their support needs in order to be able to
participate as research team members. Attendees
were then invited to join our participant pool to
collaborate on development of a research study
together.
1
Schroder Sattar , Martine Puts , Takami Fossat ,
1 ,3
4
3
Margaret Fitch , Tina Hsu , Ewa Szumacher ,
1
1 ,3
Geraldine Macdonald , Barbara Liu , Lianne
5
1 ,6
1
Jeffs , Jennifer Jones , Kathy McGilton , Sharon
1 ,5
1 ,2
Straus , Shabbir Alibhai
1
2
University Health Network, Toronto, Ontario,
3
Canada, Sunnybrook Health Sciences Centre,
4
Toronto, Ontario, Canada, Ottawa Hospital
5
Cancer Centre, Ottawa, Ontario, Canada, St.
Michael's Hospital, Toronto, Ontario, Canada,
6
Canada
Objective: Older adults are frequently
underrepresented in clinical cancer research.
More patient engagement in research may lead to
more relevant data to help improve health
outcomes. The objectives of this study are: 1) to
understand the research priorities of older adults
with cancer and their caregivers; 2) to examine
how we can engage this population research; and
3) to examine how we can support them in
becoming co-researchers in future research
projects.
P144
Metabolic syndrome (MetS) and associated
factors in middle aged women: A crosssectional study in Northeast Brazil
1
2
1
Mayle Moreira , Afshin Vafaei , Saionara Câmara ,
1
1
Rafaela Nascimento , Mariana Vieira , Maria
3
1
Victoria Zunzunegui , Álvaro Maciel
1
2
Natal, Rio Grande do Norte, Brazil, Queen’s
3
University, Kingston, Ontario, Canada, Université
de Montréal, Montreal, Québec, Canada
Objective: To determine the prevalence of MetS
and its indicators, and to identify the associated
factors in middle-aged women in Northeast Brazil.
Methods: A cross-sectional study of 419 women
aged 40 to 65 years from Parnamirim, Rio Grande
do Norte, Brazil. MetS was defined by the
presence of at least three of the following
indicators: waist circumference >88 cm (as a
measure for obesity), fasting glucose ≥110mg/dL,
triglycerides ≥150mg/dL, high density lipoprotein
(HDL) cholesterol <50mg/dL, and blood pressure
≥130/85mmHg. Socio-demographic variables,
menopausal status, reproductive history, estradiol,
life style, physical activity, anthropometrics and
163
body composition measures, quality of life, and
physical performance were considered as potential
associated factors. We constructed multivariate
Poisson regression models to estimate the
prevalence ratios (PR) for MetS with 95%
confidence intervals (CI) and thus to identify
significant associated factors.
constructed linear regression models to assess the
impacts of urinary incontinence and pelvic organ
prolapse on the indicators of physical performance,
adjusting for age, education, family income, body
mass index, and lifetime parity.
Results: 275 (65.6%) cases met the criteria of
MetS. The three most prevalent indicators were
obesity (73.5%), reduced HDL (63.0%), and
elevated blood pressure (60.9%). In final adjusted
models, black race (PR 1.34, 95%CI: 1.11-1.63),
lower grip strength/BMI (PR 1.32, CI: 1.15-1.50),
worse quality of life (PR 1.20, 95%CI: 1.03-1.40),
low levels of estradiol (PR 1.16, 95%CI: 1.00-1.34)
and surprisingly, more walking (PR 1.16, 95%CI:
1.01-1.34) were significantly associated with MetS.
Results: Mean age of participants was 52 (SD =
5.6) years and the prevalence rates of urinary
incontinence and pelvic organ prolapse were 7.2%
and 17.7%; respectively. According to our fully
adjusted models, for women who reported urinary
incontinence, on average, it took almost one
second longer to complete the chair stand test
(β=0.923; p=0.046). Compared to healthy women,
those with pelvic organ prolapse performed worse
in the open-eyed balance test and the time they
could hold their balance was on average 2.5
seconds shorter (β=-2.467; p=0.031).
Conclusions: The prevalence of MetS in this
sample was higher than other reports. One reason
maybe the low socio-economic status of our
participants. More walking remained related to
higher prevalence of MetS; however, the direction
of this relationship remains to be examined in
future longitudinal studies.
Conclusion: Urinary incontinence and pelvic
organ prolapse are associated to worse physical
performance in middle-aged women from
Northeast Brazil. This novel study highlights that
these conditions may lead to a difficulty in
performing daily activities, which are important for
preventing mobility decline.
P145
P146
Urinary incontinence, pelvic organ prolapse
and physical performance in middle-aged
women from Northeast Brazil
The Challenge of Meeting the Health Care
Needs of Older Adults: A Retrospective Chart
Review
1
1
Mariana Vieira , Saionara Câmara , Mayle
1
2
3
Moreira , Catherine Pirkle , Afshin Vafaei , Rafaela
1
1
Nascimento , Álvaro Maciel
1
2
Natal, Rio Grande do Norte, Brazil, University of
3
Hawai’i-Mãnoa, Honolulu, Havai'i, USA, Queen’s
University, Kingston, Ontario, Canada
Objective: To examine relationships between
urinary incontinence and pelvic organ prolapse and
objective measures of physical performance in a
low-income sample of middle-aged women from
Northeast Brazil.
Methods: A cross-sectional study of 361 women
aged between 40 to 65 years old living in
Parnamirim, RN, Brazil. Urinary incontinence and
pelvic organ prolapse were measured via selfreported questions. Physical performance
indicators (gait speed, chair stand test, standing
balance tests with open and closed eyes) were
evaluated objectively by the interviewers. We
1
Victoria John
1
York University, Toronto, Ontario, Canada,
2
Laurentian University, Sudbury, Ontario, Canada
As the older adults of Ontario go through the
phases of aging, some might experience functional
deficiency and loss of independence in Activities of
Daily Living (ADL). With rehabilitation and
facilitation of essential health services, older adults
will have tremendous opportunities in the pursuit of
self-sufficiency and functional independence. The
current study focused on detailing a quick-paced
rehabilitation program provided to older adults in
northeastern Ontario. The program of interest was
the Assess-Restore program provided by the St.
Joseph’s Continuing Care Centre (SJCCC) in
Sudbury, Ontario. The study involved a
retrospective chart review of 144 patients treated in
the past four years, which facilitated the
examination of patient charts, as well as the
extraction and analysis of their functional status
and capabilities prior to admission (PTA) and at
discharge. Data were extracted from the Resident
164
Assessment Instrument-Minimum Data Set Version
2.0 (RAI-MDS), which is part of the
“PointClickCare” system. Although the study did
not find significant changes in the level of
functionality and self-sufficiency, it succeeded in
effectively promoting functional restoration allowing
the majority of patients to return to a level of
independence in the community and avert
subsequent need for residential care rather than
risk further functional deterioration.
P147
Developing and evaluating an innovative social
geriatric medicine service in Québec city
1
2
S Lemire , E Proteau-Dupont
1
2
Québec, Québec, Canada, École nationale
d'administration publique, Québec, Canada
Elderly care in the community is an important
component of healthcare delivery, especially for
disabled or homebound individuals. Although
integration is an important aspect of health service
organisation in that context, there is currently no
consensus on how best to improve function and
quality of life of the elderly in the community. Our
aim is to develop a complex intervention tailored to
this population with special needs and
demonstrate its efficiency. The principles guiding
the effort are: a holistic, biopsychosocial approach
anchored in the community surrounding the
elderly; interdisciplinary, collaborative care
provided in the community setting with home care
delivery as the convergence point; a flat structure
avoiding duplications of professional input; risk
management respecting the individual’s selfdetermination right. To develop the interventions
further, normalisation process theory will guide the
qualitative method used and focus groups will be
conducted. The intervention will be refined
depending on this input. Once the complex
intervention is mature, there will be an evaluation
phase following a quasi-experimental approach.
Important dimensions will concern population
effectiveness, productivity, accessibility, global
nature and satisfaction. At the end of the project,
an innovative complex intervention will have been
developed and evaluated and will be disseminated.
P148
A scoping review of Interventions to prevent or
reduce the level of frailty in communitydwelling older adults
1
1
2
Samar Toubasi , Martine Puts , Esther Atkinson ,
3
4
Ana Patricia Ayala , Melissa K. Andrew , Maureen
5
6
7
C. Ashe , Howard Bergman , Jenny Ploeg ,
1 ,8
Katherine S. McGilton
1
2
University of Toronto, Toronto, Canada, Institute
for the History and Philosophy of Science and
Technology, University of Toronto, Toronto,
3
Canada, Gerstein Information Science Centre,
University of Toronto libraries, University of
4
Toronto, Toronto, Canada, Division of Geriatric
Medicine, Dalhousie University, Halifax, Canada,
5
Department of Family Medicine, University of
British Columbia, Vancouver, Canada,
6
7
Montreal, Canada, School of Nursing, McMaster
8
University, Hamilton, Canada, Toronto
Rehabilitation Institute, University Health Network,
Toronto, Canada
Objectives: Currently, there is no overview of
available interventions to prevent or reduce the
level of frailty which will help health care providers
in community settings caring for older adults. We
will address this gap by reviewing interventions
and international policies that are designed to
prevent or reduce the level of frailty in communitydwelling older adults.
Methods and analysis: We will conduct a scoping
review using the updated guidelines of Arksey and
O’Malley to systematically search the peerreviewed journal articles to identify interventions
that aimed to prevent or reduce the level of frailty.
All types of original studies in community-dwelling
patients aged 65 and provided a measure of frailty
(as defined by study’s authors) before and after the
implemented intervention are eligible. The
databases searched included Cochrane Central
Register of Controlled Trials, Cochrane Effective
Practice and Organisation of Care Group,
MEDLINE, EMBASE, Cumulative Index to Nursing
and Allied Health, Allied and Complementary
Medicine, Psych INFO, Ageline, Sociological
Abstracts, Web of Science, Applied Social
Sciences Index and Abstracts, Database of
Abstracts of Reviews of Effects. We will search
gray literature for international policies. The quality
of included studies will be assessed with the Mixed
Methods Appraisal Tool.
Results: the review is currently in process. Over
12,000 abstracts have been screened, and 14
studies have been included. The final results will
be presented at the conference.
165
Conclusion. Our review will summarize the
evidence with regard to interventions aimed at
preventing or reducing frailty and will highlight the
gaps in this knowledge.
P149
Postural Balance in Individuals with Central
Vision Loss
1
1
Caitlin Murphy , David Nguyen-Tri , Rand
2
1
1 ,2
Allabade , Jocelyn Faubert , Olga Overbury
1
2
University of Montreal, Montreal, Canada, Lady
Davis Institute for Medical Research, Montreal,
Canada
Vision is an important aspect of balance, but
central and peripheral vision may play different
roles. Individuals with Age-related Macular
Degeneration lose their central vision causing
them to rely more on their peripheral vision. This
research explores how central vision loss affects
control of posture. Participants eyes were tested
and their balance abilities evaluated using
traditional measures and a virtual environment.
Current results show that central vision loss may
impair balance according to traditional measures,
but may be irrelevant in maintaining postural
control.
P150
Resilience in older age: Socioeconomic
indicators and sociobehavioural mediators of
high mental wellbeing despite low physical
capability
Theodore Cosco, Rachel Cooper, Diana Kuh, Mai
Stafford
MRC Unit for Lifelong Health and Ageing, London,
UK
BACKGROUND When presented with challenges
that accompany ageing, such as reduced physical
capability, some individuals respond more
positively than others, maintaining higher levels of
wellbeing than expected, i.e. are resilient. Although
socioeconomic advantage is positively associated
with individual (internal) and external resources
that promote resilience in some contexts, the
relationship between socioeconomic position
(SEP) and resilience as defined above is not
known.
OBJECTIVES To examine the relationship
between SEP and resilience, i.e. maintaining high
wellbeing despite low physical capability, and to
assess the degree to which social support and
physical activity mediate this relationship.
METHODS Participant data at age 60-64 came
from the MRC National Survey of Health and
Development, a nationally representative birth
cohort study (n=1756). Resilience was
operationalised as having a greater than expected
level of wellbeing, captured by the WarwickEdinburgh Mental Well-being Scale (WEMWBS),
given one's level of performance-based physical
capability, assessed using grip strength, chair rise,
standing balance, and timed-up-and-go tests. The
degree of resilience was quantified as the
difference between observed and predicted
WEMWBS score, i.e. residual values, for physical
capability using linear regression. SEP was
assessed by participants' occupational status
class. Structural equation models were used to
assess mediation of SEP and resilience by social
support and physical activity
RESULTS Greater resilience was demonstrated in
individuals with higher occupational social class.
Physical activity, but not social support, mediated
the relationship between SEP and resilience.
CONCLUSIONS These results show that higher
SEP was associated with this type of resilience,
and is partly mediated by behavioural factors.
P151
Delirium prevention in the emergency
department using regional anaesthesia with
ultrasound guidance in the elderly population
with hip fracture: A pilot study
1 ,2
1 ,3
Pierre-Alexandre LeBlanc , Marcel Émond ,
2 ,3
1 ,3
Valerie Boucher , Jacob Courtemanche ,
1 ,2
Michel Ménessa
1
Département de médecine familiale et médecine
d’urgence, Université Laval, Quebec City, QC,
2
Canada, Axe santé des populations et pratiques
optimales en santé, Centre de recherche du CHU
3
de Québec, Quebec City, QC, Canada, Centre
d'excellence sur le vieillissement de Québec
(CEVQ), Quebec City, QC, Canada
Introduction We propose the use of femoral block
with ultrasound guidance in the management of
the elderly population with hip fracture in the
emergency department (ED) to reduce the risk of
delirium and the use of opiates.
166
Methods This descriptive pilot paired case-control
study, was conducted, from December 2013 to
April 2015, in CHU de Québec. Patients in both
groups were paired by age. Inclusion criteria:
Patients with (1) hip fracture; (2) admitted to the
hospital; (3) and surgically repaired. Exclusion
criteria: Patients with (1) delirium upon arrival or a
unknown mental/cognitive status; (2) less than 60
years old (3) no English or French comprehension.
Intervention group: Patients who received femoral
blocks by the five trained emergency physicians
with ultrasound guidance. Control group: Patients
who received standard pain control care by
emergency physicians and who didn't not received
a femoral block.
Analysis Incidence of delirium were noted. A
comparison of absolute pain reduction at 30
minutes at rest and mobilization was also done.
Odd ratios were derived and adjusted.
Results A total of 29 femoral blocks were
performed. A 30 minute absolute pain reduction of
3/10 at rest and at mobilization was noted. Need
for rescue medication was needed for 7% of
patients. Adjusted odd ratios revealed no decrease
in delirium.
Conclusion No significant difference in the
incidence of delirium was noted. A Canadian
prospective study «EDU-RAPID» is underway to
demonstrate the impact of regional anaesthesia
under ultrasound guidance on the incidence of
delirium in elderly patients with hip fracture.
P152
Effect of a combined physical and cognitive
training on spontaneous walking speed in older
adults
1 ,2
2
Kristell Pothier , Christine Gagnon , Maxime
2
2 ,3
Lussier , Laurence Desjardins-Crépeau , Nicolas
2 ,4
1
5
Berryman , Karen Z.H. Li , Laurent Bosquet ,
2 ,6
6
Marie-Jeanne Kergoat , Thien T.M. Vu , Louis
1 ,2
Bherer
1
PERFORM Centre and Psychology Department,
2
Concordia University, Montreal, Canada, Centre
de recherche de l’Institut Universitaire de Gériatrie
de Montréal, Laboratoire d’étude de la santé
cognitive des aînés (LESCA), Montreal, Canada,
3
Département de Psychologie, Université du
4
Québec à Montréal, Montreal, Canada, Sport
Studies Department, Bishop’s University,
5
Sherbrooke, Canada, Faculté des sciences du
sport, Université de Poitiers, Poitiers, France,
6
Centre hospitalier de l'Université de Montréal
(CHUM), Montreal, Canada
Recent literature tends to support that the
combination of physical exercise with another
activity (such as cognitive training) could boost
health markers in the elderly to a greater extent
than exercise or cognitive training alone. However,
the effect of these combined interventions on
spontaneous walking speed, known to be an
important indicator of older adults' health, has not
clearly been demonstrated yet. Thus, the objective
of the present study was to evaluate the potential
synergetic effect of a 12-week combined training
on spontaneous walking speed.
Eighty-seven community-dwelling older adults
completed this study comparing four different
training programs: 1/a combined aerobic and
cognitive (dual-task) training (AE+COG, n=26),
2/an aerobic training with computer lessons (AE,
n=20), 3/a cognitive training with stretching (COG,
n=23), 4/stretching with computer lessons as a
control group (n=18). Training sessions were held
three times per week during three months. Both
physical fitness - including a measurement of
spontaneous walking speed during 30 seconds and cognitive functions were assessed before and
after the intervention.
Both COG and AE interventions led to
improvements in dual-task performance and
cardiovascular fitness, respectively, confirming the
efficiency of these training programs. Results also
showed an improvement of spontaneous walking
speed in all groups except for the control group.
Surprisingly, the AE+COG, AE and COG
interventions showed equivalent improvement in
spontaneous walking speed, our variable of
interest.
These findings suggest that the combination of
physical and cognitive trainings do improve
mobility of older adults, but do not exert a
synergetic effect.
P153
Anticholinergic drug use by generally healthy
older adults is not associated with clinically
significant changes in quality of life
1 ,2
1 ,2
Benoit Cossette , Maimouna Bagna , Modou
2
1
1 ,2
Sene , Samuel Laroche , Hélène Payette
1
Faculty of Medicine and Health Sciences,
2
Canada, Research Centre on Aging, Centre
intégré universitaire de santé et de services
sociaux de l’Estrie – Centre hospitalier universitaire
167
de Sherbrooke, Sherbrooke, Québec, Canada,
3
Department of Pharmacy, Centre intégré
universitaire de santé et de services sociaux de
l’Estrie – Centre hospitalier universitaire de
Background: The use of drugs with anticholinergic
(AC) properties has been associated with
decreased functioning and impaired cognition in
older adults.
Objectives: To evaluate the impact of AC-drugs
on the quality of life (QoL) of community-dwelling
older adults.
Methods: The NuAge prospective cohort study
enrolled 1793 participants aged 68-82, free of
disabilities in ADL and not cognitively impaired,
who were followed annually for 3 years. AC-drug
exposure was evaluated by the Anticholinergic
Cognitive Burden Scale (ACBS). QoL was
assessed using the physical (PCS) and mental
(MCS) component summaries of the SF-36
questionnaire. The association between AC-drug
and QoL was determined by a mixed model
analysis.
Results: At enrollment the mean age was 74, 52%
were female. The mean PCS and MCS (/100)
scores were 48.0 and 54.6 respectively. The ACBS
score ranged from 0 to 9, with 67%, 24% and 9%
of participants with scores of 0, 1-2 and 3+
respectively. In the mixed model analysis, an
increase of 1 on the ACBS scale was associated
with a decrease of β=-0.14 (p=0.31) on the PCS
scale with a significant decrease with time {β=0.28,(p<0.01)} and time*ACBS {β=-0.14,(p=0.03)}.
A decrease in PCS was associated with
increasing: age (β=-0.16), number of diseases (β=1.19), depression (β=-0.21), frailty (β=-1.03) and
female gender (β=-1.60), p<0.01 for all
associations. The ACBS score was not associated
with the MCS.
Conclusions: In a cohort of generally healthy
community-dwelling older adults, AC-drug
exposure was not associated with a clinically
significant decrease in QoL, measured by the SF36 PCS or MCS.
P154
Knowledge translation strategy to reduce the
use of potentially inappropriate medications in
elderly inpatients
1 ,3
3
Benoit Cossette , Josée Bergeron , Geneviève
1 ,9
1 ,9
Ricard , Jean-François Éthier , Thomas Joly1 ,3
5 ,6
2
Mischlich , Mitchell Levine , Modou Sene ,
7
1 ,9
2
Louise Mallet , Luc Lanthier , Hélène Payette ,
8
9
Marie-Claude Rodrigue , Serge Brazeau
1
Faculty of Medicine and Health Sciences,
Université de Sherbrooke, Sherbrooke, QC,
2
Canada, Research Centre on Aging, Centre
sociaux de l’Estrie – Centre hospitalier universitaire
de Sherbrooke, Sherbrooke, QC, Canada,
3
Department of Pharmacy, Centre intégré
universitaire de santé et de services sociaux de
l’Estrie – Centre hospitalier universitaire de
4
Sherbrooke, Sherbrooke, QC, Canada, Research
center of the Centre de recherche du Centre
hospitalier universitaire de Sherbrooke, Centre
sociaux de l’Estrie – Centre hospitalier universitair,
5
Sherbrooke, QC, Canada, Department of Clinical
Epidemiology and Biostatistics, McMaster
6
University, Hamilton, ON, Canada, Programs for
Assessment of Technology in Health (PATH),
Research Institute of St. Joseph’s Hamilton,
7
Hamilton, ON, Canada, Faculty of Pharmacy,
8
Direction of Nursing, Centre intégré universitaire
de santé et de services sociaux de l’Estrie –
Centre hospitalier universitaire de Sherbrooke,
9
Sherbrooke, QC, Canada, Department of
Medicine, Centre intégré universitaire de santé et
de services sociaux de l’Estrie – Centre hospitalier
universitaire de Sherbrooke, Sherbrooke, QC,
Canada
Background: Potentially inappropriate
medications (PIM) continue to be prescribed to
elderly inpatients despite evidence that the risks
may outweigh the benefits.
Objective: To evaluate the impact of a knowledge
translation (KT) strategy on PIM use in elderly
inpatients.
Methods: Inpatients 75 years and older
discharged from a teaching hospital in 2013-14
were included. The KT strategy comprises the
distribution of educational materials, presentations
by geriatricians, pharmacist-physician interventions
based on alerts from a Computerized Alert System
(CAS), and comprehensive geriatric assessments.
The impact of the KT strategy on PIM use was
determined by a segmented regression analysis of
an Interrupted Time Series (ITS).
168
Results: For 8 622 patients with 14,071
admissions, a total of 145,061 patient-days were
analysed. The mean age was 83.3 years and
54.5% were women. The median length of stay
was 7 days. One or more PIM were prescribed on
28,776 (19.8%) patient-days; a higher rate was
found for patients aged 75-84 years (24.0%) than
for 85 and older (14.4%) (p<0.01), and in women
(20.8%) than in men (18.6%) (p<0.01). The drug
classes most frequently accounting for the PIM
were gastro-intestinal agents (21%), anithistamines
(18%), and antidepressants (17%). The regression
analysis showed a significant decrease of 3.5%
(p<0.01) of patient-days with at least one PIM
immediately after the intervention.
Conclusion: We described a KT strategy that
resulted in a decreased use of PIM in elderly
inpatients. Additional interventions will be
implemented to maintain or further reduce PIM
use.
P155
Understanding the burden experienced by
caregivers of older adults who use power
mobility
1 ,5
Method: This cross-sectional study used the
Power Mobility Caregiver Assistive Technology
Outcome Measure (PM-CATOM) to assess
caregivers’ wheelchair-specific and overall burden.
We also measured the caregiver’s wheelchair skills
(WST-Q), frequency of and perceived limitations in
their life activity (LLDI), anxiety and depression
(HADS) and social support (ISEL) and then
correlated it with the burden scores. Results:
Participants were 35 caregivers, mostly women,
ranging in age from 32 to 85 years old and
providing at least 1 hour of care/week for a PWC
user aged 50 years or older. Both the wheelchairrelated and overall burden scores were positively
and strongly correlated with perceived limitations in
daily activities, and negatively moderately with
anxiety and depression scores. The overall score
was positively and moderately associated with
perceived social support.
Conclusion: These results show that the
caregivers’ PWC-related and overall burden is
associated with mental health as well as
participation issues. These results have
implications for the type of resources required to
support informal caregivers.
2 ,6
Delphine Labbé , Paula W. Rushton , Louise
2 ,4
3
1 ,5
Demers , Lee Kirby , Ben Mortenson , William
1 ,5
C. Miller
1
2
Columbia, Canada, Université de Montréal,
3
Montréal, Québec, Canada, Dalhousie University,
4
Halifax, Nova Scotia, Canada, Centre de
recherche de l’institut universitaire de gériatrie de
5
Montréal, Montréal, Québec, Canada, GF strong
Rehabilitation Center Research Lab, Vancouver,
6
British Columbia, Canada, 2 CHU Sainte-Justine
Research Center, Montréal, Québec, Canada
Background: Power wheelchairs (PWCs) are
commonly used to support the mobility of older
adults with significant mobility disability. Despite
their benefits, the PWCs users often require
assistance from informal caregivers to get around.
Few studies have focused on the impact of PWCs
on caregivers, with mixed results. While PWCs
may increase caregivers’ sense of freedom and
independence and decrease their physical burden,
they may also limit their participation in community
activities.
Objective: To describe the association between
PWCs, overall caregiver burden and other
caregiver outcomes.
P156
Using Mobile Technology with Residents to
Support Communication in Long-term
Residential Care: An Exploratory Concept
Mapping Study
1 ,2
2
Rozanne Wilson , Jeff Small
1
Trinity Western University, Langley, British
2
Columbia, Canada, University of British Columbia,
Vancouver, British Columbia, Canada
Frail elderly living in long-term residential care
(LTRC) have chronic conditions and complex care
needs that can have a major impact on social
participation. Communication breakdowns
between care staff and residents may lead to
unmet care needs and social isolation for
residents. Mobile communication technology
(MCT) (e.g., smartphone, tablet) and their software
applications (apps) may be an innovative solution
to overcome communication difficulties by
supporting everyday communication during daily
activities (e.g., self-care, interpersonal
relationships). However, little is known about the
ways care staff could use MCT and their apps with
residents. This study explored care staffs’
169
perspectives around the use of MCT to support
everyday communication with residents. Concept
mapping (CM) method (qualitative/quantitative)
was used, which involved three stages:
brainstorming and item generation using in-person
focus groups (n = 12); sorting and rating of items
(n = 7), and data analysis (multidimensional
scaling, cluster analysis). Sorting and rating of
generated items was completed off-line or online.
Sixty-seven items were generated during the
brainstorming sessions. Preliminary analysis of the
sorted and rated items produced a visual map with
eight clusters representing the ways the MCT
could be used to support everyday communication.
Clusters representing general communication,
entertaining residents, knowing the resident better,
providing instructions, overcoming language
barriers, and games for cognitive health were rated
most useful, while the overcoming language
barriers cluster was rated most practical. This
study demonstrates that it is possible to use CM
with care staff to identify ways that technology
could be used to support caregiver-resident
communication.
P157
Association between pain and nutritional risk
in the elderly: A NuAge cohort study
1 ,2
1
Maimouna Bagna , Olivier Germain , Guillaume
1 ,2
1 ,2
1 ,2
Léonard , Hélène Payette , Alan Cohen
1
2
Canada, Research Centre on Aging,
Sherbrooke/Québec, Canada
Introduction: Pain is a very common condition in
the elderly that may have a major impact on their
quality of life. The epidemiology of pain is still
poorly understood in seniors, particularly its
relationship to nutritional risk, another risk factor for
several diseases and even mortality in this
population.
Objectives: This study focuses on the link
between pain and nutritional risk among 1783
older adults aged 68 to 82 from the NuAge cohort
study.
Methodology: Linear regression analyses and
mixed models (4 measurement times) were used
to study the link between pain (SF-36 Bodily Pain
index (BP), inverted score (100-BP)) and nutritional
risk (Elderly Nutrition Screening score, ENS (0-13)
and their trajectories over time.
Results: At baseline, nutritional risk was
significantly and positively associated with reported
pain (β = 1.7; P=0.0028). Similarly, when the
categorized nutritional risk score changes from
"low" (0-2) to "moderate" (3-5) or "high" (6-13), the
level of pain increases (β=5.95 ; P=0.0008 and
β=9,22 ; P=0.0.02, respectively). All the results
were adjusted with sex, depression, BMI and
number of medication in use. This significant
relationship was observed at T1, T3 and T4 of
measurement but not at T2. Using the mixed
models, we observed that the effect of nutrition
score was constant across time (ENS*time: β=
0.12, p=0.42).
Discussion: Pain and nutritional risk were
significantly associated but our results did not
show time interaction of pain and nutritional risk.
Further studies are therefore needed to better
understand the strength and direction of this
association.
P158
Perspectives of frail elderly living in long-term
residential care on the Veterans Rand Health
Survey (VR-12): Use of cognitive interviews to
refine a patient-reported outcome measure
1 ,2
3
Rozanne Wilson , Lena Cuthbertson , Lillian
3
1 ,2
Parsons , Richard Sawatzky
1
Trinity Western University, Langley, British
2
Columbia, Canada, University of British Columbia,
3
Vancouver, British Columbia, Canada, Providence
Health Care, Vancouver, British Columbia, Canada
There is a need to examine the validation and use
of patient-reported outcome measures (PROMs) in
frail elderly living in long-term residential care
(LTRC). To better understand residents’
perspectives about their care experience and
quality of life, a provincially coordinated LTRC
sector survey is currently underway in British
Columbia, Canada. The Veterans Rand 12 Item
Health Survey (VR-12) will be administered to the
more than 27,000 LTRC residents. This generic
PROM consists of 12 items measuring physical
and mental health status, and two additional
retrospective items. Although the VR-12 has been
widely-used in general populations, the validity,
applicability, and acceptability of the VR-12 have
not been examined in LTRC. The purpose of this
qualitative study is to analyze cognitive interview
(CI) data collected during the sector survey to
inform refinements that may be needed to
administer the VR-12 to LTRC residents. This
170
study is a part of a larger project that aims to
psychometrically validate the VR-12 for use in
LTRC. Coding of the transcribed field notes from
the CIs (n = 18, purposive sample) is currently
underway to determine the comprehension,
relevance, and acceptability of items to LTRC
residents. Preliminary findings indicate that two
VR-12 items require modification. The findings
from this qualitative study will inform a residential
care adaptation of the VR-12 and contribute to the
validation of a PROM for frail elderly residing in
LTRC. Survey data collected for the provincial
LTRC sector survey will be used to
psychometrically evaluate the resident adapted
VR-12.
P159
Safety-related challenges experienced by
caregivers while providing care in the home
1
1 ,2
identify the main themes related to home
caregiving challenges.
The average age of family caregivers was 68.0
(60% over the age of 65). PSWs had an average
age of 45.6. Family caregivers and PSWs
discussed different kinds of challenges in providing
home care. The family caregivers' themes related
to: 1) physical challenges (e.g. bathing, transfers,
and fall prevention), 2) need for respite care, and
3) financial support. PSWs were concerned with
physical caregiving challenges, home accessibility
and safety, and care team communication.
To optimize home care, family caregivers need
support to manage physical challenges, respite
services, and financial matters. PSWs could
benefit from assistance with physical challenges,
better care coordination, and assessments of
home accessibility.
1
Tara Kajaks , Emily King , Karen Ray , Jill
1 ,4
5 ,6
2
Cameron , Dorcas Beaton , Paul Holyoke ,
1 ,2
Tilak Dutta
1
Toronto Rehabilitation Institute - UHN, Toronto,
2
Ontario, Canada, Mechanical and Industrial
Engineering, University of Toronto, Toronto,
3
Ontario, Canada, Saint Elizabeth, Toronto,
4
Ontario, Canada, Occupational Science and
Occupational Therapy, University of Toronto,
5
Toronto, Ontario, Canada, Institute for Work and
6
Health, Toronto, Ontario, Canada, St. Michael's
7
Hospital, Toronto, Ontario, Canada, Institute of
Biomaterials and Biomedical Engineering,
University of Toronto, Toronto, Ontario, Canada
The shift in patient care from hospital to home has
placed high demands on family caregivers and
personal support workers (PSWs). The age of the
caregiver may impact the provision of care and,
therefore, the caregiving burden. In Canada,
middle-aged people (45-64 years) make up most
of the caregivers while senior caregivers (>65
years) provide the most hours of care (Stats Can,
2012). To improve the safety of providing care at
home, we must: characterize the provision of
homecare, identify caregivers' greatest challenges,
and understand the impact of age on care
demands.
The qualitative PhotoVoice technique was used
during individual interviews (10 family caregivers)
or focus groups (10 PSWs). Participants were
asked to photograph and discuss at least three
home caregiving challenges. The transcribed audio
recordings were used with the photographs to
P160
Music and memory in Alzheimer's disease and
the potential underlying mechanisms
1 ,2
1
1 ,2
Katlyn Peck , Todd Girard , Frank Russo ,
1 ,2
Alexandra Fiocco
1
Ryerson University , Toronto, ON, Canada,
2
Institute for Stress and Wellbeing Research,
Ryerson University, Toronto, ON, Canada
Currently 14.9% of Canadians aged 65 and older
are living with Alzheimer's disease (AD) and other
dementias. This number is expected to double by
the year 2031, increasing burden at the individual,
societal, and economic level. Consequently,
development of prevention and treatment
interventions has become a meaningful area of
research and discovery. A growing body of
research suggests that music exposure can
enhance memory and emotional function in
persons with AD. However, there is a paucity of
research that focuses on identifying specific
underlying neural mechanisms that can potentially
explain the beneficial effects of music in this
particular population. As such, this theoretical
paper reviews current anecdotal and empirical
evidence on the enhancing effects of music
exposure on cognitive function and AD and
postulates distinct, yet interconnected mechanisms
that may determine music's beneficial effect.
Specifically, this paper will outline the potential role
of the dopaminergic system, the autonomic
nervous system, and the default mode network in
171
explaining how music may enhance memory
function in persons with AD.
vieillissantes avec des limitations cognitives :
une étude transdisciplinaire
P161
Hajer Chalghoumi, Maxine Perrin, Jeffrey Jutai,
Virginie Cobigo
University of Ottawa, Ottawa, Canada
Les facteurs associés au sentiment de
présence lors d'une immersion en réalité
virtuelle chez les aînés inquiets à propos de
leur santé
1 ,2
1
Roxanne Prévost , Bruno Gunther , Sébastien
1 ,2
Grenier
1
2
Centre de Recherche de l'Institut universitaire de
Gériatrie de Montréal, Montréal, Canada
Environ 8% des personnes de 65 ans et plus ont
des inquiétudes excessives à propos de leur
santé. Ce type d'inquiétudes se traite
habituellement par exposition in vivo ou en
imagination. Or, plusieurs aînés ont des difficultés
de mobilité, rendant l'exposition in vivo difficile. De
plus, plusieurs n'arrivent pas à imaginer
correctement l'objet phobique durant les séances
d'exposition en imagination. L'exposition en réalité
virtuelle pourrait pallier ces limites. Dans ce
contexte, le sentiment de présence (c.-à-d.,
l'impression subjective d'être présent dans
l'environnement virtuel) est essentiel, car il permet
de créer une réaction émotionnelle réaliste sans
quoi l'exposition ne peut fonctionner. Des études
conduites auprès de jeunes adultes ont démontré
que le sentiment de présence était positivement
associé à la propension à l'immersion (c.-à-d., la
tendance à se laisser immerger dans un univers
fictif), aux attitudes positives envers la technologie
et à l'augmentation du niveau d'anxiété. Aucune
étude n'a testé le lien entre ces variables chez les
aînés. Ce projet a comme objectif de vérifier si la
propension à l'immersion, les attitudes envers la
technologie et l'anxiété ressentie durant
l'immersion sont corrélées au sentiment de
présence chez les aînés. Pour ce faire, quatre
groupes de 10 personnes, classées selon leur âge
(jeunes vs âgés) et leur niveau d'anxiété lié à la
santé (faible vs élevé), seront comparés sur ces
variables. Nous espérons que les données issues
de cette étude permettront de mieux adapter
l'exposition en réalité virtuelle aux caractéristiques
des aînés qui s'inquiètent de façon excessive à
propos de leur santé.
P162
Étude des problématiques éthiques entourant
l’adoption des technologies par les personnes
CONTEXTE: Les technologies constituent une
piste de solution prometteuse pour promouvoir
l’autodétermination et l’inclusion sociale des
personnes vieillissantes avec des limitations
cognitives. Toutefois, leur utilisation engendre des
problématiques éthiques telles que l’invasion de la
vie privée. Pour être en mesure d’aborder ces
problèmes complexes, une approche
transdisciplinaire est nécessaire.
Notre projet fait recours à une méthodologie
transdisciplinaire pour développer une application
logicielle qui favoriserait une gestion efficace des
médicaments au sein de cette population.
Ce projet engage des personnes avec des
limitations cognitives et leurs aidants; des
intervenants du milieu de la santé et des services
sociaux, des développeurs de technologies, des
responsables politiques et des chercheurs de
divers domaines (ex. éthique, technologie).
Cette affiche présente les aspects innovateurs de
ce projet en mettant l’accent sur des obstacles et
des conditions facilitatrices ayant influencé ses
résultats.
MÉTHODE: Nous avons mené une analyse
rétrospective en se basant sur les notes des
réunions, le journal des chercheurs et les
publications du projet. Une revue de la
documentation scientifique a été effectuée pour
identifier des critères d’évaluation propre à la
recherche transdisciplinaire. Nous avons évalué
notre projet à la lumière de ces critères.
RÉSULTATS: La flexibilité et l’attitude d’ouverture
des membres de l’équipe ont été primordiales pour
l’atteinte de consensus. Nos résultats soulignent
aussi les obstacles et les facilitateurs liés à la
participation des personnes vieillissantes avec des
limitations cognitives dans le processus de
recherche et de développement. L’accessibilité
cognitive figure au premier rang des défis à
surmonter.
P163
172
Social isolation among older adults in Canada:
Conceptual Review and Next Steps
1 ,2
1 ,2
Rachel Weldrick , Amanda Grenier , Glenys
1 ,3
Currie
1
2
Gilbrea Centre for Studies in Aging, Hamilton, ON,
3
Canada, Hamilton Council on Aging, Hamilton,
ON, Canada
Objective: Social isolation is now considered a
significant concern for many older adults in
Canada, particularly for vulnerable sub-groups,
and is being addressed through programming by
governments at many levels. Certain older adults,
including low-income seniors and those who live
alone, may be especially vulnerable to becoming
socially isolated. This is problematic and can
contribute to poor health and social outcomes for
these individuals. Unfortunately, research findings
in this area have yet to agree on how to define and
conceptualize social isolation in relation to other
concepts and experiences (e.g. loneliness). As a
result, there also exists little agreement on how
best to prevent and address social isolation among
older people.
Methods: This study provides a conceptual review
of social isolation among older adults, a review of
the literature, and a review of the existing best
practices.
Results: Disagreement exists concerning how
social isolation among older people should be
conceptualized and defined, suggesting a need for
a revised taxonomy. Although the majority of
successful interventions include a social
component, disagreement exists in this area as
well.
Conclusion: Re-conceptualizing the nature of
social isolation among older people may be
needed to develop successful interventions and
prevention strategies. Recommendations for next
steps are made.
P164
Context: The Quebec government is implementing
an Alzheimer Plan in 42 family medicine groups
(FMGs) to improve the management of patients
with dementia. This study evaluated the impact of
the Alzheimer plan on cognitive testing, diagnosis
and management of dementia.
Objectives: To evaluate the change in the quality
of management of patients with dementia and the
rate of cognitive testing and diagnosis after the
implementation of this reform. Design: Two
independent sets of charts were extracted: one pre
(2011-2013) and one post (2014-2015)
implementation. Setting: 13 FMGs in Quebec who
have implemented the Alzheimer Plan. Patients:
945 randomly selected charts of patients 75+ with
Alzheimer disease or other dementias and 1920
charts of patients 75+. Outcomes: Primary: Quality
score on the management of dementia. The score
was based on 10 validated quality indicators
including the evaluation of cognition, functional
status, behaviour, weight, caregiver status, driving
ability, medication and support services.
Secondary: Proportion of patients 75+ with a
cognitive test and with a diagnosis of dementia.
Results: The quality of follow-score in the
dementia sample increased from 44.1% to 52.0%
(p<0.001) after the Alzheimer Plan. The proportion
of patients 75+ with a cognitive test was 14.5% pre
and 17.0% post Alzheimer plan; a diagnosis of
dementia was present in 13.5% of charts pre and
14.5% post Alzheimer Plan.
Conclusions: These results provide an initial
portrait of the impact of the Alzheimer Plan in
Quebec. The government plans to use these
results to refine the Alzheimer Plan before
province-wide dissemination.
P165
Vers une politique de soin à domicile des
personnes âgées
Effect of the Alzheimer Plan on the
Management of Patients with Dementia in
Family Medicine Groups
1 ,2
2
Montreal, Quebec, Canada, Lady Davis Institute,
Jewish General Hospital, Montreal, Quebec,
Canada
1 ,2
Nadia Sourial , Geneviève Arsenault-Lapierre ,
1 ,2
2
Howard Bergman , Geva Maimon , Mélanie
2
2
1 ,2
LeBerre , Lucie Vaillancourt , Isabelle Vedel
1
Asma Ben Hassine, Philippe Voyer, Hatem
Laaroussi, Amira Abbassi, Intissar Souli, Boutheina
Mejri
Université Laval, Québec, Canada
173
Le contexte actuel des systèmes de santé exige
des transformations dans les modes d’organisation
et de dispensation des soins de santé. Ces
transformations s’imposent plus que jamais,
compte tenu des nouveaux défis liés au
vieillissement de la population et des besoins de
santé grandissant an quantité et en complexité.
Des nouvelles façons de déploiement du rôle de
l’infirmier doivent être implantées afin d’assurer
l’accessibilité, la continuité des soins et la mise en
place d’une approche globale centrée sur les
besoins des personnes âgées et de leur famille
(TSAI et al., 2005). Ces nouvelles approches
doivent préserver l’autonomie, la dignité et
l’Independence de la personne âgée.
Cette étude consiste à une revue de la littérature
sur les politiques d’implantation des programmes
de soin à domicile des personnes âgées de
différents pays (Danemark, Islande, Angleterre et
Japon). Dans le cadre de cette présentation par
affiche, les caractéristiques similaires et distingues
de ces politiques seront mises en évidences. De
plus, les bienfaits, et les conséquences de ces
politiques sur les populations seront dégagées. En
conclusion, une analyse est présentée sur les
leçons pouvant être retirées de ces expériences
internationales pour les services canadiens de
soutien à domicile.
P166
Examining Choice in Health Policy for Older
Adults: A Critical Discourse Analysis
Ashley Hyde
Purpose The purpose of this research study is to
explore how choice is manifested in continuing
care policy. It will explore the experience of choice
from the perspective of older adults and/or family
caregivers, policymakers and health policy
documents.
Method This research study will be conducted
using the critical discourse analysis (CDA)
approach proposed by Fairclough. I will examine
the concept of choice in health policy documents
and qualitative interviews from three main aspects:
(i) the sociocultural level, (ii) the discourse practice
level, and (iii) the textual level.
Sample The sample for this study will include text
generated from qualitative interviews and Alberta
continuing care policy documents. I will interview 68 policymakers and 12 older adults or their family
caregivers that currently access continuing care
services.
Data Collection I will collect data for this study in
two ways: (i) by retrieving relevant continuing care
policy documents and, (ii) face-to-face, semistructured interviews with each participant lasting
1-1.5 hours.
Data Analysis I will analyze data according to the
CDA approach proposed by Fairclough.
Implications The creation of health policy that
addresses the needs of older adults remains a top
priority for policymakers. To have person-centered
health care as desired by many older adults, it is
crucial that there is a mutual understanding of
choice between policymakers; policy documents
and end-users of continuing care services.
P167
The older adult patient and caregiver
experience of care transitions – A review of the
literature
1
2
2
Kristina Miller , Lorelei Lingard , Mark Goldszmidt
1
Health and Rehabilitation Sciences, Western
2
University, London, Ontario, Canada, Centre for
Education Research & Innovation and Department
of Medicine, Schulich School of Medicine &
Dentistry, Western University, London, Ontario,
Canada
Transitional care is defined as a set of actions
designed to ensure the coordination and continuity
of health care as patients transfer between
different locations or different levels of care within
location. The aim of this literature review was to
determine the current status of the literature on
older adult patient and informal caregiver
experiences in care transitions from hospital to
home. Databases searched included Scopus,
CINHAL, PubMed, and EMBASE using search
terms of care transitions, older adults, and patient
experience. Themes from the literature included: 1)
older adult patients and their caregivers felt limited
control of or contribution to transitions; 2) they did
not know what to expect and 3) they found
discharge instructions to be poor. This literature
review suggests a need for greater research in the
area of patient and caregiver experiences of care
174
transitions in order to improve patient and system
outcomes for older adults.
Canadians’ values and preferences to enhance
equitable access to assistive technology in
Canada.
P168
P169
Ethical Concepts and Challenges related to
Assistive Technology Access: A Scoping
Review
1
2
1
Winnie Sun , Daphne Schreiber , Rosalie Wang ,
3
Michael Wilson
1
2
University of Toronto, Toronto, Canada, March of
3
Dimes, Toronto, Canada, McMaster University,
Hamilton, Canada
Objectives: Despite the surge of research and
development for assistive technologies, policies on
access and procurement have lagged in
responding to the growing demands from users.
Developing policy that aligns with the values and
preferences of Canadians must require an
understanding of the ethical concepts and
challenges underlying approaches to provide
access to assistive technologies. Our scoping
review will begin to address this by systematically
and comprehensively examining the ethical
concepts and challenges related to assistive
technology access and procurement.
Methods: We apply established approaches for
scoping reviews, consisting of broad searches to
identify relevant literature related to the research
question, selecting articles that meet inclusion
criteria, conceptually mapping/charting included
articles, extracting relevant information, and
summarizing and synthesizing key findings. We will
analyze data by thematically grouping the
descriptions of assistive technologies identified in
included articles, and conducting a content
analysis to iteratively develop a conceptualization
of ethical concepts and challenges related to
assistive technology access and procurement.
Findings: Our scoping review is currently in
progress, but findings will focus on the models,
frameworks and principles that have been used to
understand ethical concepts and challenges
related to technology access, with a focus on their
use for older adults and/or those living with
disabilities.
Conclusion: Our scoping review will provide an
analysis of literature related to ethical concepts
and challenges related to technology access that
can be used as part of future efforts to identify
The effects of economic adversity life course
transitions on leisure time physical activity in
older adults: a cross-sectional analysis from
the International Mobility in Aging Study
1
2
Phoebe W. Hwang , Cristiano dos Santos Gomes ,
3
1
Mohammad Auais , Catherine M. Pirkle
1
Office of Public Health Studies, University of
2
Hawaii at Mānoa, Honolulu, HI, USA, Federal
University of Rio Grande do Norte, Natal, Brazil,
3
School of Rehabilitation Therapy, Queen’s
University, Ontario, Canada
Introduction: Leisure time physical activity (LTPA)
is more effective in improving overall older adult
health compared to other forms of physical activity.
Socioeconomic statuses across the lifecourse may
influence the development of LTPA behaviors.
Objective: To examine if lifecourse economic
adversity (EA) transitions from childhood to older
adulthood influence LTPA engagement among
community dwelling older adults (65-74 years old)
in Kingston(n=374) and St-Hyacinthe,
Canada(n=355); Tirana, Albania(n=387);
Manizales, Colombia(n=407); and Natal,
Brazil(n=402).
Methods: Cross-sectional analysis of baseline
data. Principal exposure variable was EA
transition, defined as: 1) Persistent, with EA during
childhood and older adulthood; 2) Improved, with
EA during childhood, but not older adulthood; 3)
Worsened, with EA during older adulthood, but not
childhood and 4) No adversity at either life stage.
Covariates included age, sex, and education.
Outcome was self-reported LTPA engagement
(categorized yes/no).
Results: In St-Hyacinthe, compared to no
adversity, those with severe adversity were less
likely to engage in LTPA (OR:0.39, 95%CI:0.020.79), followed by worsened (OR:0.53,
95%CI:0.28-0.99). In Tirana, those with severe
adversity were more likely to engage in LTPA
(OR:2.25, 95%CI:1.00-5.05) compared to no
adversity. In Manizales, those with worsened
adversity were less likely to engage in LTPA
(OR:0.29, 95%CI: 0.15-0.59) compared to no
175
adversity. In Kingston and Natal, low education
was associated with less LTPA engagement, but
not EA transition.
of positive to negative mealtime interactions [F(2,
632)=34.72, p=< 0.001; never/rarely=2.3,
sometimes= 1.6, often=1.5].
Conclusion: Effects of EA on LTPA were highly
site-specific, suggesting distinct pathways by which
lifecourse socioeconomic position influences LTPA
behaviors at each site.
Conclusions: Residents requiring more physical
eating assistance received fewer positive
interactions with staff compared to those requiring
no assistance. Further work will examine the
independence of this association and if it
influences food intake. (Funding from Canadian
Institutes of Health Research)
P170
Making the Most of Mealtimes (M3): Differences
in person-centered care (PCC) delivery during
mealtime eating assistance among residents
living in long-term care facilities located across
Canada
1
1
2
Sarah Wu , Heather Keller , Susan Slaughter , Jill
1
Morrison
1
2
Canada
Introduction: PCC can improve the mealtime
experience for residents, yet practices specific to
mealtimes are poorly understood. The Meal Time
Scan (MTS) is a face valid and reliable instrument
for assessing these interactions.
Objectives: It was hypothesized that residents
who require eating assistance would receive fewer
positive mealtime interactions and care practices
than those who do not require assistance.
Methods: M3 is a cross-sectional study based in
32 long-term care homes across AB, MB, ON and
NB. Mealtime practices were observed by one of
eight trained assessors for 637 randomly selected
residents at three meals on non-consecutive days.
Observation ratings were averaged across the
three meals. An Edingburgh Feeding Evaluation in
Dementia Questionnaire item determined if
assistance was required (‘never/rarely’,
‘sometimes’, ‘often’). A summary score from MTS
was calculated based on the ratio of positive to
negative mealtime specific interactions, with higher
scores indicating more positive interactions.
ANOVA determined if frequency of physical eating
assistance a resident received was associated with
the ratio of positive-to-negative PCC interactions.
Results: Almost one-quarter (23%) of residents
required some level of assistance (11%
sometimes; 12% often). Frequency of eating
assistance was negatively associated with the ratio
P171
Artistic and expressive modalities in
gerontological social work research: A visual
ethnography of transmigrant Jamaican
Canadian older adults
Shamette Hepburn
The Ontario Institute for Studies in Education
(OISE)/University of Toronto, Toronto, Canada
This paper presents preliminary findings of a visual
ethnographic study of the migratory lifecourse and
everyday life geographies of Jamaican Canadian
older adults in order to document, analyze, and
share how they sustain their social and economic
wellbeing. My research questions are: What are
the transmigrant experiences of Jamaican
Canadian transmigrant older adults who live in and
across Canada and Jamaica? What factors
determine their geographical options at retirement?
How do systemic barriers stemming from
intersections of age, race, gender, and class
impact their mobility strategies and decisions?
Transmigrant mobility presents social workers with
challenges, such as how to deliver services to
older adults who move between countries, what
their needs are, and how to develop support
networks beyond a singular state. I utilize visual
ethnography, operationalized as photovoice- a
participatory action research method and in
conjunction with grounded theory in order to
advance social work theory and revise practice
models directed at transmigrant older adults. This
paper presents findings gleaned on the lives and
living conditions of four participants from a larger
research project. My study is grounded in the use
of artistic and expressive modalities in gerontology
and social work. The participants and I pursue a
process of collaborative interpretation of older
adults' social realities (as depicted in narratives
and photographs) that values their authentic selfexpression and meaning-making. This approach
provides a multi-modal record of older adults' lives,
176
thereby providing rich data through images,
narratives, and video/audio recordings.
P172
Réceptivité organisationnelle au changement
des services de soutien à domicile québécois:
étude pilote
1 ,2
2 ,3
4 ,5
MR Ruest , GL Léonard , AT Thomas , DC
6
2 ,3
2 ,3
Contandriopoulos , JD Desrosiers , MG Guay
1
Programmes recherche en sciences de la santé Université de Sherbrooke, Sherbrooke, Canada,
2
Centre de recherche sur le vieillissement - Centre
sociaux de l'Estrie-Centre hospitalier universitaire
3
de Sherbrooke, Sherbrooke, Canada, École de
réadaptation - Université de Sherbrooke,
4
Sherbrooke, Canada, École de physiothérapie et
d'ergothérapie - Université McGill, Montréal,
5
Canada, Centre de recherche interdisciplinaire du
6
Montréal métropolitain, Montréal, Canada, Faculté
des sciences infirmières - Université de Montréal,
Montréal, Canada
Objectif: Mesurer le niveau de réceptivité
organisationnelle à l'implantation d'un changement
pour les services offerts aux aînés dans les
services de soutien à domicile (SAD) des Centres
intégrés de santé et de services sociaux
québécois, tel que perçu par les ergothérapeutes.
Méthode: Cent-vingt-quatre des 470 (26%)
ergothérapeutes du Québec œuvrant en SAD qui
furent rejoints ont complété la version électronique
française de l'Organizational Readiness for
Implementing Change (ORIC), comprenant 10
indicateurs. Des statistiques descriptives ont
permis de documenter la perception des
ergothérapeutes au regard du niveau
d'engagement (5 indicateurs) et du niveau
d'efficacité (5 indicateurs) des membres de leur
milieu de travail à implanter un changement.
Résultats: Sur le plan de l'engagement face au
changement, les ergothérapeutes rapportent
davantage être ni d'accord ni en désaccord pour
une majorité d'indicateurs. Sur le plan de
l'efficacité face au changement, 34% et 25% de
ceux-ci rapportent être plutôt en désaccord
respectivement pour la confiance en les membres
de l'organisation à les soutenir en cours
d'adaptation et celle à pouvoir gérer les enjeux de
pouvoir et de reconnaissance.
Conclusions : La réceptivité organisationnelle des
SAD québécois face à l'implantation d'un
changement apparaît mitigée selon la perspective
des ergothérapeutes. Le niveau d'engagement
perçu face au changement semble davantage
favorable que le niveau d'efficacité face à celui-ci.
Ce portrait des caractéristiques contextuelles
pourra soutenir l'identification des cibles
d'intervention lors de changements
organisationnels pour appliquer de nouvelles
innovations issues de la recherche dans les
services offerts aux aînés.
P173
Development and psychometric testing of a
measure of the healthcare experiences of
persons with dementia and their caregivers:
Study protocol and preliminary results
Jeanette Prorok, Paul Stolee
University of Waterloo, Waterloo, Ontario, Canada
Objectives: While research interest in healthcare
experiences has grown, to date no measure of
experience for persons with dementia (PWD) and
their caregivers has been developed. The
objectives of this study are: to conduct a thematic
synthesis with the aim of developing a healthcare
experiences framework and identifying possible
measure domains; to consult with PWD and their
caregivers in order to inform measure
development; and to test the psychometric
properties of the developed measure.
Methods: The MEDLINE, Embase, PsycINFO, and
CINAHL electronic databases were searched to
identify relevant articles. Study characteristics,
methodologies, and results were abstracted from
the included studies. The results of these studies
will be synthesized into a healthcare experiences
framework which will form the basis of potential
measure domains. Focus groups will be conducted
with PWD and their caregivers to better inform the
resulting synthesis and selection of measure
domains. Validity and reliability of the developed
tool will be determined.
Results: Preliminary results of the thematic
synthesis indicate that several factors can
influence the healthcare experience. These include
communication between the PWD/caregiver and
healthcare provider, the relationship between the
PWD/caregiver and healthcare provider, access to
care and necessary supports, and healthcare
provider knowledge.
177
Conclusions: It is anticipated that PWD and their
caregivers will provide invaluable feedback on the
framework once it is synthesized which will greatly
inform the measure development. Special
consideration will need to be given to methodology
in the psychometric testing phase, particularly with
regard to assessment of reliability given the target
population.
Conclusions: There are limited studies with high
levels of evidence for interventions that decrease
elder abuse and neglect. The scarcity of
community-based elder abuse and neglect
interventions for older adults and caregivers
highlights the need for further work to elevate the
quality of studies to move the field forward.
P175
P174
A Systematic Review on Community-based
Interventions for Elder Abuse And Neglect
1
2
Gwendolyn Fearing , Christine Sheppard , Lynn
1
3
McDonald , Sander Hitzig
1
Institute for Life Course and Aging, FactorInwentash Faculty of Social Work, University of
2
Toronto, Toronto, ON, Canada, School of Public
Health and Health Systems, University of
3
Waterloo, Waterloo, ON, Canada, St-John’s
Rehab Research Program, Sunnybrook Research
Institute, Toronto, ON, Canada
Objective: Elder abuse and neglect is a serious
societal issue that requires prevention and
intervention strategies at the practice and policy
level. In order to help advance the state of
knowledge on the efficacy of available
interventions, a systematic review on communitybased elder abuse interventions was undertaken to
assess the state of the field.
Method: The peer-reviewed literature from 2009 to
February 2015 were searched across 4 databases
(e.g., OVID, Proquest, CINHAL and Ageline).
Included articles were studies published in English
that assessed elder abuse interventions. Two
raters independently reviewed all articles and
assessed their methodological quality and used a
modified Sackett Scale to assign levels of
evidence.
Results: Four thousand and ninety-one articles
were identified and nine were selected for
inclusion. Although there was Level-1 evidence for
psychological interventions (n=2), only one study
on strategies for relatives (START) led to a
reported decrease in elder abuse. There was
Level-4 evidence for conservatorship, ECARE (an
elder abuse intervention/prevention program) and
a multidisciplinary intervention (n=4), which all
yielded significant decreases in elder abuse and/or
neglect. The remaining three were classified as
Level-5 evidence (n=3) for elder mediation and
multidisciplinary interventions.
The Relationship among Nursing Homes
Environment and Elderly’s Quality of Life
1 ,2
2
2
Hadi kooshiar , Negar Sari , Saeed Vaghee ,
3
Hamed Kamelnia
1
University Western Ontario, London/Ontario,
2
Canada, Mashhad University of Medical Sciences,
3
Mashhad/Khorasan, Iran, Ferdowsi University of
Mashhad, Mashhad/Khorasan, Iran
Purpose: Elderly’s Quality of Life (EQoL) can be
easily threatened by some factors. Therefore, it is
crucial to have enough information about EQoL
and its influencing factors. The purpose of this
study was to determine the relationship between
nursing homes environment and the EQoL.
Method: In this cross-sectional correlational study,
census sampling method was used. The sample
included 220 nursing home residents in Mashhad
city in Iran who aged more than 60 years with a
minimum of 6 months residency at nursing home
considering certain including and excluding criteria.
The Nursing home quality of life questionnaire and
multiphasic environmental assessment procedure
(rating scale) were used to measure the EQoL and
nursing homes environment respectively.
Results: In this study the mean of EQoL total
score was 56.7±10.8. Also, it identified the mean
of the EQoL score domains in health and
functioning 54.7±13.8, in spiritual 57.4±14.7, in
economic and social 55.4±11.4, and in family
63.5±12.8. The mean score of four diminution of
nursing homes environment were for physical
attractiveness 42.0 ±10.6, environmental diversity
34.5 ± 14.3, resident functioning 40.0± 7.00, and
staff functioning 44.3±10.5. In addition, all nursing
homes physical and social environment aspects
had significant correlations with EQoL P<0.05.
Conclusion: More focus on nursing homes
environment reduce some aging problems and
enhance the EQoL.
178
P176
Understanding the grief experiences of family
caregivers of persons living with dementia
through application of the Dual Process Model
of Coping with Bereavement
Lori Pollard
University of Alberta, Edmonton, AB, Canada
Background: Many family caregivers are
vulnerable experiencing incessant grief that
severely affects their physical, mental, and
emotional health, possibly leading to premature
death. The Dual Process Model of Coping with
Bereavement (DPM) (Stroebe & Schut,1999) is a
potential theoretical framework to better
understand this unique grief experience of family
caregivers.
Objective: The objective was to assess the utility
of the DPM to understand the grief experience of
family caregivers of persons living with dementia
and the potential challenges and issues in applying
the model.
Methods: Databases (CINAHL, MEDLINE via
OVID, PubMed, SCOPUS) were searched for
English pertinent articles published within the last
15 years. Search terms included: dementia;
caregiver(s), son(s), daughter(s), wife or wives,
husband or spouse or family or adult child or
partner; mourn(ing); (bereave)ment or grief(ing);
Alzheimer; and ambiguous loss.
Results: The literature suggests family caregivers
experience chronic grief; the DPM deals with
chronic grief, therefore has the potential to assist
them. However, healthcare professionals
implementing the DPM need to do so with caution
to avoid family caregivers becoming too
independent as they oscillate between the two
coping behaviors.
Conclusion: The DPM has the potential to assist
family caregivers to achieve constructive grief work
and re-orientation to life. Implementing the DPM
with family caregivers can increase our
understanding of their grief experience, and can be
useful in guiding future research to support family
caregivers.
P177
Childhood adversity and leisure time physical
activity in older adults: a cross-sectional
analysis from the International Mobility in
Aging Study
1
Phoebe W. Hwang , Cristiano Dos Santos
2
3
1
Gomes , Mohammad Auais , Catherine M. Pirkle
1
University of Hawaii at Manoa, Honolulu, HI, USA,
2
Federal University of Rio Grande do Norte, Natal,
3
Brazil, School of Rehabilitation Therapy, Queen’s
University, Ontario, Canada
Introduction: Leisure time physical activity (LTPA)
engagement results in better health outcomes for
elders compared to other physical activity
(occupation, sport competition, and transportation).
Previous studies showed that childhood adversity
is associated to poor functional fitness. It’s
hypothesized that LTPA is an explanatory factor in
this relationship.
Objective: To examine the relationship between
childhood adversity occurring before 15 years of
age and self-reported LTPA engagement among
community dwelling older adults (65-74 years old)
in Kingston (n=374) and St. Hyacinthe, Canada
(n=355); Tirana, Albania (n=387); Manizales,
Colombia (n=407); and Natal, Brazil (n=402).
Methods: Cross-sectional analysis of baseline
data from a longitudinal study. Principal exposure
variables were childhood social and economic
adversity. Covariates included participant age, sex,
income, and educational attainment. Results:
Correlates of current-reported LTPA were highly
site-specific. LTPA engagement was 68.1% in
Kingston, 51.4% in St. Hyacinthe, 17.5% in Tirana,
27.3% in Manizales, and 22.6% in Natal. In
Canada, low-educated individuals were less likely
to engage in LTPA compared to medium and high
educated (Kingston OR: 0.39, 95%CI: 0.20-0.73;
St. Hyacinthe OR: 0.56, 95%CI: 0.33-0.98). This
was also observed in Natal (OR: 0.46, 95%CI:
0.25-0.85), but not in Manizales or Tirana. In
Manizales, female sex was associated with LTPA
engagement (OR: 1.98, 95%CI: 1.25-3.14). In
Tirana, presence of childhood economic adversity
was associated with LTPA engagement.
Conclusion: Results suggest that a person’s
location of residence is the most important
determinant of LTPA engagement. Identifying the
predictors of LTPA can inform future public efforts
in improving elder health.
179
1
P178
Re-Conceptualizing ‘Successful Aging’ from
the Older Adults’ Vantage Point
Oriana Vaccarino, Kimberley Wilson, Jeffery Yen
University of Guelph, Guelph, Ontario, Canada
Researchers have often defined successful aging
on behalf of older adults. These definitions have
tended to emphasize the absence of physical
disability, placing less emphasis on psychosocial
variables. Only recently have studies begun to ask
older adults what successful aging may mean from
their perspective. The scarce research that exists
on this topic has shown that older adults
emphasize psychosocial factors as most important
to successful aging, and see successful aging as a
multidimensional process.
This study aims to explore the meanings of
‘successful aging’ and the possible issues
associated with this term for older adults, which
can be gained through processes of public
deliberation, in the Guelph-Wellington region.
Public deliberation is a means for collective
negotiation surrounding various topics that aims to
have practical and policy implications.
Given the lack of clarity on conceptualizations of
successful aging and that the current literature
individualizes aging, there is a need for a collective
negotiation and discussion with older adults in
terms of what successful aging means. In this
study, public deliberative forums are used to get to
a collective response and understanding of
‘successful aging’, through the eyes of older
adults.
The ultimate aim is to arrive at a publically agreed
upon understanding of the meanings of successful
aging and to inform programs, services, and
policies on the specific needs associated with
being an older adult in the Guelph-Wellington
region. Findings from the public deliberation will be
presented as well as implications for future
research and policy.
P179
Teaching online navigation skills to seniors
with vision loss: Using orientation and mobility
concepts as a framework for curriculum design
1 ,2
2
Natalie Martiniello , Isabelle Brennan , Michele
2
1 ,2
Reed , Walter Wittich
École d’optométrie, Université de Montréal,
2
Montreal, Quebec, Canada, CRIR/Centre de
réadaptation MAB-Mackay du CIUSSS du CentreOuest-de-l’Île-de-Montréal, Montreal, Quebec,
Canada
Rehabilitation professionals have encountered an
increase in the number of individuals experiencing
vision loss in recent years, and who must learn to
navigate the Internet using assistive technologies.
Traditional approaches to assistive technology
instruction rely on rote learning and memorization,
failing to teach senior learners to apply what has
been taught in diverse real-life situations.
Objective: To develop a framework through which
vision rehabilitation professionals can adapt
teaching strategies to address the reduced longterm and working memory, attention, visuospatial
abilities, verbal fluency, and problem-solving skills
of older learners.
Methods: This poster presents an interdisciplinary
curriculum drawing on proven techniques used in
orientation and mobility training to foster and
develop the navigation and problem-solving skills
of senior learners in virtual, online environments.
Results: Using a common language and
framework from the field of orientation and mobility,
we present tangible approaches to circumvent
some of the difficulties encountered by older
learners during online navigation, including:
drawing on other senses to provide concrete
examples of abstract concepts; moving from
simple to complex websites based on learner
pace; using prompting questions to stimulate
comprehension and retention; and incorporating
problem-solving scenarios to monitor and
continuously evaluate learner understanding.
Discussion: The development of this model lays
the groundwork for future research on efficacy, and
aims to stimulate an important conversation about
the need for a holistic, interdisciplinary framework
with a shared language and approach to internet
training as it relates to older learners with vision
loss.
P180
The McGill School of Social Work-CREGES
Social Gerontology Satellite Office: An
Example of Capacity and Community Building
180
1
among Researchers, Students, Practitioners
and Educators
1
1
1
Shari Brotman , Tamara Sussman , Shadi Martin ,
1
1
1
Zelda Freitas , Myra Giberovitch , Pam Orzeck
1
School of Social Work, McGill University,
2
Montreal, Quebec, Canada, Centre for Research
and Expertise in Social Gerontology (CREGES),
Montreal, Quebec, Canada
As the population ages, increased demand is
placed on social work researchers, practitioners
and educators to both understand and respond to
the complex issues associated with aging. Despite
the need for informed social work practitioners and
researchers, university programs across the
country continue to face challenges attracting and
engaging students interested in gerontological
practice and scholarship. In an effort to address
this challenge, faculty members at the McGill
School of Social Work partnered with the Centre
for Research and Expertise in Social Gerontology
(CREGES) in 2014 to develop a social gerontology
satellite office aimed at building a community of
students, educators, and researchers interested in
the advancement of gerontological scholarship and
practice. To date activities have focused on
knowledge dissemination (journal clubs, lunch and
learns, web-based informational materials);
practice innovation (social gerontology job fairs);
training (research based practica, tutorials) and
curriculum support (creation and development of
case scenarios, literature, and exercises to infuse
gerontological knowledge into the broader
curriculum).
This poster describes the development of the
satellite office including its mission/objectives and
associated activities, and offers preliminary data on
how this localized centre has built community,
capacity, and interest in social gerontology among
the McGill social work community. Steps for
replicating this process in other localities are
offered.
P181
The ENGAGE study: Combining cognitive
training with engaging leisure activities to
promote cognitive reserve in older adults with
subjective cognitive decline
1
2
Sylvie Belleville , Nicole Anderson , Ana Ines
1
1
1
Ansaldo , Patricia Belchior , Louis Bherer ,
1
1
Véronique Bohbot , Nathalie Bier , Marie-Andrée
1
5
1
Bruneau , Lola Cuddy , Céline Fouquet , Brigitte
2
2
Gilbert , Regina Jokel , Brian Levine , Katherine
4
1
2
McGilton , Aline Moussard , Kelly Murphy , Gary
2
4
2
Naglie , Elizabeth Rochon , Angela Troyer
1
Institut Universitaire de Gériatrie de Montréal,
2
Montréal, Canada, Rotman Research Institute,
3
Baycrest, Toronto, Canada, Douglas Mental
Health University Institute, Montréal, Canada,
4
Toronto Rehabilitation Institute, Toronto, Canada,
5
Queen's University, Kingston, Canada
We report the results of a feasibility and
acceptability pilot study for the CCNA (Canadian
Consortium on Neurodegeneration in Aging)
ENGAGE study, which goal is to create and test a
leisure-based stimulation program in persons at
risk of dementia. The intervention is based on the
findings that involvement in cognitively-engaging
leisure activities reduces the risk of dementia and
that cognitive training increases memory and wellbeing in older adults with mild cognitive
impairment. ENGAGE will be a two-site (Toronto
and Montreal) double-blind randomized controlled
trial where 180 participants with subjective
cognitive decline will be allocated to either a
multifaceted program integrating cognitive
strategies into leisure activities, or to an active
control program. The study will collect data on
cognition, well-being, quality of life, as well as
brain-related training effects. Our pilot study
involved 21 healthy older adults (age range 66-82;
11 men) who received either the experimental or
control intervention. Participants rated the
interventions on various parameters including
enjoyment (M = 9.3/10), degree of
stimulation/interest (M = 9.4/10), and relevance to
their needs and worries about aging (M = 8.9/10),
showing that both the intervention and control
programs met participants' expectations.
Attendance was high (93.5 %) and attrition rate
was reasonably low (16.6 %). ENGAGE is an
ambitious two-site study that will provide invaluable
data regarding the capacity to increase cognition in
persons with subjective cognitive decline by
offering enriched leisure activities. The pilot study
indicates excellent feasibility and acceptability of
the intervention.
P182
A personal story about life in a long term care
facility in Alberta, Canada
1 ,2
Linda McFarlane
1
Volunteer Alberta College of Social Workers
Gerontology Action Group, Calgary, Alberta,
2
Canada, Volunteer Alberta Health Services,
181
Continuing Care Quality Committee , Calgary,
Alberta, Canada
Medical Research, Jewish General Hospital,
In May 2005 I was discharged from hospital and
admitted to a long term care facility in Calgary. I
was 57 years old and physically healthy but
suffered from depression and akathisia.
Background: Urinary tract infections (UTIs) are
the most common reason for antibiotic-prescribing
in long-term care facilities (LTCFs). The use of
effective yet narrow-spectrum antibiotics is an
important consideration given the risk of antibiotic
resistance.
The charge nurse led me along a smelly corridor
past people waiting in wheelchairs to a tiny room
which I was to share. Music blasted from a radio. I
had lost my hope, relationship and home. I felt that
I had been tossed into a warehouse to wait until
death.
I dreaded waking up to face each meaningless,
lonely day. Staff did not ask me to help plan my
care. Care did not meet my needs and activities
were more appropriate for children.
My objective is to deepen your understanding of
the experience of a vulnerable person in care. It is
a unique but universal story as we all share needs
for dignity, meaning, independence and support,
choice and caring relationships. I hope my
presentation will encourage you to involve
residents and family members as partners in
research and to advocate strongly for the use of
research and best practice to guide our care
system.
The data for this presentation are my recall of
painful years in the care facility. My method is a
narrative. The results are observations of lack of
respect, poor care and quality of life and absence
of oversite in the system combined with my
knowledge gained though volunteering with the
Social Work Gerontology Action Group and with
Alberta Health Services Continuing Care Quality.
P183
What role do laboratory culture results play in
the management of episodes of suspected UTI
in long-term care?
1
1 ,2
1
Sarasa Johnson , Ruby Friedman , Brian Gore ,
3 ,4
Machelle Wilchesky
1
Donald Berman Maimonides Geriatric Centre,
2
Montreal, QC, Canada, Division of Geriatric
Medicine, McGill University, Montreal, QC,
3
Canada, Department of Family Medicine, McGill
4
University, Montreal, QC, Canada, Centre for
Clinical Epidemiology, Lady Davis Institute for
Objective: To assess the relationship between
laboratory culture results and antibiotic decisionmaking for episodes of suspected UTIs in LTC.
Methods: A retrospective review of all suspected
UTIs in a 387-bed LTCF over a 2-year period was
conducted, linking pharmacy, laboratory and chart
data. Among empirically treated episodes, the
proportion of prescriptions stopped and switched in
accordance with culture results (including organism
resistance profiles) was calculated. For patients in
whom treatment was initiated after availability of
culture results, the proportion of infections
prescribed an effective antibiotic was determined.
Logistic regression was performed to ascertain
whether resident characteristics were associated
with antibiotic decision-making.
Results: Among a total of 774 episodes, 59.6%
were culture positive. Effective antibiotics had
been prescribed in 24.5% of empirically treated
episodes with positive culture results. Among
empirically treated episodes where negative
culture results were subsequently obtained, 25.3%
stopped treatment. Similarly, 15.7% of empirically
treated episodes initially prescribed an ineffective
antibiotic were switched accordingly. Among
episodes where treatment was initiated after
positive culture results were obtained, 55.5% were
prescribed effective antimicrobials. Age, sex,
Charlson comorbidity score, dementia and catheter
status were not associated with treatment.
Conclusions: Laboratory culture results may not
be adequately considered when making antibiotic
decisions for suspected UTIs in LTC. Future
research should endeavor to better understand
antibiotic decision-making in this population.
P184
The Relationship between Multimorbidity
Clusters, Health and Well-Being, and Health
Care Use
182
Verena Menec, Scott Nowicki, Philip St. John
The University of Manitoba, Winnipeg, Manitoba,
Canada
Objectives: Having multiple chronic health
conditions, or multimorbidity is common in older
age. Multimorbidity has been varyingly defined in
previous research. This study was designed to: 1)
identify multimorbidity clusters using latent class
analysis (LCA); 2) examine the cross-sectional
relationship between multimorbidity clusters and
health-related outcomes; and 3) examine the
prospective relationship between multimorbidity
clusters and health care use.
Methods: The study was based on face-to-face
interviews with 954 individuals aged 45-94 years
residing in Winnipeg, Manitoba. Survey data were
linked with administrative data to determine health
care use within two and half years following the
interview.
Results: Based on 25 chronic conditions, LCA
revealed three multimorbidity clusters, one
composed of healthy individuals with none to few
chronic conditions and two clusters consisting of
individuals with several chronic conditions, each
associated with distinct chronic condition profiles (a
mostly ‘diabetes/heart disease' versus
‘disability/mental health' cluster). Cross-sectional
analyses indicated that both multimorbidity clusters
were associated with poorer self-rated health and
mental health and more functional limitations than
the healthy cluster, controlling for sociodemographic characteristics. However, only the
disability/mental health cluster differed from
healthy participants on life satisfaction.
Prospectively, individuals in both multimorbidity
clusters incurred more physician visits and more
visits to family/general practitioners than healthy
individuals. They also had greater odds of being
hospitalized (adjusted odds ratio=1.95 vs. 1.90,
p<.05).
1
2
Sabrina Iuglio , Habib Chaudhury , Susan
3
1
4 ,1
Slaughter , Jill M. Morrison , Heather H. Keller
1
2
Canada, Simon Fraser University, Buraby, British
3
Columbia, Canada, University of Alberta,
4
Edmonton, Alberta, Canada, Schlegel-University
of Waterloo, Research Institute for Aging,
Waterloo, Ontario, Canada
Objectives: Poor food intake is common among
residents of LTC and may be influenced by the
physical dining environment. DEAP is a
standardized content valid and reliable instrument
that assesses dining spaces.
Methods: M3 is a cross-sectional, multi-site study
with data collected from 83 dining spaces in 32
LTC homes in New Brunswick, Ontario, Manitoba
and Alberta. As part of the M3 study, DEAP was
completed by four trained observers once for each
dining space. Key categories in DEAP are spatial
characteristics, safety and security, functional
ability, table arrangement to support social
interaction and homelikeness.
Results: Prevalence of key environmental features
were: ≥75% of residents with a garden view (59%);
contrast between table and dishes (68.3%); no
television in dining area (67.5%); private family
dining room (33.7%); dining room is open between
meals (78.3%); plenty of lighting (48.2%);
residents' opinions are respected and responded
to regarding light, noise and temperature (51.8%);
homelike room size (36.4%); short pathway for
meal delivery (36.4%); no restraints (56.2%),
multiple seating arrangements (8.43%); no
obstacles or clutter in dining area (37.4%); and a
clock present in the dining room (83.1%). The
mean homelikeness score was 4.5, on a scale of
1-8, with 30% of the homes receiving a moderate
to high score (6 -8).
Conclusions: LCA allowed differentiation between
multimorbidity clusters that were characterized by
unique chronic condition profiles. Identifying such
clusters may provide useful information about the
need for health services.
Conclusion: DEAP described a range of key
physical environmental features of dining spaces
that potentially influences residents' mealtime
experience in M3 sites. Future research will
determine if these features influence food intake in
residents. (Supported by Canadian Institutes of
Health Research)
P185
P186
Making Most of Mealtimes (M3) Project: The
Dining Environment Assessment Protocol
(DEAP) for Evaluating Homelikeness
Prevalence of Modified Texture Diets in
Canadian Long Term Care Homes
183
1
3 ,2
Vanessa Vucea , Lisa M. Duizer , Alison M.
3 ,2
4
Duncan , Christina O. Lengyel , Catriona M.
5 ,6
1
2 ,1
Steele , Jill M. Morrison , Heather H. Keller
1
2
Canada, Schlegel-University of Waterloo,
Research Institute for Aging, Waterloo, Ontario,
3
Canada, University of Guelph, Guelph, Ontario,
4
Canada, University of Manitoba, Winnipeg,
5
Manitoba , Canada, Toronto Rehabilitation
Institute–University Health Network, Toronto,
6
Ontario, Canada
Objectives: Prevalence of modified texture diets
(MTD) is elusive, with estimates from Western
nations ranging between 15-30%. Differences in
terminology and inclusion of only selected textures
(e.g. pureed) in the definition of MTDs limits our
understanding of prevalence. The aim of this study
was to describe the current prevalence of
prescribed MTDs in Canada using standardized
terminology.
P187
60 days to functional mobility decline in newly
admitted nursing home residents with
dementia
1 ,2
2 ,1
Charlene Chu , Katherine McGilton
1
2
University of Toronto, Toronto, Canada, Toronto
Rehabilitation Institute - University Health Network,
Toronto, Canada
Background: Nursing home (NH) residents with
dementia experience physical inactivity and
consequently functional mobility decline over 12 to
52 months. However, the short-term trajectory of
mobility decline in this population remains unclear.
Objective: To assess changes in functional
mobility, activities of daily living (ADL) function, and
quality of life (QOL) in newly admitted NH residents
with dementia over a 60-day period.
Methods: Making the Most of Mealtimes (M3)
study is a cross-sectional multi-site study that has
collected data from 639 residents in 32 LTC homes
in four Canadian provinces (AB, MB, ON, NB). Use
of MTDs was identified from health records and
confirmed with mealtime observations. Homes
used a variety of terms to describe MTDs. Diets
were re-categorized using the International
Dysphagia Diet Standardization Initiative (IDDSI)
Framework: regular, soft, minced and moist,
pureed, and liquidized. Descriptive statistics
summarized prevalence.
Methods: A prospective one-group pre-test/posttest design was used. All newly admitted
ambulatory NH residents with a diagnosis of
dementia were eligible. The study was conducted
in two NHs in Toronto, Canada. Validated
measures were used to assess functional mobility
(2-Minute-Walk-Test [2MWT], Timed-Up-And-Go
[TUG]), ADL function (Functional Independence
Measure [FIM]) and QOL (Alzheimer-related-QOL).
A descriptive qualitative approach was used to
describe NH staff and families' perceived barriers
to providing physical activity (PA) to residents.
Results: MTDs were prescribed to just under half
(47%, n=298) of residents. Specific MTD
prescriptions included minced and moist (22%,
n=139; NB=26%, n=42; MB=22%, n=35; ON=21%,
n=33; AB=18%, n=29); soft (14%, n=91; AB=29%,
n=47; MB=14%, n=22; NB=11%, n=17; ON=3%,
n=5); pureed (11%, n=68; NB=16%, n=25;
AB=12%, n=19; ON=11%, n=17; MB=4%, n=7);
and liquid (<1%, n=3).
Findings: Residents' (n=26) mean age was 87
(range=74-100; MMSE=15; 77% female) with a
mean of 6 co-morbidities. There was significant
decline in the TUG (-3.4 seconds, P=0.006), FIMmotor, and FIM-cognition (P=0.000, P=0.000) in
60-days. There was decline in the 2MWT (-7.6
meters, P=0.141) and QOL (P=0.066) but the
decline was not statistically significant. Families
identified the monotony of the NH environment,
untailored and unstimulating PA activities, and lack
of staff as barriers to providing PA, whereas staff
predominantly identified their lack of time.
Conclusions: This is the first Canadian study that
used a diverse sample of LTC residents to
determine prevalence of MTDs. Prevalence of
prescribed MTDs was found to be high and diverse
across Canada and can be used to inform policy.
Further research will explore use of MTD and food
intake. (Supported by Canadian Institutes of Health
Research).
Conclusions: Functional mobility and ADL
function can significantly decline in a 60-day
period. Future studies should evaluate the
feasibility and efficacy of individualized PA
interventions to maintain mobility related outcomes
in this population.
184
P188
Family Caregiver Perceptions of Technologies
to Support Community-Dwelling Older Adults
with Dementia
1
2
3
Debra Sheets , Cheryl Beach , Andrew S. Mitz ,
1
1
Sandra R. Hundza , Stuart MacDonald , Carl
1
1
1
Asche , Brent Gali , Julie Gorenko
1
2
Canadian Institute for Health Information, Victoria,
3
BC, Canada, National Institute of Mental Health,
National Institutes of Health, Bethesda, MD, USA
Over 2.7 million Canadians are family caregivers;
they are “the backbone of home care” and provide
more than three-quarters of the care needed by
older adults (CIHI, 2010). Caregiving is a
demanding role and the demands increase over
time. Recent technologies have great potential to
reduce caregiver burden, including reduced
homecare support hours needed.
Purpose: This project explores family caregiver
needs and priorities and investigates preferences
for technologies that can safely support caregiving
functions.
Method: Structured interviews, 1 hour in length,
were conducted with 8 family caregivers, a
convenience sample, caring for older adults with
dementia who were receiving homecare.
Questions focused on gathering detailed
information on caregiving needs, attitudes towards
technologies, and preferences for support.
Descriptive analyses were run as well as thematic
coding for qualitative data.
Results: Caregivers of older adults with dementia
report high levels of caregiver burden. Participants
were interested in technologies to support
caregiving but were unaware of many existing
technologies. Caregiver preferences point to the
need for technologies that are easy to use,
function automatically, and provide simple,
informative alerts.
Implications: Implementing technologies widely
requires understanding caregiver attitudes and
priorities.
P189
Off-Label use of Antipsychotics in Elderly
populations in Quebec: a trans-sectional study
Hamzah Bakouni, Helen-Maria Vasiliadis
Centre de recherche HCLM- Université de
Sherbrooke, Longueuil, Canada
Introduction: Reports have shown that the
prevalence of off-label use of antipsychotic
medications can reach up to 65%. Little is known
on the determinants of antipsychotic off-label use
in older adults.
Objectives: To determine the prevalence of offlabel antipsychotics use in a community living older
adult population in Quebec, and to explore the
different factors related to off-label prescriptions.
Methods: We used data from (n = 1657) older
adults living in the community with MMSE score
>21 and participating in the (Enquête sur la Santé
des Aînés) ESA-study. Off-label use of antipsychotics (yes/no) was identified via
administrative databases (RAMQ : Régie
d'assurance Maladie du Québec) where the
absence of a diagnosis of both schizophrenia (
[ICD-9-CM] code 295) and bipolar disorder (ICD-9CM codes 296.0, 296.1, 296.4-296.8) was
indicative of off-label use.Multinomial logistic
regression modelling was used to assess the
association between off-label and on-label
antipsychotic use and the socio-demographic and
clinical factors.
Results: The prevalence of antipsychotics in this
study sample reached 3.3%, where 94% was offlabel. As The use of antipsychotics overall was
positively associated with antidepressant use (OR:
7.36; 95%CI: 3.89 - 13.92) and negatively
associated with cognitive status (OR: 0.84; 95%CI:
0.72 - 0.99). Off-label use as opposed to non-use
was positively associated with antidepressant use
and chronic diseases. On-label use as opposed to
non-use was positively associated with male
gender.
Conclusions: Off-label prescription of
antipsychotics is common among old adults in
Quebec. Further study of the determinants of offlabel indications is recommended in older adults.
P190
Neuropsychological test performance in
patients with normal Montreal Cognitive
Assessment (MoCA) scores
185
1
1
Sofia Nene , Marie-Eve Charbonneau , Anne1
3
Catherine Fontaine , Véronique Martel , Francis
2
3 ,4
Langlois , Christian Bocti
1
Université de Sherbrooke - Faculty of Medicine,
2
Sherbrooke, Canada, Memory Clinic, Institut
universitaire de gériatrie de Sherbrooke (IUGS),
3
Sherbrooke, Canada, Division of Neurology,
Department of Medicine, Centre Hospitalier
Universitaire de Sherbrooke (CHUS), Sherbrooke,
4
Canada, Research Center on Aging, CSSS-IUGS,
Sherbrooke, Canada
Introduction: The Montreal Cognitive Assessment
(MoCA) is a valuable tool in the assessment of
cognition. A score ≥ 26 usually indicates normal
cognitive functions, but neuropsychological testing
(NT) may still demonstrate a deficit in some cases.
Objective: To compare results for 4 cognitive
domains on standard NT for individuals with
“normal” MoCA scores.
Examining the benefits of and the challenges of
implementing intergenerational volunteer
programs involving students and older adults
in long-term care
1
1
2
Stephanie Blais , Lynn McCleary , Linda Garcia ,
2
Annie Robitaille
1
Brock University, St Catharines, Canada,
2
University of Ottawa, Ottawa, Canada
Objective: This review examines the benefits and
challenges of implementing intergenerational
volunteer programs involving students and older
adults in long-term care homes.
Method: A comprehensive search of CINAHL,
Web of Science, Google Scholar, and a university
library was undertaken. Peer reviewed journal
articles, book, and grey literature was utilized.
Results: Sixty-two patients (mean age: 66,3 ± 10,1
years; average schooling: 13,6 ± 3,5 years) were
included. Results demonstrate that NT established
a cognitive deficit in: 20 % for memory, 19% for
language, 12 % for visuospatial ability, and 2% for
executive functions. MoCA subtests showed an
area under the receiver operating characteristic
curve (AUC) for the corresponding
neuropsychological tests of 0,71 for memory and
0,77 for EF, but MoCA subtests were not as
sensitive for language or visuo-spatial deficits.
Results: Twelve journal articles, three books, and
four reports were located. They described and
evaluated programs with high school students,
post-secondary students, or both. Many studies
evaluated time-limited volunteering, four with
extended volunteer commitment beyond three
months. Benefits to students were the
development of new social skills and acquisition of
new knowledge. The advantages for the residents
were an increase in quality of life and social
interaction, a decrease in the level of depression,
and having a feeling of connectedness with
society. Residents preferred reciprocal interactions
and the opportunity to contribute to student
learning. Meanwhile, some of the drawbacks for
students were the fear of getting too emotionally
involved and issues of transportation. Likewise,
some residents were apprehensive that students
would not be able to accommodate their sensory
impairments, which they feared would alter their
communication. Volunteer screening, formal
training, support for volunteer skill and knowledge
development, and resident involvement in program
planning were important for program success.
Conclusion: Detailed NT reveal cognitive deficits
in up to 20% of patients with “normal” MoCA
scores (memory and language domains). This has
the potential to alter diagnostic and management
plans. Clinicians should not be “falsely” reassured
by a normal MoCA score.
Conclusions: Despite challenges of implementing
these programs, the literature indicates that
intergenerational volunteer programs have benefits
for both residents and students. Future research is
needed to confirm findings with stronger and larger
controlled studies.
P191
P192
Methods: A convenience sample of 730 patients
referred to the Memory Clinic of Sherbrooke
between 2007 and 2015 was screened. From this
cohort, we selected patients with a MoCA score of
26 or more who underwent standardized NT within
6 months. We established a Z-score in each major
cognitive domain based on published norms:
memory, language, visuospatial (VS) and
executive functions (EF). Z-scores at or below z= 1.5 was considered indicative of a deficit.
186
A systematic review of internet-based
interventions for caregivers of older adults:
critical appraisal of components and outcomes
1 ,2
Cassioppée Guay , Dominique Gélinas1 ,2
3 ,2
1 ,4
Bronsard , Sarah Ahmed , Louise Demers ,
5 ,8
6 ,7
Jeffrey William Jutai , William Ben Mortenson ,
6 ,7
1 ,2
Bill Miller , Claudine Auger
1
Université de Montréal , Montréal, Québec,
2
Canada, Center for Interdisciplinary Research in
Rehabilitation of Greater Montreal , Montréal,
3
Québec , Canada, McGill University , Montréal,
4
Québec, Canada, Institut universitaire de gériatrie
de Montréal, Montréal, Québec, Canada,
5
6
University of British Columbia , Vancouver, British
7
Columbia, Canada, GF Strong Rehabilitation
Center, Vancouver, British Columbia, Canada,
8
Bruyère Research Institute, Ottawa, Ontario,
Canada
Background: Using internet-based interventions
to support caregivers of older adults can offer an
efficient and accessible alternative to traditional
face-to-face interventions. However, little is known
about the existing links between the components
of such interventions and their outcomes on
caregivers.
Objective: To explore which components of
internet-based interventions generate the best
outcomes when remotely supporting caregivers of
older adults.
Methods: A systematic review of evidence from
2000 to July 2015 was performed. Studies had to
1) report on an intervention delivered mainly using
the Internet, 2) report on caregiver-specific
outcomes, 3) include at least one care recipient or
caregiver older than 50 years and 4) score high
level of evidence according to the Grading of
Recommendations Assessment, Development and
Evaluation criteria. Components of interest were:
content, multimedia use, interactive online
activities (e.g. self-administered questionnaires)
and provision of support and feedback. Outcomes
were categorized as having an effect on
psychological factors (e.g. mood, anxiety) or on
mediating factors (e.g. self-efficacy, coping
strategies).
Results: For 12 retained studies, preliminary
analysis reveals that web-based human support,
either from professionals or peers, is associated
with positive caregiver outcomes such as a
decrease in negative mood. Moreover,
customization of educational content leads to
greater gains in self-efficacy and a reduction in
depressive and anxiety symptoms.
Conclusion: This systematic review highlighted
two components of internet-based interventions
that can positively affect psychological and
mediating factors of caregiving. Results will inform
the development of a future online platform for the
monitoring and training of caregivers of older
adults.
P193
What do community dwelling seniors know
about financial and legal decision making
capacity? A study
1 ,2
2 ,3
Frances Carr , Michelle Valpreda
1
2
University of Alberta, Edmonton, Canada, Alberta
3
Health Services, Edmonton, Canada, Royal
Alexandra Hospital, Edmonton, Canada
Objectives: The objectives of this qualitative study
were to assess understanding of decision making
capacity in community dwelling seniors with a
specific focus on legal and financial domains, and
to explore methods of communication of financial
and legal decision making in people with aphasia.
Method: Three focus groups were conducted with
each group consisting of four to nine
participants. Discussions were based on 26
questions assessing understanding of capacity,
including financial and legal decision making, and
communication methods. Feedback was obtained
for a newly created visual capacity aid that would
be used to assist the assessment of financial and
legal capacity in persons with aphasia. Focus
groups were audio taped with transcription and
hand coding.
Results: Of the 19 participants recruited, 17 were
included. Common themes included; a basic
understanding of general, legal and financial
capacity, reasons for pursuing capacity,
implications to capacity assessments, and forms of
communication. Lack of awareness regarding the
process for assessing capacity, and a lack of
understanding for the term aphasia was
identified. Feedback obtained from the visual
capacity aid revealed the need for consistent
pictures and sensitivity to individual interpretation.
187
Conclusion: Whilst there is a general
understanding around decision making capacity
and communication, there remains a lack of
knowledge regarding capacity assessment
process. The visual capacity aid has the potential
to aid in the assessment of financial and legal
capacity. These results support the need for future
research in this area, along with modification and
validation of our visual capacity aid.
P194
Theory-informed development of the Getting
Older adults OUTdoors (GO-OUT) program: An
intervention designed to improve outdoor
walking in older adults who infrequently walk
outdoors
1
2 ,1
2
Nancy Salbach , Ruth Barclay , Sara Braun ,
1
3
4
Dina Brooks , Theresa Grant , Allyson Jones , Lisa
2
5
2
Lix , Nancy Mayo , Jacquie Ripat , Cornelia
2
2
vanIneveld , Sandra Webber
1
2
3
Canada, Bruyère Research Institute, Ottawa,
4
Ontario, Canada, University of Alberta, Edmonton,
5
Alberta, Canada, McGill University, Montreal,
Quebec, Canada
Objectives: To develop a theory- and evidenceinformed intervention to improve outdoor walking in
community-living older adults who infrequently
walk outdoors.
Method: Theories informing intervention
development included a framework describing
environmental dimensions of community mobility
(distance, temporal factors, ambient conditions,
physical load, terrain, attentional demands,
postural transitions, and traffic density); strategies
for increasing self-efficacy; and task-specific
training. Empirical evidence informing intervention
development included systematic reviews of speed
and distance requirements for and interventions to
improve community ambulation; an empirically
derived model of community ambulation poststroke; and results from focus groups with people
post-stroke on outdoor walking programs for
individuals with mobility impairment.
Results: A two-component intervention was
developed. During a 1-day workshop, 18
participants will circulate through eight, expert-led
stations to increase knowledge and skill related to
physical activity recommendations, goal-setting,
equipment (pedometers, Nordic poles), footwear,
falls prevention, exercise intensity monitoring,
posture and balance exercises. Subsequently,
individuals will participate in a 3-month, supervised
outdoor walking group. A maximum group size of
nine participants and a supervisor-to-participant
ratio of 1-to-3 will optimize safety and
accommodate different ability levels. One-hour
sessions, twice-a-week, will include a warm-up,
walking in increasingly challenging built and
natural environments to build capacity for outdoor
ambulation, and a cool-down. Use of experts,
groups and task-specific training, were designed to
improve skill, self-efficacy, motivation, and social
support and reduce fear for personal safety.
Conclusions: This process exemplifies the use of
theoretical and empirical evidence to develop a
complex intervention to improve outdoor walking in
older adults who infrequently walk outdoors.
P195
Can Sensors Help Determine Pressure Ulcer
Risk?
1 ,3
3
Frank Knoefel , Stephanie Bennett , Louise
2
2
3
Carreau , Ambika Dewan , Rafik Goubran
1
Bruyere Research Institute, Ottawa, Canada,
2
Bruyere Continuing Care, Ottawa, Canada,
3
Objective Ongoing pressure applied to skin can
cause capillary compression, decreased
oxygenation, and skin breakdown. The resulting
pressure ulcers (PU) typically occur in cases of
reduced mobility and pre-existing vascular and
skin conditions, and cause morbidity/mortality.
Pressure mat sensors (PMS) provide the ability to
monitor pressure continuously. Infra-red (IR)
cameras can help identify micro-circulation
patterns. This project compares data from these
technologies in the context of PU risk.
Methods Data was collected from a 70 year-old
female Complex Continuing Care in-patient with
diabetes, heart disease, peripheral vascular
disease, dialysis and high PU risk. A PMS (S4
Sensors Inc.) was placed under the mattress below
the feet. An IR camera (FLIR Systems Inc.)
captured skin temperature. The images were
processed using custom software (SB). The mat
data was converted to a mean sum of pressures
using custom software (SB) - representing
cumulative pressure amount.
188
Results This patient typically slept with the L foot
rotated externally. The PMS confirmed a larger
pressure area around the L lateral malleolus. IR
comparisons of the lateral malleoli of the L and R
feet showed a significant temperature difference
(28 C vs. 31 C).
Conclusions We found a relationship between
regular increased pressure on the lateral foot
(PMS) and reduced skin temperature (IR). We
believe that we are the first to combine these 2
sensors to suggest that immobility results in
decreased microcirculation in the context of PU
risk. If replicated, using PMSs may provide a novel,
automated way of measuring pressure ulcer risk.
P196
Factors affecting caregiver burden: Canadian
Longitudinal Study on Aging
Yoko Ishigami, Emily Skrastins, Susan Kirkland
Dalhousie University, Halifax, Canada
Objectives: In light of the looming challenges of
aging-related caregiving expected over the next
two decades, our objective is to describe factors
affecting the current burden of caregivers, who are
also aging.
Method: To provide a description of the current
burden on caregivers, we conducted a preliminary
analysis on data from the Canadian Longitudinal
Study of Aging (CLSA). The baseline CLSA survey
was administered to a representative sample of
more than 20,000 participants between the ages of
45 and 85.
Caregiver burden is associated with characteristics
of the patient, including their age, sex, and
relationship with the caregivers, but it is also
associated with the characteristics of the caregiver,
including caregiver age and sex, and the amount
of time spent on caregiving tasks. Descriptive
statistics were used to provide an overview of
these factors.
Results: The mean age of the participants (N =
21,241, Female 51.0%) was 60 years (SD = 10.7).
Among the participants, 45% provided assistance
to another person. Among the care-receivers, 69%
were female, 64% did not live with the caregiver,
and 29% were parent of the caregiver. The
caregivers tended to be female (55%), between
50-70 years old (55%), married (70%), and have at
least bachelor’s degree (46%). Mean number of
hours/week providing assistance was 51 (SD =
182).
Conclusions: Our preliminary analysis gives an
insight into the current burden of caregivers: who
they are and to whom they provide assistance. The
next step will include analysis to determine mental
and physical health outcomes for caregivers.
P197
Model-based recursive partitioning to identify
risk clusters for metabolic syndrome and it
components: Findings from the International
Mobility in Aging Study
1
1
Yan Yan Wu , Catherine Pirkle , Maria-Victoria
2
3
Zunzunegui , José Fernando Gómez Montes
1
University of Hawai'i at Manoa, Honolulu, Hawai'i,
2
USA, Institut de recherche en santé publique,
3
Montréal, Québec, Canada, Universidad de
Caldas, Manizales, Colombia
Objective: Explore risk clustering for metabolic
syndrome (MetS) and its components using data
from the International Mobility in Aging Study
(IMIAS) of community-dwelling older adults
(N=1587) from Kingston and St Hyacinthe
(Canada), Tirana (Albania), Manizales (Colombia),
and Natal (Brazil).
Methods: We employ model-based recursive
partitioning (MOB) to cluster participants into ageadjusted risk groups based on variabilities in the
following partitioning (explanatory) variables: sex,
living arrangements, smoking, childhood adversity,
education, income and work status. MOB is a datadriven method that integrates parametric statistical
models into classification trees. It allows for
modeling of non-linear relationships and
automated detection of interactions among
partitioning variables.
Results: 29% of IMIAS participants had MetS.
Participants clustered solely by study site and sex,
with the greatest MetS prevalence estimated for
women from Natal and Tirana (52%) and the least
among men and women from Kingston (18%). With
regards to MetS components, elevated estimated
blood pressure measures were concentrated
among income-insufficient participants from Tirana
and Natal. The greatest waist circumference
values were clustered among income insufficientparticipants from Kingston, Tirana, and Natal. The
189
greatest estimated triglyceride concentrations were
clustered among those with low education from
non-Canadian sites. Elevated glycosylated
haemoglobin clustered in participants from Natal,
while the lowest HDL cholesterol cluster was
estimated for men from Tirana and Manizales.
Conclusions: This work identifies distinct
combinations of risk variables that may jointly
influence metabolic syndrome risk and can inform
less data-driven methods of testing for effect
interaction.
P198
How much time do older adults spend in bed?
1 ,2
3
Frank Knoefel , Sarah Robichaud , Maged
2
3 ,1
3
Makramalla , Martin Bilodeau , Heidi Sveistrup ,
4
3 ,1
1
Theresa Grant , Jeff Jutai , Caroline Gaudet ,
2
Rafik Goubran
1
Bruyere Research Institute, Ottawa, Canada,
2
3
Carleton University, Ottawa, Canada, University
4
of Ottawa, Ottawa, Canada, Bruyere Continuing
Care, Ottawa, Canada
Objective: In the elderly, sleep disturbances are
associated with depression, cognitive impairment
and some chronic diseases. Historically research
on sleep has used questionnaires or a sleep lab.
Recently actigraphy has measured hours of sleep,
but little is known about time in bed (TiB).
Pressure-sensitive mat (PSM) technology can
unobtrusively monitor bed occupancy. We used
PSMs to observe TiB patterns of older adults.
Methods: 22 older adults (77.1 yrs, 18 females)
from Ottawa, Canada had an S4 Inc. PSM installed
under their mattress at home for 3 -12 consecutive
months. Data from the PSM was recorded
continuously (20 Hz). An algorithm determined bed
occupancy over 24 hour s. Means and standard
deviations (SD) of TiB were calculated.
Results: Analysis was completed on five
participants (average 75.0 yrs, range 65-83 yrs, 4
females). Over 790 nights, they spent an average
of 8.7 hours in bed. Individual variability, quantified
using SD, ranged from 0.9 to 2.4 hours/day.
Conclusions: We believe this is the first project to
monitor older adult TiB data continuously over an
extended period of time in the home. Older adults
show significant variability in the time they spend in
bed. Further work will be needed to explore the
factors that affect time in bed. Combining TiB data
and sleep time may provide richer sleep
information about sleep habits. Adding other
clinical parameters such as breathing and bed
mobility may allow the development of smart beds
which could become core components of
technology to support aging in place.
P199
OA-Involve project: Finding the Best Practices
for Active Involvement of Older Adults in AGEWELL’s Aging and Technology Research and
Development
1
1
2
Yoko Ishigami , Izabela Panek , Karla Stroud ,
1
3
4
Ellen T. Crumley , Lupin Battersby , Pia Kontos ,
2
3
Kieran O'Doherty , Judith Sixsmith , Susan
1
Kirkland
1
Dalhousie University, Halifax, NS, Canada,
2
University of Guelph, Guelph, ON, Canada,
3
4
The use of technological supports within a
comprehensive model of care for older adults
(OAs) can increase their ability to maintain
independence. Assistive technology can also
reduce the burden on caregivers and result in
health care cost savings. However, many OA’s do
not take up technologies because they do not fit
their needs and preferences. Engaging OAs early
in the process of technology research and
development (R&D) has shown promising results,
including the increased likelihood of technology
uptake and better product development. The
objective of our project (OA-INVOLVE) is to
determine and facilitate best practices for active
OA involvement in AGE-WELL, a National Centre
of Excellence focusing on technology and aging
network in Canada.
In this paper we present an OA engagement
process, including planning, recruitment and
training strategies for OA participation as codesigners/collaborators/consultants involved at
every stage of research and development to
ensure that 1) research questions that drive
studies are relevant, 2) research designs and
methods are appropriate, and 3) the interpretation
of data is focused on how technologies improve
peoples’ everyday lives.
OA-INVOLVE applies an innovative method based
on participatory action research, working closely
with projects within AGE-WELL, their OA
190
participants, partner organizations, and advisory
groups of OAs across Canada. We report on
facilitators, barriers, lessons learned, and solutions
to enhance recruitment and meaningful
engagement of OA.
and therefore should to be considered as first-line
therapy. Caution should be used in interpretation
of findings as few trials were included, risk of bias
was variable, sample sizes were small and pooled
treatment effects were small to moderate.
P200
P201
Interventions for treating pain in nursing home
residents: A systematic review and metaanalysis
Dementia and end-of-life care
1 ,2
3
Jennifer Knopp-Sihota , Pooja Patel , Carole
2
Estabrooks
1
Athabasca University, Edmonton, Alberta,
2
3
Canada, University of Toronto, Toronto, Ontario,
Canada
Objectives: To assess the analgesic efficacy of
interventions for reducing pain in nursing home
residents (>65 years) with acute or chronic pain.
Method: Using Cochrane techniques, we searched
for controlled trials comparing and measuring pain
interventions using standardized pain scales. Two
reviewers independently selected, abstracted data
and assessed risk of bias of included studies. We
preformed meta-analyses calculating standardized
mean differences (SMDs) using a random effect
model.
Results: Fourteen trials (n=2293) were included in
the meta-analysis: seven reported non-analgesic
treatments, four reported analgesic treatments, five
reported system modifications and two reported
educational interventions. A variety of pain scales
were used reporting outcome measures from 1
week to 1 year. Pooled results, at trial completion,
revealed a statistically significant small treatment
effect (SMD -0.33, 95% CI=-0.51, -0.14). Further
subgroup analysis revealed residents who
received analgesic interventions benefited the
most (SMD -0.65, 95% CI= -1.07, -0.23) followed
by educational interventions (SMD -0.40, 95% CI 0.59, -0.21) and system modification interventions
(SMD -0.26, 95% CI -0.51, -0.02). There were no
statistical differences between non-analgesic
treatment and control groups.
Conclusions: Treating pain of nursing home
residents is complex and interventions ought to be
multi-factorial based on type of pain, co-morbidity
and resident preference. Our finding suggests
analgesics are the most effective pain intervention
Mary Schulz
Alzheimer Society of Canada, Toronto, Ontario,
Canada
Dementia is a progressive illness that will
eventually lead to death. Because dementia is very
different than other fatal illnesses, the needs of
people with this disease at the end of life are
unique and require special considerations. While it
is human nature to avoid talking about sad and
difficult topics such as end of life, people impacted
by dementia are hungry for practical, reliable
information about what to expect at this stage.
The Alzheimer Society of Canada has developed
an online resource in English and French to help
families supporting a person with dementia
prepare for end of life, make difficult decisions, and
cope with grief and loss.
This resource provides strategies to help
individuals with dementia and their families have
conversations about death and the person's
wishes for end-of-life care as early in the disease
as possible, and includes practical information
about what to expect when death is near.
Individuals with dementia and family caregivers
can take an active role in ensuring that the end of
life care is in accordance with the person's wishes,
beliefs and values. Families can overcome barriers
to good end-of-life care for people with dementia
and avoid commonly reported problems, and
inappropriate use of aggressive treatments that
may compromise the quality of care at the end of
life.
P202
Social support makes all the difference in
small, rural, and aging communities
Elizabeth Russell
Department of Psychology, Trent University,
Peterborough, ON, Canada
191
There is a strong association between seniors'
social support and health. Seniors in small towns
and rural and remote communities in
Newfoundland and Labrador (NL) are particularly
vulnerable to challenges in maintaining social
networks, given outmigration and distance from
larger centres. Seniors lacking social support are
more likely to be unable to age in place and
require institutional living, may have more severe
impairment or mobility challenges, and may
experience role identity absences. Conversely,
seniors' social involvement is positively related to
longevity, and can protect or create new role
identities. This study sought to examine the a)
impact of age-friendly programming on seniors'
experience of social support, and, b) the impacts of
social support on seniors' health and well-being.
Qualitative research was conducted in small, rural
communities in NL experiencing population aging,
and who were implementing age-friendly
programming. Focus groups and interviews were
conducted with a sample of a) 35 age-friendly
committee members in 11 communities, and b) 43
seniors who participated in programming in four
rural towns. Findings suggest that the social
support provided by involvement in age-friendly
programming benefitted seniors' health and wellbeing. Involvement in age-friendly organizations or
events provided seniors with a new network of
support, and enhanced physical and health
outcomes. In particular, these supports benefitted
seniors who tended to increasingly remain in their
homes more often. This presentation will discuss
the specific benefits of social support resulting from
involvement in age-friendly programming on
seniors' health, well-being, and ability to age in
place.
P204
An Evaluation of the Daily Diary Method for
Assessing Staff-Family Caregiver Conflicts in
Nursing homes
Candace Konnert, Calandra Speirs, Camille Mori,
Ana Petrovic-Poljak
Department of Psychology, University of Calgary,
Calgary, Canada
Nursing homes can be stressful environments with
a high potential for conflict between staff and
family caregivers. To date, research on this topic
has relied on retrospective accounts that are
influenced by recall biases. The daily diary method
(DDM) has the advantage of assessing conflict in
(almost) real time. The purpose of this study was to
investigate the feasibility of the DDM for assessing
family caregivers’ reports of conflict with staff and
the relationship between conflict and mood. Nine
female caregivers were contacted by telephone at
a predetermined time for 14 days over a 2-week
interval (mean age=59.67, SD=9.46). Each day,
participants indicated whether a conflict had
occurred in the previous 24-hour period, described
the severity and type of conflict, and rated their
positive and negative affect on the PANAS.
Compliance was excellent with no attrition and only
2 missing data points over 126 potential
observations. Conflict occurred on 22% of the days
and was rated as moderately severe (mean=2.62,
SD=.94) on a 5-point Likert scale. Independent ttests compared conflict and no-conflict days and
found significant differences on both positive
(p<.05) and negative mood (p<.001) in the
expected directions. Exit data indicated that the
majority of participants (88.9%) did not find the
study too time-consuming or inconvenient and
strongly preferred the telephone over other
potential platforms (e.g., smart phones). These
results support the feasibility of the DDM in
assessing staff-family conflict and would ideally be
used in conjunction with other outcome variables
to evaluate interventions to improve staff-family
relationships.
P205
Seniors in the Suburbs: Perspectives and
experiences of belonging and community
connection for health and wellbeing
1
1
1
Sonya Jakubec , Marg Olfert , Liza Choi , Nicole
2
1
Dawe , Dwayne Sheehan
1
2
Mount Royal University, Calgary, Canada, Vivo
for Healthier Generations, Calgary, Canada
While much has been explored about notions of
both place and belonging in regards to community
health of various populations, little is known of the
phenomena specific to seniors living in the
suburbs. More and more seniors are living in
suburban neighborhoods, communities that do not
tend well to the belonging needs for this
population. It is timely to explore the views of
seniors and to understand their connection to
communities. This qualitative study sought the
perspectives of suburban dwelling seniors about
the role of belonging and community connection to
their health and wellbeing. Informed by strengthsbased approaches to community development and
health, this study engaged people from three
north-east Calgary community groups (a seniors'
192
recreational/walking group, and two seniors'
cultural groups - Chinese and Punjabi seniors) in
focus group interviews concerning the topic. These
findings are important to inform decision making
and programme development for seniors in the
areas of recreation, leisure, health services,
community policing, city planning and other
services.
P206
Greener generations: Planting seeds for
community inclusion through a participatory
campus-community horticultural therapy
program
1
1
A 2015 initiative to revitalize an underutilized
campus community garden engaging with seniors
from the surrounding community has planted
seeds for community inclusion and belonging. This
presentation describes the participatory action
research (PAR) project that involved community
stakeholders from seniors and community mental
health rehabilitation groups supported by a
horticultural therapy intervention. Guided by ecohealth and permaculture principles, a number of
data sources (including individual/group interviews
and observations) were analyzed to explore
experiences planting the seeds of revitalization
through inclusive community gardening. New
foundations for understanding seniors' community
health, wellbeing and inclusion as connected to
eco-health principles were uncovered in the
project. Finally, this presentation highlights how the
project influenced intersectoral practice and
planted seeds for community engagement and
citizenship across otherwise disconnected
community groups.
P207
Problem and goal: Even if NGO work in the field
of older adult mistreatment is highly valued,
including volunteers work, seldom are the studies
looking at issues associated with this type of
practice. This paper aims to present the results of
5 case studies on NGO practice, including
volunteer practice, to counter material and financial
mistreatment of older adults.
Results: NGO are facing a series of issues related
to recruiting and training of volunteer,
accountability, sustainability, etc. There is a
tendency to a professional transposition of
competencies form work to volunteer in this type of
action (several former police officers). Volunteer
are mainly involved in prevention and sensitisation
activities. They are less involved in follow-ups
which are done by practitioners or coordinators.
Seniors highly value the services of NGO's they
ask for more financial counselling including more
legal awareness and coaching.
Conclusion: We encountered a series of
recruitment issues in this project that need to be
discussed. Funding of NGO's is a real challenge.
Next step is the production of a practice guide in
order to support NGO's.
P208
Do we need a global symbol for Dementia
Friendly Communities?
1 ,5
NGO'S and volunteer actions to counter
material and financial mistreatment of older
adults
2
2
U. Sherbrooke, Sherbrooke, QC, Canada, U.
3
Laval, Québec, QC, Canada, UQTR, TroisRvières, QC, Canada
Method: 5 NGO's were selected to conduct the
case studies (4 in Québec and 1 disperse all
around Canada). Data collection included
interviews with board members (19 participants), 3
practitioners, 6 coordinators, 19 volunteers and 9
older adults who received accompaniment, so 56
interviews in total. All 5 case studies were
separately analysed. The analysis was exposed
and discussed with each NGO. Then, the analyses
were compared between the 5 cases.
Sonya Jakubec , Joanna Szabo Hart , Sonya
1
1
1
Flessati , Judy Gleeson , Genevieve Currie ,
1
2 ,1
Elaine Schow , Janet Melrose , Alana-Dawn
1
Eirikson
1
Mount Royal University, Calgary, Alberta,
2
Canada, Calgary's Cottage Gardener, Calgary,
Alberta, Canada
1
1
2
Marie Beaulieu , Andrée Sévigny , Sophie Éthier ,
2
1
isabelle Maillé , Jessica Calvé , Jordan Bédard1
3
3
Lessard , Julie Fortier , Hélène Carbonneau
2 ,5
3
Clare Walton , Laura Booi , Kristine Newman
,5
4 ,5
, William Hu
1
UK Alzheimer's Society, London, England, UK,
2
3
Ryerson University, Toronto, Ontario, Canada,
4
5
Emory University, Atlanta, Georgia, USA, World
Young Leaders in Dementia, WYLD, UK
193
Dementia Friendly communities empower people
with dementia to have high aspirations and feel
confident, knowing they can contribute and
participate in meaningful. Dementia Friendly
initiatives are emerging around the world and
many of them use a symbol or a brand to promote
their activities.
Some dementia advocates have highlighted the
need for a Dementia Friendly symbol that has
global recognition. This could connect Dementia
Friendly efforts across regions and countries and
help people with dementia and caregivers to
recognize the symbol when they travel. The World
Young Leader in Dementia (WYLD) have
completed a review of Dementia Friendly symbols
currently in use around the world and collected
attitudes towards the concept of developing a
global Dementia Friendly symbol.
Survey responses were received from 21
representatives of 16 countries, 15 of which have
at least one Dementia Friendly initiative in place. A
wide range of symbols are already in use. No
survey responders rejected the idea of a global
Dementia Friendly symbol. Fewer people favoured
a global symbol (29%) than a global theme or
element (67%), i.e. a colour, logo or design that
can be incorporated into existing symbols or
adapted for different regions. A second
consultation gave an opposite view, with 65% of
responders favouring a global symbol and 28%
favouring a global element or theme. A key reason
for this difference could be a separation of views
between nations that already have a wellestablished symbol and those that do not. Further
results from WYLD’s scoping review will be
presented.
P209
Secondary data analysis and moral political
theories : epidemiology and social justice
among ageing populations
Kathleen Cruttenden
University of New Brunswick, Moncton, Canada
The purpose of this proposed secondary data
analysis is to identify clinical and social
determinants of health (SDH) with 5 Populations
composed of 123 older adults in 4 Atlantic
Provinces (ASHRA, Focus Groups, 2007). Use of
secondary data analysis will support the
development of new social scientific and
methodological understandings of health (Irwin,
2013). A training period will take place with a small,
interdisciplinary group to learn to analyze audio
data in relation to moral political theory. Initially,
data from one Population participating in a Focus
Group from the Atlantic study as teaching and
learning to understand and moral political theories.
Further, others have observed that social
determinants of health raise 2 categories of
philosophical problems: one concerning ethics,
and the other to the philosophy of health and social
justice (Venkatapuram & Marmot ((2009). The
theories include Rawls (1987) two principals of
moral political theory, Agger's (1998) critical
theory, and social learning theories. Thorne's
Interpretive Description method will guide this
clinical and social analysis. The clinical theory is
based on what Sandelowski refers to as 'classical'
methods of grounded theory, ethnography and
phenomenology (Forward, p.12, 2008).
Populations and epidemiology relate to Rawls
justice as fairness or equity. Populations and
justice as fairness may analyze the scope of
bioethics beyond individual patients or persons.
Epidemiology will consider the clinical causes and
social responses of ill-health among the
populations to address the social determinants of
Health. In fact, Venkatapuram and Marmot (2009)
have shown the need for epidemiology and social
justice to come together to address social
determinants of health to meet the WHO challenge
(2011).
P210
An interprofessional approach to implementing
and sustaining best practices in geriatic care
Calen Freeman, Lisa Sokoloff, Angie Troyer,
Raquel Meyer, Rosea Casem, Rachna Chaudhary
Baycrest, Toronto, ON, Canada
Objectives In 2012, Baycrest was selected as a
Best Practice Spotlight Organization© (BPSO)
candidate by the Registered Nurses' Association of
Ontario (RNAO). This opportunity encouraged
Baycrest to explore innovative ways of
incorporating evidence-based clinical knowledge
into practice. An interprofessional group was
formed to implement RNAO Best Practice
Guidelines (BPG) related to Delirium, Dementia
and Depression in Older Adults.
Method The objective was to develop resources
and tools for building organizational capacity to
recognize and respond to clients at high-risk for
delirium and depression (DD). This included
194
establishing a structured approach to screening;
capacity building to implement caregiving
strategies; and developing policies and
procedures.
The Patient Health Questionnaire and the
Confusion Assessment Method were the
assessment tools chosen to support best practices
in the early identification of individuals with DD.
Integration of the tools within the electronic health
record (EHR) supports implementation and
evaluation, teamwork, prompts clinicians to
consider potential interventions and supports
adherence to organizational policy and procedure.
Results Through the intensive efforts of
interprofessional clinicians, two BPG's have been
implemented successfully across targeted units. In
2015, Baycrest was designated as a BPSO© by
the RNAO. Practice changes have been sustained
through orientation, Clinical Skills Day, tools
embedded in the EHR, and on our BPSO intranet
site. A policy has been drafted to support these
practice changes. It is currently under review for
approval.
Conclusions With strong leadership and
organizational support, Baycrest has been able to
implement and sustain evidence-based practice
changes relating to DD.
P211
Optimizing Resident Care and Quality of Life
with Environmental Enhancements
1 ,2
2 ,3
Iris Gutmanis , Catherine Blake , Steve
3
Crawford
1
St. Joseph's Health Care London, London,
2
Ontario, Canada, Western University, London,
3
Ontario, Canada, McCormick Home, London,
Ontario, Canada
Background In November 2014, all long-term care
homes (LTCHs) in the South West LHIN were
invited to apply for one-time funding (maximum
$5000) for evidence-based environmental
enhancements focused on decreasing/preventing
responsive behaviours. Following a peer-review
process, successful applicants were notified in
January 2015. Projects were to be completed by
March 31.
Methods The 74 participating LTCHs were
surveyed six months after project completion and
asked: if their enhancement decreased targeted
responsive behaviours; to describe lessons
learned; to share feedback from residents and
family members; to indicate if they would
recommend this project to other homes; and to
suggest factors that would ensure success
elsewhere.
Results Forty-two (56.8%) homes purchased
multi-sensory equipment, 16 (21.6%) purchased
expressive therapy equipment, 16 (21.6%) created
more home-like settings, and 13 (17.6%)
camouflaged exit points. Fifty-two homes
responded to the survey (70.3% response rate). All
felt their project was transferable, valuable, and
had a positive impact on their residents. The
enhancements resulted in: decreased responsive
behaviours; increased staff and resident
engagement and quality of life; reduced
depression; and enhanced communication among
residents, their family members and staff. A
number of homes reported that communication
with both residents and staff regarding why
projects were chosen and their expected impacts
was key to success.
Conclusions LTCHs are committed to enhancing
their environments and demonstrated that even
relatively small monetary investments can
significantly enrich the lives of residents and their
families. Project feedback will assist in the planning
and implementation of similar projects should
future funds become available.
P212
Lived experiences of aging immigrants: A
narrative-photovoice project
1
1
Kaylee Sohng , Shimmon Hutchison , Alexandra
1
1 ,3
1 ,3
Lang , Shari Brotman , Ilyan Ferrer , Sharon
2
2
Koehn , Melissa Badger
1
2
McGill University, Montreal, QC, Canada, Simon
Fraser University, Vancouver, BC, Canada,
3
CREGES, Montreal, QC, Canada
Objectives: This poster presents the results of a
narrative-photovoice project on the life stories of
older immigrants living in two Canadian provinces.
The objectives included (1) deepening our
understanding of the diverse lived experiences of
immigrant older adults (those who immigrated in
later life and those who immigrated earlier and
have aged in Canada), and (2) elaborating a
framework that maps the intersections of identity,
195
social location, and structural discrimination on
aging experiences across the lifecourse.
Methods: Data in this three-year qualitative study
were collected using a critical life story narrative
approach in combination with photovoice. 18
Caribbean, Latin American, Afghani, Pakistani,
Korean, and Filipino immigrant older adults were
interviewed about their lives and experiences of
immigration and aging. Participants received
cameras to photograph their lived experiences and
perspectives.
Results: Findings reveal factors impacting the
immigrant aging experience, including language
barriers, income (in)security, family and
transnational relationships/obligations, work,
retirement, health, social isolation, community
engagement, and sense of fulfillment in life.
Photographs provided visual documentation of
significant places, objects, and people that embody
the struggles and rewards of aging. Each
photograph is accompanied by a participant
narrative reflecting its meaning.
Conclusions: Our study uncovers significant
heterogeneity among immigrant older adults and
common structural stressors that deserve attention
from policy-makers and service providers. The
results highlight the community sector as an outlet
for engagement, information and social
connection, and the role of government in funding
services and programs to support older immigrant
adults.
P213
Exploring the Role of 'Information Burden' in
the Experiences of Family Caregivers for Older
Adults
Raza Mirza
University of Toronto, Institute for Life Course and
Aging, Toronto, Canada
With the onus of care for the elderly shifting onto
informal caregivers in Canada, older adults may
often be accompanied by their caregivers to
medical visits. In order to optimize care and to
participate in healthcare decision-making for the
older patient, caregivers are often privy to
significant health information. This may include
personal details about the patient previously
unknown to the caregiver, information about
advance care and end-of-life planning, and a 'bad
news' diagnosis. However, a commonly overlooked
issue in geriatric practice is the amount of
information that caregivers must acquire and
manage as patients get older and more dependent
on them. Caregivers, often deemed the 'invisible
second patient', may feel inundated with the health
information shared and feel unprepared,
vulnerable and in need of healthcare support
themselves. Using a qualitative research design,
49 in-depth interviews with 23 caregivers of older
adults were conducted over a year. Our results
illustrate how caregivers often provide care and
conceal information from loved ones at the
detriment to their own health and social well-being.
Interview data highlights the complexity of
managing health information with some gender
differences in caregiving experiences. Results
suggest that caregivers sometimes felt emotionally
compromised when making objective healthcare
decisions, and that 'too much information' resulted
in information burden, conflict and a desire to
override patient wishes out of compassion and
fear. These findings may impact care by illustrating
that caregiver involvement should trigger further
dialogue between doctors, elderly patients and
their caregivers, especially with respect to
information sharing boundaries.
P214
Changes in frailty over time among adults with
intellectual and developmental disabilities
2
1
Lynn Martin , Katherine McKenzie , Helene
1 ,3
Ouellette-Kuntz
1
Queen's University, Kingston, ON, Canada,
2
Lakehead University, Thunder Bay, ON, Canada,
3
Ongwanada, Kingston, ON, Canada
Objectives: Using a retrospective, longitudinal
research design, this study examined the factors
associated with changes in frailty status in a
population of adults with intellectual and
developmental disabilities (IDD) receiving home
care services in Ontario.
Methods: Analyses were based on populationlevel information on long-stay home care clients
between 2003 and 2015. Individuals with IDD
between the ages of 25 and 99 years of age with
an initial home care assessment followed by
another assessment within six to nine months were
included in our cohort (n=1,243). A frailty index (FI)
developed for a population with IDD, using 42
items from the Resident Assessment InstrumentHome Care (RAI-HC), indicated frailty status.
196
Frailty was categorized as non-frail (FI≤0.21), prefrail (0.21< FI≤0.3), and frail (FI>0.3). A change in
frailty category indicated a transition.
Results: Most individuals were non-frail at
baseline (67%), and after controlling for age and
sex, frail individuals were more likely to receive
multiple medications and to have limitations in
activities of daily living, and less likely to live in a
group home. At the next assessment, most
individuals had not changed frailty groups (75%),
while 14% showed improvement and 11%
worsened.
Conclusions: Frailty can be measured in adults
with IDD using aging care, and furthermore, can be
used to better understand how individuals' status
changes over time. This tool, embedded in the
routinely collected interRAI assessments, could
improve policy and planning to promote aging in
the community for this vulnerable population.
P215
Preserving Personhood of Older Adults Living
in Homes and Institutionalized Settings: A
Comparative Study
Remani Rabindranath
The purpose of this study is to compare how
personhood of older adults living in institutions and
in private dwellings is preserved. Due to the
differences between the roles of informal and
formal care, this study explored how these care
providers contribute to preserving older adults’
personhood. Issues and challenges that exist as
barriers to providing effective person-centered care
and suggested approaches and strategies which
can improve person-centered care, were
identified. A comprehensive literature review of
twenty-one current journal articles was conducted
focusing on the topic of preserving personhood of
older adults. Results showed that family members
play key roles in home settings as well as longterm care settings in preserving personhood.
Informal care providers, the care recipient and
formal care providers all influence how the
outcomes are achieved related to preserving
personhood. Organizational structures that are
centered around traditional a bureaucratic and
medical model and the lack of staff training and
education on personhood both present as major
barriers (Palmer 2013). Another barrier cited in the
literature review was staffing models where the
ratio of care aides to residents directly influenced
relationship with older adults (Ford and
McCormack 2000). As a result person-centered
care is currently not a normative practice in longterm care facilities. Suggested approaches and
strategies to improve person- centered care are
highlighted including transforming culture of longterm facilities where relationships are valued along
with ongoing staff education on person-centered
care.
P216
Developing an evidence-based tool to evaluate
successful implementation of an online frailty
assessment for primary health care providers
1
1
1
Grace Warner , Beverly Lawson , Victoria Law ,
2
2
1
Melissa Buckler , Stephanie Wood , Caitlin Lees
,2
1 ,2
, Fred Burge
1
2
Dalhousie University, Halifax, Canada, Nova
Scotia Health Authority, Halifax, Canada
Objective: To use an implementation science
framework to develop quantitative and qualitative
tools for identifying factors affecting successful
implementation of a web-based frailty assessment
tool for primary health care.
Methods: The Consolidated Framework for
Implementation Research (CFIR) has identified key
domains (setting, intervention, process, and
characteristics of individuals) that affect successful
implementation of novel interventions. Semistructured interview guides and survey tools were
developed based on CFIR domains, and an
iterative process was used to create appropriate
questions for the tools. Qualitative interviews were
conducted with individuals at different levels of
involvement in implementation. Qualitative
framework analysis examined whether the CFIR
domains were relevant to participants and if there
were key factors not covered by the tools.
Quantitative descriptive analysis of surveys looked
at CFIR factors related to provider implementation.
Results: Semi-structured interviews may provide a
more accurate assessment of implementation
feasibility. However, a strong foundation in the
CFIR is necessary to interpret how interviewees’
experiences relate to the framework. Response
rate for provider surveys was low, making
quantitative analysis less conclusive. Key factors
driving successful implementation appear to be
training on the web-based assessment tool and a
197
personal motivation to improve care for frail older
adults.
Conclusion: The piloted tools are an important
first step toward being able to identify factors that
affect successful implementation of innovative
interventions. The tools are well positioned to be
used as a quality assessment of novel
interventions to identify aspects of the intervention
that need to be modified.
P217
Widowhood and Psychological Well-Being
among Chinese Older Adults
1
4
3
2
Joohong Min , Yawen Li , Ling Xu , Iris Chi
1
2
University of Southern California, LA, CA, USA,
3
University of Texas at Arlington, Arlington, TX,
4
USA, San Diego State University, San Diego, CA,
USA
Objectives. This study aimed to document the
effect of widowhood duration on psychological
well-being, focusing on the role of social
engagement and financial strain.
Methods. Using a nationally representative sample
of older adults from China in 2006, we examined
the association between widowhood duration and
psychological well-being. We tested the effect of
financial strain and social engagement in the
association between widowhood duration and
psychological well-being.
Results. We found widowhood duration is
significantly related to psychological well-being. In
addition, Social engagement and financial strain
were significant factors which moderate the
relations between widowhood duration and
psychological well-being. Specifically, long-term
widowed older adults with higher financial strain
had significantly lower life satisfaction. This was
not significant for depressive symptoms.
Discussion. It is important to consider the financial
context of widowed older adults and its long-term
effect on psychological well-being among Chinese
older adults. Widowhood duration and types of
psychological well-being are also important to
consider in widowhood studies.
P218
If You Look For It, You Will Find It: Families'
Role in Breast Cancer Treatment DecisionMaking Among Older African American Women
Shadi Martin
McGill University, Montreal, Quebec, Canada
Although mortality rates from breast cancer
increase for all women with age, the mortality rates
are highest among older African American women,
due to the combination of age and ethnicity.
Inadequate decisions regarding treatment have
been identified as one possible factor contributing
to cancer disparities. Studies suggest that family
members play an important role in helping older
African American women make decisions about
breast cancer treatment. The purpose of this study
was to understand the family’s role in the decision
making process when older African American
women are confronted with breast cancer. These
findings are part of a larger study of breast cancer
decision making among older African American
women and their family members. A qualitative
phenomenological approach was utilized in this
study. In-depth interviews were conducted with 15
older African American women (45 and older) who
had been diagnosed with and received treatment
for breast cancer and 15 family members as
identified by the patients. This report focuses
specifically on experiences of the family members.
The Emerging themes include: 1) family’s desire
for more aggressive treatment, 2) family member
concern for own health, 3) family’s opinion of the
doctors, 4) husbands less engaged in cancer care,
5) if you look for it, you will find it. The findings of
this study can have implications for family-focused
interventions that would enhance the decision
making process for breast cancer treatment among
older African American women.
P219
Exploring The Intersectional Dynamics
Between Two Cohorts of Older Women Living
on their Own in a Small Town in Rural Australia
Pamela Irwin
Institute of Population Ageing, Oxford, UK
A 12-month ethnographic fieldwork study explored
the dynamic inter-relationships between two
cohorts of older women living on their own in a
small town in rural Australia. The naturally
occurring groups consisted of older old (aged 80
years and older) widows who were long-term
residents, and newcomers–late middle-aged (aged
198
55 to 65 years) divorcees who had relocated to the
town within the past five years. For each cohort,
the community acted as an arbiter of belonging
and social worth, assigning differential values
according to predetermined social identities and
social roles. Even though the older old women
were locals, their marginalised social positioning
left them with a limited and relational social
identity, yet required that they retain their service
to the town. Conversely, late middle-aged women
were systematically curtailed from fully
participating and contributing to the community,
because they were designated as unwelcome
outsiders. In effect, the older old cohort was
deemed socially invisible, while the late middleaged group, without a purpose, were rudderless.
However, when the older old women perceived
their social role and value to the town to be under
threat from the late middle-aged women, they
mounted a concerted campaign to protect their
turf. By contrast, the younger women attempted to
establish a more favourable social identity for
themselves in contradistinction to the older old
women and younger unemployed people. As such,
the social relations between the two cohorts of
women represented a volatile tension around their
relative positionality that served to reinforce the
town’s exclusionary structural practices.
P220
Examining and Understanding Meaningful
Social Engagement and Social Connectedness
Among Lebanese Muslim Canadian Older
Adults
Nada Chams, Carri Hand, Suzanne Huot
With the projected increase in the older adult
population in Canada and the exponential rise of
immigrants to Canada, there is a critical need to
explore whether immigrant older adults experience
aging differently in comparison to their Canadianborn counterparts. Relatively few studies focus on
examining and understanding immigrant older
adults in Canada and even fewer explore aging
Arab immigrants in particular. With no known
studies of older Lebanese immigrants’ social
engagement and connectedness, the objectives of
this study are to: understand what it means to be
an aging, Lebanese immigrant in Canada; and
if/how meaningful social engagement and
connectedness shape their experiences.
Constructivist narrative inquiry will be used to
provide direct insight into the diverse lived
experiences of Lebanese Muslim men and women
who came to London, Ontario during the 1960s
and decided to stay and age in the city.
Participants will be involved in two in-depth
narrative interviews in which they will be asked to
narrate their experiences of connecting with others
within the community, now and over time. This
study will inform a deeper understanding of the
experiences of these participants and enable a
better understanding of how their immigration
experience has shaped their lives as they age.
This study will also help identify factors that have
assisted or hindered their connectedness with
others within the community. This research study
will provide novel findings on how these individuals
stay socially engaged and connected within their
community, giving insight into their possible
struggles and strategies to overcome social
barriers.
P221
End-of-life preparation: a comparison of gay
men and lesbians
Sarah Paterson, Áine Humble
Mount Saint Vincent University, Halifax, Nova
Scotia, Canada
This study will provide an in-depth analysis of the
similarities and differences between older gay men
and lesbians in how they think about and prepare
for end of life preparation. This analysis will also
incorporate the role that technology plays in this
preparation process. This qualitative study, based
in a Canadian context, will consist of secondary
data analysis of 8 focus groups (collected in 4
cities) from the research project "Fostering End-ofLife Conversations, Community, and Care among
LGBT Older Adults. The content analysis will be
informed by minority stress and intersectionality
theory.
P222
Considering Professional Quality of Life (PQoL)
framework for LTC
Jenna Johnstone, Colleen Whyte
Brock University, St. Catharines/ Ontario, Canada
199
Research on the quality of work life in long-term
care (LTC) homes shows growing systemic issues
including stress related to managing and dealing
with continuing and complex health conditions,
overwhelming time constraints and high caseloads,
with lack of support related to staffing. Literature
indicates that these stressful experiences can have
a downward spiral effect and transfer to other
facets of our lives, including personal health and
wellness, and relationships with others
(Fredrickson, 2009). Working under these
conditions, and being in close proximity to human
suffering and vulnerability exposes professionals to
great emotional risk, and has led researchers to
conclude that LTC homes are breeding grounds for
compounded stressors.
Professional Quality of Life (PQoL) is a well-known
concept among health care professionals (Stamm,
2010) yet the framework and its two main
components of compassion fatigue and
compassion satisfaction have not been fully
explored in the LTC literature. According to the
framework, health care providers are exposed
negative aspects of traumatic stress such as
vicarious and secondary trauma, and when
coupled with burnout, leads to the development of
compassion fatigue (Stamm, 2010). Alternately,
positive feelings and experiences from being in a
helping role is known as compassion satisfaction
(Stamm, 2010). This review of literature will
demonstrate the potential of incorporating this
framework into LTC practice to better understand
how to support a positive working environment and
ultimately improve quality of care.
P223
The effect of health on retirement rates by age
and gender in Canada, 1976-2014
1
1
2
Yves Carrière , Jacques Légaré , Janice Keefe ,
1
Judith Lefebvre
1
2
Université de Montréal, Montréal, Canada, Mount
Saint Vincent University, Halifax, Canada
The effective age of retirement has gone through
different stages since the mid-1970s. It first
declined quite significantly up until the mid-1990s
before taking a significant upturn. Longer life
expectancy and the likely improvement in the
health status of older adults may have played a
role in this latter trend. This poster presents trends
in retirement rates by age and gender for health
reasons between 1976 and 2014, and estimates
the role that these decreasing retirement rates
played in the recent increase in the effective age of
retirement.
Data from the Labour Force Survey are analysed
to estimate retirement rates for health reason by
age and gender. The trend in these rates is
compared to the trend in mortality rates to
determine any link between the two. Different
scenarios are proposed to demonstrate the effect
that health trends could have on the future of
working life expectancy. These scenarios are
based on recent health trends observed in OECD
countries among the 45-69 age group.
Although the ratio of retirement rates for health
reason to mortality rates by age are lower among
men, women have experienced a significant
decrease in these ratios while men have
experience fairly constant ratios by age over time.
If improvements in mortality rates translate into
better health and lower retirement rates for health
reasons, then working life expectancy, other things
being equal, would increase. These results have
significant implications for labour force planning,
policies to support older workers and so on.
P224
« Tout le plaisir est pour vous! » : un nouveau
programme de promotion de la santé visant à
favoriser le maintien de la pratique d'activités
signifiantes chez les aînés
2 ,1
1 ,2
Chloé Aquin , Claudé Vérité-Aubry , Johanne
1 ,2
Filiatrault
1
Centre de recherche de l'Institut universitaire de
gériatrie de Montréal, Montréal, Canada,
2
Objectifs : Plusieurs études établissent une
association entre la participation à des activités
signifiantes et la santé des aînés. La pratique
d'activités signifiantes présente toutefois certains
défis pour les aînés avec l'apparition de limitations
physiques. Malgré l'existence de stratégies
compensatoires pour défier les obstacles à la
pratique d'activités signifiantes, des études
suggèrent que celles-ci sont relativement peu
connues des aînés. Ce projet visait à développer
un programme de promotion de la santé pouvant
être offert en groupe par des pairs et ciblant le
maintien des activités signifiantes chez les aînés.
Méthode : Une recension des écrits relatifs aux
activités signifiantes et aux stratégies
200
compensatoires a guidé l'élaboration d'une
première version du programme. Le programme
initial a été développé par des ergothérapeutes,
dont une chercheuse en promotion de la santé et
une étudiante de 2e cycle en ergothérapie.
Résultats : Le nouveau programme (Tout le plaisir
est pour vous!) traite du bien-être, du
vieillissement, des activités signifiantes et des
moyens pour maintenir la pratique d'activités
signifiantes. Il comprend 6 séances de groupe de
90 minutes chacune. Des mises à l'essai
successives du programme permettront d'explorer
ses effets et de déterminer la faisabilité de
l'implanter en résidences pour aînés et d'autres
milieux communautaires.
Conclusions : Le programme a le potentiel de
contribuer à maintenir la santé et le bien-être des
aînés en les sensibilisant à l'importance des
activités signifiantes et en les outillant sur les
moyens de maintenir leur engagement dans ces
activités avec le vieillissement.
P225
Evaluation of NICE Elder Abuse Tools
1
2
3
Lynn McDonald , Marie Beaulieu , Gloria Gutman ,
4
1
5 ,6
Karen Kobayashi , Karen Lau , Sander Hitzig ,
1
Raza Mirza
1
Institute for Life Course & Aging, FactorInwentash Faculty of Social Work, University of
2
Toronto, Toronto, ON, Canada, Université de
3
Sherbrooke, Québec, QC, Canada, Simon Fraser
4
University, Vancouver, BC, Canada, University of
5
Victoria, Victoria, BC, Canada, St-John’s Rehab
Research Program, Sunnybrook Research
Institute, Sunnybrook Health Sciences Centre,
6
Toronto, ON, Canada, York University, Faculty of
Health, School of Kinesiology and Health Science,
7
Toronto, ON, Canada, University Health Network,
Toronto Rehabilitation Institute, Toronto, ON,
Canada
Objective: As part of a larger project, The National
Initiative for the Care of the Elderly (NICE)
developed evidence-based pocket tools to address
elder abuse (EA). However, there has been no
formal evaluation of the EA tools. To address this
gap, the current study examines the impact of
NICE EA tools.
Methods: A random sample from the NICE were
recruited to participate in a telephone survey on
their knowledge about NICE tools, and asked
specific questions on the tool they used most
often. Instrumental (how they use the tools),
conceptual (how the tools have impacted their
knowledge), and symbolic (how the tools have
confirmed their actions/decisions) impact were
assessed.
Results: Four-hundred and thirty-eight NICE
members were recruited (79.7% practitioners;
7.5% students; 4.5% older adults/informal
caregivers; 8.2% unknown). Of those, 254 were
familiar with NICE pocket tools, and 74 reported
using EA tools the most. Of the EA tool users (N
=74), 46% indicated the tools had an instrumental
impact (i.e., information in the EA tool changed
their daily work practices; they adopted
ideas/actions from the tool). With regard to
conceptual impact, 31% responded the tools
improved their knowledge on EA and influenced
their work practices. Finally, 45% reported the EA
tools confirmed their actions at work and helped to
justify their decisions to co-workers and clients.
Conclusions: The findings suggest that NICE EA
pocket tools are having a moderate conceptual,
instrumental and symbolic impact and influence on
knowledge construction and practices related to
EA among multiple stakeholder groups.
P226
‘What story do you want to tell?': Stories about
aging written by older adults
Jessica Gish, Audrey Tan
Ageist beliefs and attitudes about older adults
proliferate in the mass media and are even found
in children's books. Arts-based participatory
research is a knowledge production tool used by
gerontologists to produce representations and
understandings of aging that resonate with older
people's lives and experiences. To explore the
ability of arts-based methods to create less ageist
children's stories, 6 older adults over the age of 60
were invited to write stories for children between
the ages of 3 to 9 about aging and late life. Indepth interviews were also conducted with
participants to explore their motivations for creating
the plot lines, characterizations, and imagery that
their stories depict. Content analysis finds that the
stories reproduce both traditional (age as decline)
and third age (active aging) discursive elements.
Participants' motivations for telling stories to young
201
children about aging fell into three categories: 1)
Informing children about the physical, social and
‘inner' realities of aging; 2) Teaching children to
respect older people; and, 3) Advising children
about how to grow old and live life well. Although
participants expressed the desire to create more
realistic depictions of aging, analysis suggests that
they struggled to translate these desires into reality
and lacked the cultural resources and narrative
templates to do so. Conclusions reflect on the use
of older adult authors to shift children's perceptions
about aging.
P227
Exploring the Cultural Factors that Influence
Breast Cancer Screening Behavior of Older
Emirati Women
Shadi Martin
Although more women are diagnosed with breast
cancer in US and UK, the breast cancer mortality
rate in the UAE is significantly higher than rates in
the U.S and the UK (Boehm, 2009). It is estimated
that forty-four percent of women diagnosed with
breast cancer in the UAE die from the disease
(Boehm, 2009). The high mortality rate of breast
cancer in the UAE has been associated with the
“cultural taboos which deter women from coming
forward for early diagnosis and screening”
(Underwood & Al Shamsi, 2008). The purpose of
this study was to gain a better understanding of the
cultural factors that influence breast cancer
screening behavior of older Emirati women. The
research method involved qualitative
phenomenological study, which elicited social and
cultural themes related to breast cancer screening
behavior through in-depth interviews. The themes
of misinformation about breast cancer, an
overabundance of trust in doctors, an ineffective
disclosure of cancer diagnoses, and the influence
of friends and family members on breast cancer
patients emerged. After our session, participants
may be able to gain better understanding of breast
cancer screening and treatment among Emirati
women, as well as have a more complete
comprehension of the cultural barriers that
contribute to high mortality rates. This research
has implications for breast cancer patients and
health care professionals in UAE and other
countries. In the face of such a shocking mortality
rate, this research has the potential to influence
medical practices in a way that will positively affect
breast cancer patients.
P228
Adapting programs to indigenous
perspectives: Developing a yoga program with
kanaka, for kanaka
1
2
Phoebe W. Hwang , Ilima Ho-Lastimosa , Vanessa
3
3
3
Keluholokai , Mabel Ho , Val Kim , Jane Chung1
Do
1
University of Hawai‘i at Manoa, Office of Public
2
Health Studies, Honolulu, HI, USA, God’s Country
3
Waimanalo, Waimanalo, HI, USA, Waimanalo
Ahupua‘a , Waimanalo, HI, USA
Native Hawaiians (NH) are the indigenous people
of Hawai‘i. Only 38.6% of NH and Pacific Islanders
in the United States met physical activity (PA)
recommendations compared to 45.8% of the total
population. Besides the lack of PA, NH experience
an unequal burden of chronic illnesses, and lowest
life expectancy compared to other ethnicities. It is
theorized that the forced assimilation of NH by their
colonizers is the root of their health disparity. NH
elders have perceptions towards health and wellbeing that are similar to other indigenous
populations, but different from their Caucasian
counterparts. Thus, evidence-based PA programs
proven effective in non-indigenous populations
often do not resonate with indigenous populations.
The purpose of this study is to explore the best
practices of adapting yoga to Native Hawaiian
elders. A focus group was conducted with Native
Hawaiian women age 50 and over who have
participated in an 8-week long yoga program in
their community. Major themes for a successful
yoga program were respect, spirituality, and
moving at your own pace. Participants felt that the
spiritual aspects of yoga aligned with their beliefs
and cultural practices. However, participants felt
that the Western adaptations of fast-paced yoga
did not. Therefore, traditional teachings of yoga
were preferred. Previous indigenous studies have
identified similar themes in other health areas. This
suggests the need for evidence-based programs
that align with an indigenous framework. Findings
from this study will inform future NH PA programs.
P229
Tackling exclusion through a peer-led social
program for persons with dementia and their
spouses
1
2
Darla Fortune , Janet McKeown
1
Concordia University, Montreal, Quebec, Canada,
2
University of Waterloo, Waterloo, Ontario, Canada
202
A diagnosis of dementia often results in a
diminution of leisure opportunities and exclusion
from social spaces, both for the individual who
receives the diagnosis as well as their spouse. It is
not uncommon for persons with dementia and their
spouses to withdraw from social situations to avoid
stigma and negative reactions from others.
Challenging these ideas, we describe a peer-led
community social program aimed at inclusion for
persons with dementia and their spouses. It is an
innovative example of spousal couples tackling
exclusion by addressing challenges of finding
meaningful leisure pursuits to enjoy together. As
part of research by the Partnerships in Dementia
Care Alliance, we conducted focus groups with
members of the social group to better understand
their need for, and experiences in the social
program. Findings highlight ways thoughtfully
designed leisure programs and spaces can bring
people living with dementia, who have traditionally
been marginalized and excluded, into community
life. Themes centred on common experiences and
shared understandings, the development of familylike relationships, strengths-based approaches,
and an emphasis on fun and celebration. We
present findings in the form of a composite
narrative that captures the shared journey of social
group members. We draw from this narrative to
suggest ways for researchers and practitioners
who are involved in helping create inclusive
spaces to work directly with persons with dementia
and their spouses, discover what they desire in
terms of inclusion within their communities, and
collectively determine what changes are needed to
improve access to leisure opportunities.
P230
Assess & Restore Workshops: Living the
Philosophy to Enhance the Care of Older
Adults
Andrea Rochon, Alysa Shaw, Caryn Langstaff
Providence Care, Kingston, Canada
The Assess & Restore (A&R) Workshops were
provided using an interprofessional approach for
51 staff of one patient care unit. Funding for the
Workshop was provided by the Local Health
Integration Network (LHIN).
The Workshop was developed based on the A&R
framework and guideline document. A&R
interventions are targeted to frail seniors who have
experienced a loss of functional ability following a
decline in health; are at high risk for imminent
hospitalization or admission into Long-Term Care
as a result of that functional loss; and have the
restorative potential to regain that functional loss.
The priority topics chosen were: pain;
polypharmacy; dementia, delirium and depression;
and responsive behaviours.
The overall goals of the Workshop were to improve
quality of care and patient outcomes through best
practice applications, and to enhance staff
knowledge and skill related to care of the older
adult. The Workshop was collaboratively
developed and delivered by the Program Educator,
the Program Manager, the Clinical Nurse Specialist
(CNS) (Gerontology), a Geriatrician, and staff from
the Centre for Studies in Aging and Health.
The education was delivered using multiple
modalities. Staff participated in presentations and
group activities, and worked through case studies
in order to enhance their knowledge and
understanding of the topics. The Workshop has
been recorded and will be archived. Relevant elearning modules were consolidated into an A&R
resource on geriatric syndromes. These tools will
support ongoing unit and corporate orientation.
Post-Workshop evaluations indicated positive
results and staff satisfaction.
P231
Increasing Retention Rate of Older Adults in a
Longitudinal Research Design: A Case Study
Ohad Green
Bar Ilan University, Ramat Gan, Israel
Objective: Retention of older adults in a
longitudinal research design is complicated. This
case study presents the efficacy of a retention
method, which was used throughout the course of
a 3-year longitudinal qualitative research project.
Methods: During the 3-years course of the
research, the researcher kept in touch with the 21
older adults and 16 family members regularly,
making the gap between each yearly interview as
minimal as possible. Phone calls were made on
birthdays and holidays, and a mid-term official
thank you letter was sent. Each interview was
preformed on the date, time and place which was
convenient to the participants.
Results: Only two older adults and one family
member refused to participate further after the 1st
203
interview. Only one older adult refused to
participate further after the 2nd interview.
Retrospective interviews with the respondents
revealed that the frequent contact with the
researcher made them feel that the researcher saw
them as "persons", and not merely as
"participants". The mid-term thank you letter was
also very valued by participants, as they expected
such gestures only at the end of the study, if at all.
They also mentioned the researcher
characteristics.
Conclusion: This case study emphasizes the
importance of an ongoing and close relationship
with the participants throughout the course of the
study. This cost-effective method can be
implemented in any research design.
who are not well served by more traditional models
of medical management. The evaluation identified
strengths of the program, as well as opportunities
for improvement.
Conclusions: The benefit of this approach to
proactively identify at risk older adults is discussed
and opportunities to expand the use of the
information gained by screening considered.
Community Paramedicine and front-line
paramedical interventions can play an important
role in supporting frail individuals to remain living in
the community.
P233
P232
The relationship between multimorbidity and
function: A prospective analysis
Evaluation of proactive screening by frontline
paramedics of older adults for loss of
independence
Verena Menec, Scott Nowicki, Philip St. John
The University of Manitoba, Winnipeg, Canada
Kelly McIntyre Muddle , Dustin Carter , Shelly
1
1
1
Billings , Jacobi Elliott , Elizabeth McCarthy
1
St. Joseph's Health Care (London), London,
2
Ontario, Canada, Middlesex-London EMS,
Objectives: Multimorbidity, or the co-occurrence of
two or more chronic conditions, has many
detrimental consequences. The objective of this
study was to examine, prospectively, the
relationship between different types of
multimorbidity clusters and function.
Objectives: Community Paramedicine is an
innovative model of community based health care
in which paramedics function outside their
traditional scope to facilitate access to care for
underserviced populations. In the MiddlesexLondon region of Ontario, in addition to emergency
care and transport, frontline paramedics are able to
refer high risk non-emergent individuals to a
number of community health care providers. This
project describes the development and evaluation
of a process to screen older adults for risk of loss
of independent function at the point of contact with
the Emergency Medical Services.
Methods: The study included 333 individuals aged
65 years or older residing in Winnipeg, Manitoba.
Participants were interviewed in 2007/08 and again
in 2010/11. Chronic conditions were measured by
asking participants if they currently had any one of
25 long-term health conditions. Function was
assessed with the 32-item function subscale of the
Late Life Function and Disability Instrument. The
subscale can further be divided into three
subscales: upper extremity functioning, basic lower
extremity functioning, and advanced lower
extremity functioning.
1
2
Methods: Semi-structured interviews were
conducted with paramedics (n=5) to explore their
experience with this approach to care. Quantitative
data related to number of individuals screened, risk
levels identified and types of referrals were
collected and analyzed. Qualitative and
quantitative data were collected concurrently and
analyzed separately using appropriate methods.
Results: This model of care addresses the need to
identify at risk older adults living in the community
Results: Multimorbidity clusters were identified
using Latent Class Analysis (LCA). Three
multimorbidity clusters emerged, one characterized
by low probabilities of having any one of the
chronic conditions, one with high probabilities of
having heart disease and diabetes, and one with
high probabilities of having arthritis/rheumatism
and back problems. Participants in the
arthritis/rheumatism and back problem cluster had
significantly poorer function overall and on the
three function subscales, relative to healthy
individuals. The relationship between the heart
204
disease/diabetes cluster and function measures
was less consistent.
Conclusions: The relationship between
multimorbidity and function differed depending on
the unique combination of co-occurring chronic
conditions, as well as the function measure. The
findings highlight the importance of differentiating
between types of multimorbidity clusters.
P234
Nurses’ Perceptions about the Use of
Continence Aids for Hospitalized Older Adults:
An Integrative Review
Marnie Colborne, Sherry Dahlke
Background: Physiological decline in older adults
can lead to increased incidence of incontinence.
Nursing staff often initiate use of continence
products with older patients in efforts to be efficient
with their time. Unfortunately, improper use of
continence products can result in skin breakdown,
infection, discomfort, and long-term negative
effects to older adults’ health, well-being,
independence, self-image, and comfort.
Objective: The purpose of this study was to
determine nurses’ perceptions about the use of
continence products on older adults admitted to
acute care settings.
Methods: An integrative review of the literature
was conducted using medical data-bases from the
years 1995-2015. Keywords include: nurse’
perceptions, nursing, older adults, continence,
evidence based practice, competence and
continence aids.
Findings: Common themes within the data include
lack of knowledge regarding continence aids, and
nurses’ rationale for using continence aids. There
is a paucity of knowledge about the factors that
influence nurses use of continence products.
Conclusions: Further research is warranted to
better understand factors that lead to the
prevalence of continence products. Alternative
strategies to maintaining continence among
hospitalized older adults are only possible when
underlying causes of the inappropriate use of
these products are understood.
P235
Interventions aiming at reducing acute care
transfers from long-term care facilities:
Preliminary overview of a systematic mixed
studies literature review
1 ,2
1 ,3
Deniz Cetin-Sahin , Matteo Peretti , Genevieve
4
5
1
Gore , Philippe Voyer , Brian Gore , Machelle
3 ,6
Wilchesky
1
Donald Berman Maimonides Geriatric Centre,
2
Montreal, QC, Canada, St. Mary's Research
3
Centre, Montreal, QC, Canada, Department of
Family Medicine, McGill University, Montreal, QC,
4
Canada, Life Sciences Library, McGill University ,
5
Montreal, QC, Canada, Faculté des Sciences
Infirmières, Université de Laval, Québec City, QC ,
6
Canada, Centre for Clinical Epidemiology, Lady
Davis Institute for Medical Research, Jewish
General Hospital, Montreal, QC, Canada
Objectives: The majority of acute health status
changes among long-term care facility (LTCF)
patients are potentially manageable within their
facility, and do not necessitate acute care transfers
(ACTs). To support this, interventions to reduce
potentially avoidable ACTs have been designed to
build LTCF capacity. Our aim is to synthesize the
current scientific literature pertaining to these
interventions.
Methods: We are conducting a systematic mixed
studies review by searching MEDLINE, CINAHL,
EMBASE, Social Work Abstracts, and other
relevant databases for primary studies using
quantitative, qualitative, and mixed methods. The
primary outcomes of interest are reduction in ACTs
and/or hospitalizations. Secondary outcomes
include reduction in adverse events. Qualitative
data pertaining to intervention components are
being extracted and coded using thematic
analysis.
Results: To date, 51 studies have been included.
Interventions are being categorized into the
following themes: enhancing care processes,
improving communication, increasing LTCF
capacity, promoting education, endorsing
organizational initiatives, adapting healthcare
payment models, and involving families in care.
Interventions could be comprised of multiple
components. Common features of all interventions
included continuity (through sustainability),
maintenance (e.g., timely updating of advanced
directives from admission until end-of-life),
collaborative interaction (both between LTCF
stakeholders and between institutions), and culture
205
change (commitment at both individual and
organizational levels).
medications can impact fall risk and perhaps
modify medication prescription.
Conclusions: This workprovides a preliminary
overview of capacity building processes to manage
acute clinical status changes in LTCFs. Study
inclusion and data extraction is in progress by two
independent reviewers. The full study results will
produce a comprehensive knowledge synthesis for
LTCFs considering these quality improvement
initiatives.
P237
P236
Examining the associations between alcohol,
medication and falls in Canadian older adults
1
2
Sarah Laberge , Emmanuel Lagarde , Philip
1
1
Bigelow , Alexander Crizzle
1
School of Public Health and Health Systems,
University of Waterloo, Waterloo, Ontario, Canada,
2
National Institute of Health and Medical Research,
University of Bordeaux, Bordeaux, AquitaineLimousin-Poitou-Charentes, France
Objectives: The purpose of this study is to
examine the role of alcohol and its interaction with
medications (e.g., antihistamines,
benzodiazepines, NSAIDs) on fall risk in Canadian
older adults (aged 65+).
Methods: We have disseminated a Canadian
survey on health behaviours and injury risk,
developed in collaboration with researchers at the
University of Bordeaux (France), who have
administered this same survey in France over the
past 25 years. The surveys are being distributed
through local and national networks (e.g. Canadian
Association for Retired Persons; Royal Canadian
Legion) via their member list-serve over the next
year. We anticipate survey responses of more than
10,000 participants in the coming year.
Results: General demographic variables will be
presented (e.g., age, gender, # of fallers) using
measures of central tendency (mean and S.D.)
and frequencies (valid percentages). The
prevalence of alcohol and its interaction with
medications (e.g., specific types, frequency of
usage) will be examined individually and together
in the context of falls, controlling for medical
conditions using multivariate logistic regression.
Pilot data will be presented at the CAG conference.
Conclusion: Study findings will raise awareness
among health providers about how alcohol and
Profiling Depression in Continuing Care
Patients in Nova Scotia
Samantha A. Libbus, Éric R. Thériault
Cape Breton University, Sydney, Nova Scotia,
Canada
In continuing care, the prevalence of depression
varies depending on the type and stage of the
patient's disease, their setting and their caregivers.
Despite the studies that have reported that over a
quarter of patients with advanced diseases suffer
from depression, only a minority of them receive
the necessary treatment.
As such, this study takes a quantitative approach
to examine the differences between patients and
depression in hope to provide a richer
understanding of depression among care patients
in Nova Scotia. Data provided by the Continuing
Care Reporting System by the Canadian Institute
for Health Information, this study utilised the
Resident Assessment Instrument (RAI), a
comprehensive assessment that measures health
and well-being, in those receiving institutionalized
care (n=7269; Mage = 84.4, SD=9.0).
In this sample 16.8% of older adults had
depressive symptoms. Results showed that
patients experiencing depressive symptoms had
significantly worse social, physical, and cognitive
impairment, and exhibit significantly more
aggressive behaviour. It was also found that there
is a lack of evaluation done by a mental health
specialist for those experiencing depressive
symptoms. In conclusion, it is necessary for health
care professionals to examine not only to the
physical health of a patient, but also the mental
health; depression is something that cannot be
overlooked and believed to be inevitable for people
who are facing illness. Continuing care in Nova
Scotia attempts to give the best quality of life to
their patients, but might possible if mental health
isn't addressed.
P238
Vitamin K distribution in male and female Lou/c
rats during development and aging
206
1
1
Guylaine Ferland , Bouchra Ouliass , Pierrette
2
Gaudreau
1
Centre de recherche, Hôpital du Sacré-Coeur de
2
Montréal, Montreal, QC, Canada, Laboratory of
Neuroendocrinology of Aging, Centre Hospitalier
de l’Université de Montreal Research Center,
Introduction: Discovered for its role in blood
coagulation, vitamin K (VK) is now known to be
involved in bone, cardiovascular and energy
metabolisms as well as brain function. In SpragueDawley rats, we have shown differential tissue
distributions of the K vitamers phylloquinone (K1)
and menaquinone-4 (MK-4) as a function of sex,
age, and diet. The LOU/c rat is a model of healthy
aging characterized by longer lifespan free of
disease, low adiposity, and preserved metabolic
functions. Here we present the tissue VK
distribution of LOU/c rats.
Methods: Young (Y 4-7 mo), Old (O 24-32 mo)
and Very-Old (VO 39-42 months) male (M) and
female (F) LOU/c rats (n=6) were used for this
study. K1 and MK-4 were assessed in
hippocampus, frontal cortex, cerebellum, pons
medulla, striatum, liver (L), pancreas (P), heart (H),
kidney (K), and adipose tissue (AT), by HPLC.
Results. In all brain regions and in H, K and P,
MK-4 was the main K vitamer whereas a mixture of
K1 and MK-4 was observed in AT and L. In all
tissue investigated, the effect of sex was minimal.
Except in L, total VK tended to increase as a
function of age (Y vs O and VO, p<0.05),
especially in F rats ; in VO M rats, total VK tended
to decrease (ns).
Conclusion. Whether the observed age-related
changes in VK tissue distribution are linked to the
phenotype of this rat strain remains to be
determined. Funded by the Quebec Network for
Research on Aging.
P239
Évaluation du fer sérique chez des personnes
âgées hospitalisées. Étude cas-témoins
1 ,3
2
3
3
S Belbraouet , N Chau , H Biaudet , A Tébi , G
3
Debry
1
Université de Moncton, Moncton, Canada,
2
3
INSERM, Paris, France, CNH, Nancy, France
Objectif: Évaluer les concentrations sériques en
fer des personnes âgées hospitalisées atteintes de
différentes maladies en comparaison avec des
témoins de même âge en bonne santé vivant à
domicile.
Méthodes: L'évaluation des niveaux de fer sérique
est réalisée sur 668 personnes âgées (>70 ans)
hospitalisés et 104 témoins de même âge.
Résultats: Les sujets en bonne santé ont des
niveaux de fer sérique sensiblement plus élevés
(1.02 ± 0.23 mg/L) que les sujets malades, toutes
catégories de maladies confondues (0.69 ± 0.28
mg/L). 48.4% du groupe hospitalisé présentaient
des niveaux faibles de Fe (<0.65 mg/L) alors que
seulement 3.8% des témoins sains sont déficients.
Conclusion: Les personnes âgées en bonne
santé ne sont pas à grand risque de carence en
fer. Les concentrations de fer sérique observées
chez les sujets âgés hospitalisés sont
vraisemblablement plus liées aux maladies qu'aux
processus de vieillissement en soi.
P240
Promoting Community Safety for Persons with
Dementia: The Impact of the Finding Your
TM
Way Program on Safety Knowledge
1
2
1
Cathy Conway , Loretta Hillier , Felicia White ,
1
David Harvey
1
Alzheimer Society of Ontario, Toronto, Ontario,
2
Canada, St. Joseph's Health Care London,
Objectives: Getting lost poses a significant threat
to safety of persons with dementia (PWD), with the
potential for injury and death. The Finding Your
TM
Way program is a community-wide program to
increase awareness and reduce risk of missing
person events among PWD. This presentation
describes the program and the impact of
awareness-raising seminars on safety.
Methods: Participants completed surveys
assessing the impact of the seminar on selfreported knowledge of the risks of living with
dementia, how to respond in a missing person
event, how to speak with a PWD who may be lost,
and how to promote community safety (3-point
scale: know less now, no change, know more
now). Intentions to apply new knowledge was
207
measured with a 5-point scale (strongly disagree to
strongly agree).
Results: Sixty seminars were delivered over a 6month period, with 831 in attendance; 366 surveys
were completed across 35 seminars (70%
response rate). Respondents were community
members (54%), caregivers of PWD (12%), PWD
(3%), and professionals (6%). Knowledge increase
was most frequent for how to respond in a missing
person event (87%), how to be prepared (85%)
and how to speak to someone with dementia who
might be lost or confused (83%). Knowledge
increase was less frequent but still fairly high for
risks of living with dementia (71%), and how to
promote community safety (76%); 87% of
respondents intended to apply learned knowledge.
Conclusions: This program is an effective vehicle
for promoting community safety for PWD and is
applicable for to vulnerable populations.
P241
Enhancing Visual Function with Fixation
Stability and Eye Movement Training
before training and following each training module.
Outcome measures including optical coherence
tomography (OCT), microperimetry, and fixation
stability, were assessed by the Optos OCT/SLO.
Reading speed and comprehension were
evaluated using the MNREAD acuity chart, and the
participant's ability to locate objects in a scene was
recorded using the SMI eye tracking glasses.
We were able to quantitatively show that patients
with AMD could gain additional benefit when
trained on two established programs. The
knowledge acquired through this project will allow
researchers to quantify the changes that occur
during and after a standardized fixation stability
and eye movement training program, and
eventually allow rehabilitation specialists to
introduce these programs to more individuals
affected with AMD.
P242
"Neighbours helping neighbours". A volunteer
peer health support program in rural Ontario,
Canada
1
2 ,3
Rand Allabade , Caitlin Murphy , William H.
1
3 ,2
Seiple , Olga Overbury
1
Lighthouse Guild, New York, NY, USA,
2
Opthamology, Sir Mortimer B. Davis / Jewish
3
General Hospital, Montreal, QC, Canada, École
d'Optométrie, Université de Montréal, Montréal,
QC, Canada
Shelly Billings , Sheila Schuehlein , Kelly
1
1
McIntyre Muddle , Jacobi Elliott , Elizabeth
1
McCarthy
1
St. Joseph's Health Care (London), London,
2
Ontario, Canada, Alexandra and Marine General
3
Hospital, Goderich, Ontario, Canada, Gateway
Centre of Excellence in Rural Health, Seaforth,
Ontario, Canada
Age-related Macular Degeneration (AMD) is
characterized by the loss of central vision, leaving
peripheral vision mostly intact. Individually, eye
movement training techniques and fixation stability
training have been utilized to teach patients how to
effectively use their remaining vision. However, the
possible gains of combining the two training
programs is yet to be examined. The purpose of
our study is to directly measure fixation stability
and scanning patterns of individuals affected by
AMD before and after training with the two
established approaches. Participants with a
diagnosis of dry AMD or wet AMD, that has been
stable for at least 3 months, were recruited for this
study.
Objectives: The challenges of providing support to
frail individuals in rural communities in the face of a
population that is aging and resources that are
shrinking demand innovative strategies. The use of
trained volunteers to provide peer support and
education is one such innovation. In addition to the
benefits experienced by the at risk older adults the
literature would suggest that volunteering has the
potential to improve the social, physical and
cognitive well-being of the volunteers as well.
(Schneider, Altpeter & Whitelaw, 2007) This project
describes the experiences of the volunteers and
the older adults in the community who are
participants in the Peer Health Support Falls
Prevention Program in rural Southwestern Ontario.
Participants were divided into 3 groups in a
crossover design. Training sessions were
monitored using the FaceLAB5TM eye tracking
apparatus. A set of outcome measures were taken
Methods: Semi-structured interviews were
conducted with peer volunteers (n=4) and the older
adults being served by the program (n=4) to
explore their experience with this approach to care.
2
3
208
Qualitative analysis of the interviews was used to
identify themes.
chutes, l'autonomie fonctionnelle et la qualité de
vie des personnes âgées.
Results: This model addresses the need to
identify and provide support to at risk older adults
living in the community who are not well served by
more traditional models of medical management.
The evaluation identified strengths of the program,
as well as opportunities for improvement.
P244
Conclusions: The benefits of this approach to
serve at risk older adults are discussed and risks
and limitations of this model are considered.
P243
Le taping neuro-proprioceptif, une innovation
en gériatrie. Neuro-proprioceptive taping, an
innovation in geriatrics
L. Ferland
Hôpital Ste-Anne, Ste-Anne-de-Bellevue, Québec,
Canada
Le taping neuro-proprioceptif est un ruban adhésif
élastique pouvant avoir un effet neurologique,
mécanique ou circulatoire. C'est une modalité
utilisée fréquemment avec les athlètes et patients
en orthopédie. Nous faisons l'hypothèse que cette
pratique peut être appliquée à une clientèle
gériatrique pour diminuer la douleur et améliorer
l'équilibre. Le but de cette affiche est de présenter
la démarche exploratoire que nous avons menée
pour vérifier nos hypothèses.
Pour vérifier l'impact du taping sur la douleur, nous
avons fait l'évaluation subjective de la douleur
(échelle de 1 à 10) avec et sans tape pour un
même patient.
Pour vérifier l'impact du taping sur l'équilibre, nous
avons comparé les résultats au tests standardisés
de Berg, avec et sans tape pour un même patient.
À la lumière des essais qui ont été faits, nous
avons raison de croire que le taping neuroproprioceptif peut contribuer à diminuer la douleur
et à améliorer l'équilibre chez une clientèle
gériatrique. Cette pratique apparait être une
alternative aux traitements traditionnels de contrôle
de la douleur qui aurait beaucoup d'avantages. Il
serait intéressant de poursuivre des recherches
plus poussées afin de vérifier l'impact que le taping
neuro-proprioceptif pourrait avoir sur le risque de
How Can We Best Promote Community Safety
for Persons with Dementia? Results of
Community-Based Town Hall Meetings
1
2
1
Cathy Conway , Loretta Hillier , Felicia White ,
1
David Harvey
1
Alzheimer Society of Ontario, Toronto, Ontario,
2
Canada, St. Joseph's Health Care London,
Objectives: Supporting active living among
persons with dementia (PWD) while ensuring their
safety in the community is paramount to optimizing
TM
quality of life. The Finding Your Way program, a
program to increase awareness and reduce risk of
missing person events among PWD, held six Town
Hall meetings, across Ontario, with community
stakeholders to learn and share ideas for living
safely in the community. This presentation
describes the outcomes of these meetings.
Methods: Large and small group discussion
formats were used to reflect on and develop
strategies for promoting community safety.
Proceedings were recorded, transcribed and
analyzed using a qualitative naturalistic inquiry
approach.
Results: A total of 210 individuals attended these
meetings, representing a broad range of
community services (social and health-related
services, home care, first-responders, government
officials, professional associations, retirement
home and supportive housing, college instructors
and students, and PWD and care partners). Five
key themes were identified: Many existing services
that promote community safety are not well-known;
being proactive/prepared is key to keeping
vulnerable persons safe; coordination and
information sharing among agencies and
community services is critical; greater awarenessraising and education on community safety is
needed for professionals, services serving
vulnerable populations, and the general public; and
community safety initiatives should be diverse and
inclusive, including all types of vulnerable persons
(homeless, mentally ill) and different cultural
communities. Barriers to community safety and
promotional strategies were identified.
209
Conclusions: Collaborative and coordinated
efforts among a variety of community services and
agencies are needed to promote community safety
for PWD.
P245
Dementia Care Research Initiative: Improving
Care and Quality of Life for Older Adults
1
1
Susan Slaughter , Carole Estabrooks , Jayna
2
2
3
Holroyd-Leduc , Zahinoor Ismail , Jennifer Milne ,
2
2
2
Marc Poulin , Eric Smith , Lorraine Venturato
1
2
University of Calgary, Calgary, Alberta, Canada,
3
Campus Alberta Neuroscience, Alberta, Canada
The Dementia Care Research Initiative (DCRI) is
an outcome-focused approach to creating
knowledge-based improvements to the care
pathway of Albertans with cognitive impairment
and dementia. Facilitated by Campus Alberta
Neuroscience (CAN), the DCRI includes several of
the leading dementia clinician researchers in
Alberta who have designed a strategic initiative,
consisting of a suite of integrated projects that will
lead to improved dementia care in the province.
The initiative aims to create near-term outcomes
through focused research in primary, acute and
long term care, involving management and
intervention projects along this care continuum.
Specifically, the DCRI proposes to 1) improve
patients' and caregivers' quality of life through
interventions that improve mobility and cognition,
increase functional ability in activities of daily living,
decrease reliance on hospitals and extend time
spent outside of long term care, 2) better equip the
workforce with training and resources to screen,
diagnose and manage patients resulting in
effective and quality care, and 3) decrease
resource and financial burdens on acute and long
term care facilities. Proposed projects include a
cognitive screening tool embedded in the
electronic medical record, an exercise and
cognition intervention, an intervention to reduce
responsive behaviours in people with Alzheimer's
disease, an integrated palliative care program and
a restorative care program. Through partnerships
with research, the health system, government and
community stakeholders that are currently in
development, the DCRI team will design,
implement and evaluate solutions for providing
better-coordinated care and improving the quality
of life of older adults and their caregivers.
Grip Strength as a Measure of Frailty in Adult
Day Programs
Diana Markova, Moushumi Das Gupta, Celine
Sakran, Jay Patel, Anna Berall, Jurgis Karuza,
Beatrise Edelstein
Baycrest Health Sciences, Toronto, Canada
Frailty is a state of vulnerability that carries an
increased risk of poor outcomes for older adults. It
has been considered synonymous with disability,
comorbidity, and is associated with high risk for
falls, disability, hospitalization and mortality (Fried,
2001). Awareness and understanding of frailty and
its risks in Adult Day Programs (ADPs) could
improve care for members thereby improving their
wellbeing and quality of life. Frailty is traditionally
measured through an assessment such as the
Clinical Frailty Scale (Rockwood et al., 2005) when
a member begins the program and on an annual
basis. The Jamar ® dynamometer is a fast, easyto-use tool for measuring grip strength. We
investigated the feasibility of using a Jamar ®
dynamometer as an alternative measure to assess
frailty in older adults in an ADP. Results show a
strong negative correlation between grip strength
and the frailty index for males (r = -.53, p < .001)
but not for females (r = -.17, p = .20). We
investigated the association between grip strength
and variables retrieved from the interRAI
Community Health Assessment (CHA). In females
(N = 59), grip strength was associated with
cognitive loss (r = .27, p < .05), coronary heart
disease (r = .29, p < .05), cop_dis (r = -.27, p <
.05), self-reported health (r = .26, p < .05), amount
of days of help from home aides (r = -.33, p < .03).
In males (N = 33), grip strength was not associated
with any interRAI CHA variables.
P247
Patterns of Patient Safety Events and
Transition Processes from the Emergency
Department: Results from the Trans-ED-HC
Study
1
1
2
Martin Farrugia , Graham Campbell , Jeff Poss ,
2
3
George Heckman , Veronique Boscart , Lauren
1
1
Crutchlow , Andrew Costa
1
2
3
Conestoga College, Kitchener, ON, Canada
Introduction Retrospective cohort study
employing quantitative analysis of the transitions
P246
210
7
from Emergency Department (ED) to home care
was completed for fiscal year 2013/14.
France, Icahn School of Medicine at Mount Sinai,
New York, USA
Objectives were to quantify: Incidence of patient
safety and other adverse health events among ED
patients who transitioned to home care from the
ED. Influence of poor referral processes on the
incidence of adverse health events. Influence of
adverse health events on negative health
outcomes.
OBJECTIVES: Type 2 diabetes and obesity
increase the risk of Alzheimer's disease (AD) and
may promote cognitive decline. Here, we studied
the effect of a diet, known to induce obesity and
insulin resistance, on memory in LOU/C/Jall (LOU)
rats. This strain is considered a model of healthy
aging with increased longevity, low body fat mass
throughout life, low incidence of age-related
diseases and maintenance of cognitive functions in
advance age.
Methods
Analysis of hospital data validated the incidence of
adverse patient safety events at 90 days post ED
discharge. Adverse outcomes were tracked.
Factors related to these transitions that may
explain the likelihood of adverse health events
were examined. Logistic regression analysis was
used to examine the association between patient
safety events and variations in referral processes,
as well as between patient safety events and
negative health outcomes.
Results At least 16% of home care patients will
have an adverse patient safety event 90-days post
ED visit. This rate is twice as high as all home
care patients, which is already higher than the
general population. All home care patients should
be considered as ‘high risk' for an adverse patient
safety event. The main risks or priorities are: Falls,
Medication Issues, or Delirium.
Conclusion The results of this research may be
extrapolated, providing guidance with respect to
the incidence of adverse events in this population.
Hospitals and those providing care within the
community would be better able to evaluate the
risk to their patients upon discharge from an ED.
P248
Effects of HF/HG diet on the aging LOU rat
1 ,2
1 ,3
Pierrette Gaudreau , Oriane Lié , Guylaine
4 ,5
6
1 ,7
Ferland , Emmanuel Moyse , Caroline Ménard
1
Laboratory of Neuroendocrinology of Aging,
Centre Hospitalier de l’Université de Montreal
2
Research Center, Montreal, Canada, Department
of Medicine, University of Montreal, Montreal,
3
Canada, Université Paris Descartes, Paris,
4
France, Institut de Cardiologie de Montréal
5
Research Center, Montreal, Canada, Department
of Nutrition, University of Montreal, Montreal,
6
Canada, Université Francois Rabelais, Tours,
METHODS: Six- and 24-month-old male LOU rats
were metabolically challenged using a long-term
HF/HG diet (16 weeks, 60% calorie intake from
high fat chow + 10% glucose in water). Control
groups had access to standard diet and tap water.
Body weight (BW) and intakes were measured
regularly. Serum/plasma glucose, insulin and leptin
and hippocampal and hypothalamic mRNA levels
were determined at sacrifice. Recognition and
spatial memory and body composition were
assessed before and at the end of the regimen.
RESULTS: The HF/HG diet increased leptinemia
and fat mass in young and old animals and
increased hypothalamic SOCS-3 mRNA levels. In,
contrast, memory performances remained
unaltered and comparable to those of young and
old controls.
CONCLUSIONS: These results suggest that the
LOU rat not only maintains good memory functions
in aging but may also better resist to diet-induced
severe metabolic disturbances than common
laboratory rat strains. Identification of molecular
targets linked to this phenotype should help
developing novel pharmacological strategies to
preserve or enhance cognitive abilities in aging
and possibly delay memory impairments
associated with AD.
P249
Serum IGF1 associates with carotid and
coronary profiles in physically fit very old
subjects
1
3
Otavio Nobrega , Wladimir Freitas , Andrei
3
2
Sposito , Claudio Cordova
1
2
University of Brasília, Brasília, Brazil, Catholic
3
University of Brasília, Brasília, Brazil, State
University of Campinas , Campinas, Brazil
211
Our aim was to investigate whether physiological
levels of soluble insulin-like growth factor I (IGF1)
associate with coronary and carotid atherosclerotic
burden in physically fit oldest old by means of a
cross-sectional study including 100 communitydwelling individuals with no previous
cardiovascular events. Linear correlation was
found between IGF1 and intima-media thickness,
number of carotid plaques, and walking speed.
Individuals in the upper IGF1 tertile had smaller
right and left intima-media thickness compared to
the intermediate and lower tertiles, along with
reduced atherosclerotic plaques. Also, walking
speed was greater in the upper IGF1 tertile. On the
other hand, a nonlinear correlation was observed
between IGF1 and coronary calcification scores,
with the intermediate IGF1 tertile associated to the
lowest scores of calcification and subjects with
lower circulating levels of IGF1 showing higher
frequency of high-risk morphology plaques. All in
all, our report supports a territory-dependent,
atherorefractory phenotype in the oldest old
carrying middle and/or higher serum levels of
IGF1.
0-2 and were able to provide informed consent.
Randomization to intervention versus control group
is 1:1 and stratified by treatment intent. The
intervention includeda full CGA by a
multidisciplinary team. Based on the CGA and
discussion with the patient, tailored evidencebased interventions using a standardized
intervention protocol were implemented.
Participants in the intervention group were seen by
the intervention team at baseline for the CGA and
development of the integrated care plan; and at 3
and 6 months to assess intervention fidelity and
measure outcomes. The co-primary outcomes are:
1) quality of life (QoL) (EORTC QLQ-C30); 2)
modification of the cancer treatment plan. The
secondary outcomes are : 1) functional status
(OARS Instrumental Activities of Daily Living); and
2) feasibility of the study by tumor site. Descriptive
statistics and repeated measures ANOVA will be
used to analyze the data.
Results: Analyses will take place in May 2016 and
results will be reported at the meeting.
P250
Conclusion: This study will inform the design of a
phase 3 trial.
A Feasibility Trial of Comprehensive Geriatric
Assessment and Integrated Care Plan for Older
Cancer Patients
ClinicalTrials.gov Identifier:NCT02222259
1
1
Martine Puts , Schroder Sattar , Mary Ellen
1
1
1
Macdonald , Michael Kulik , Kara McWatters ,
1
2
2
Katharine Lee , Raymond Jang , Eitan Amir ,
2
4
Monika Krzyzanowska , Anthony Joshua ,
3
3
Johanne Monette , Doreen Wan-Chow-Wah ,
2
Shabbir Alibhai
1
2
3
Canada, Jewish General Hospital, Montreal,
4
Quebec, Canada, Garvan Institute of Medical
Research, Sydney, New South Wales, Australia
Objective: To examine the feasibility and impact of
a CGA and integrated care plan in optimizing
outcomes in older patients with advanced breast
(BC), gastrointestinal (GI) or genitourinary (GU)
cancers.
Methods: A two-group parallel single-blind phase
II RCT enrolled 60 patients aged 70 +, diagnosed
with stage 2-4 GI, GU or BC, referred for
chemotherapy at Princess Margaret Cancer
Centre, Toronto. Eligible patients were fluent in
English, had a life expectancy >6 months, Eastern
Collaborative Oncology Group Peformance Status
P251
Mixed-methods study of knowledge brokering
in the context of the healthy aging in Canada
1
2
Kristine Newman , Dwayne Van Eerd , Ryan De
3
Forge
1
Ryerson University, Toronto, Ontario, Canada,
2
Institute for Work & Health, Toronto, Ontario,
3
Canada, World Health Innovation Network |
Odette School of Business, University of Windsor,
Windsor, Ontario, Canada
With supporting healthy aging in mind and to
develop a better understanding of current
Knowledge Brokering (KB) practices and how KB
practices evolve(d), we engaged in a scoping
review, a survey study and an in-depth qualitative
interviews to determine how KB is conceptualized,
designed and practiced in healthcare and public
health settings. However, it is important to
understand end-user perspectives of knowledge
brokering in the context of aging through
interactive discussions.
212
Information will be shared on: (1) A scoping review
focussed on the key elements of KB described in
the literature; (2) Semi-structured interviews
conducted with eight practicing knowledge brokers,
focused on: defining knowledge brokering; practice
& theory; and the current and potential applications
of KB in a healthy aging context; (3) online survey
conducted to solicit experiences from a broad
community of KB practitioners. Attendees of
workshop will complete a short survey on their
experiences of seeking information in the context
of aging at the beginning and end of workshop. A
short presentation will review major findings of the
three-pronged study. Having highlighted our
examination of KB practices and KB frameworks,
this interactive presentation will raise a number of
implications, including applications for aging
population. How KB might better support a culture
of healthy aging warrants further discussion and
investigation of end-user needs. This workshop will
broaden end-user understanding and assist with
identifying gaps.
P252
Using Experience Based Design to Improve
Hospital Care for Frail Seniors
Susan Steels, Annie Hayward
Canada
Under the Excellent Care For All Act (2010), every
health care organization must engage patients and
their caregivers as active participants in quality
improvement. Frail seniors and caregivers tell us
that the experience of navigating the healthcare
system is frustrating and seniors want to be
included as partners in change (The Change
Foundation, 2010). Stronger partnerships with
patients at the center of change, requires a culture
shift for hospitals, and leadership who can model
this shift of power. A framework for change is
essential to building a shared understanding of
process and collaboration across sectors.
Developed by the NHS Institute for Innovation and
Improvement, Experienced Based Design (ebd)
provides an innovative framework to bring patients,
caregivers and providers together to share the role
of improving care and re-designing services
(www.institute.nhs.uk).
The purpose of this workshop is to learn how to
apply Experience Based Design to healthcare
improvement. Participants will engage in simulated
learning to improve the patient experience and
collaborative decision making to co-produce
change. Format will include video story telling,
completing mapping worksheets, and engaging in
both individual and group dialogue.
P253
Attitudes toward the elderly
Paul Valliant, Laura Palmer
Laurentian University, Sudbury, Canada
Attitudes toward older adults are likely to influence
quality of life, access to services, and standards of
care later in life. With a growing population of
older adults around the world, this becomes an
issue of importance. To study individuals’
attitudes, this research compared participants’
personality traits and their attitudes towards older
adults. Kogan’s Attitudes Toward Old People
Scale and the 16 Personality Factor (16 PF)
Questionnaire were used for this research. This
research first studied the attitudes of
undergraduate students, which found that female
undergraduate students with elevated personality
scores for rule-consciousness, warmth, emotional
stability, and tension had positive attitudes toward
older adults. The attitudes of Indigenous peoples
were then studied where it was found that
Indigenous people hold positive attitudes toward
older adults. To expand on previous findings, this
research project is now studying the attitudes of
the general population. The new population of
study includes individuals 18 to 50 years of age
who reside in Ontario. Findings from this research
project will add to the previous findings on
undergraduate students’ and Indigenous peoples’
attitudes toward older adults.
P254
Group digital activities for people with
dementia
Arlene Astell, Erica Dove
Ontario Shores Centre for Mental Health Sciences,
Whitby, ON, Canada
Purpose: Engagement in meaningful activity can
become difficult for people with dementia to
achieve independently. Digital technologies
provide opportunity for engagement in a variety of
independent and group activities, but a good
understanding of how best to present these for
people with dementia is required. This purpose of
this study was to explore the ways an interactive
213
games technology (Xbox Kinect) could be used to
provide stimulating and engaging group activity for
people living with dementia in the community.
Method: The study took place in a specialized day
program for people living with moderate to severe
dementia. Participant observation was used to gain
a good understanding of the environment and
capture naturalistic data on the group activity.
Observations focused on how the day centre
clients were introduced to the Xbox games, how
they were supported during play and how they
participated in this as a group activity.
Results & Discussion: A range of games from the
Kinect Sports software were used including
bowling, darts and baseball. The staff are trained
in order to support each client in relation to their
specific needs which enables all clients to play,
irrespective of cognitive or mobility challenges.
Although these are presented as single player
games, people take turns and the rest of the group
supports them, which creates a positive social
environment where people can play ‘independently
together’ as a group. These findings highlight
important features for making the most of this
technology to provide engagement in meaningful
activity for people with dementia.
emotions and an increase in life satisfaction at the
end of the study compared to pre-program
measures. These results, along with qualitative
evidence, suggest that personalized music
listening positively affects the well-being of patients
on a complex-supportive care unit.
P256
Driving and aging in New Brunswick:
Comparison of driving exposure, perceptions
and personal characteristics of rural versus
urban living older drivers
Valerie McLaughlin
Université de Moncton, Moncton, New-Brunswick,
Canada
Research has shown that driver perceptions, such
as driving comfort, are closely related to the selfregulation of driving behaviors. However, previous
studies have suggested that circumstances, such
as limited transportation alternatives, may
determine driving exposure, even in situations
where drivers aren’t comfortable. Furthermore,
most studies examining driving practices of older
adults took place in urban centers, therefore
limiting the generalization of previous
conclusions. The main goal of this study is to
explore differences in exposure and perceptions
(driving comfort and self-perceived driving abilities)
amongst rural and urban drivers aged 65 years
and older in New-Brunswick.
P255
A Musical Affair: Songs, Memories, and Social
Connections in Complex Care Patients at
Bruyère’s Saint-Vincent Hospital
1
1
2
Angela Paric , Renate Ysseldyk , Tracy Luciani ,
1
Hymie Anisman
1
2
Carleton University, Ottawa, Canada, Bruyère
Centre for Learning, Research & Innovation in
Long-Term Care, Ottawa, Canada
This study assessed the benefits of personalized
music listening in eight complex-supportive care
patients by measuring changes in cognition, mood,
self-esteem, social identity, life satisfaction, and
self-reported health before, during, and after a
program based on the Music & Memory iPod
initiative. Personalized playlists were uploaded for
each individual patient on to an iPod for them to
listen to at their request, provided there was a
volunteer available to distribute and collect their
iPod. Results demonstrated a reduction in negative
For a period of two weeks, the driving patterns of
older drivers (n = 103) were measured via a twotime odometer reading and trip log reports. Other
measurements include the Driving Comfort Scales,
the Clock Draw Test as well as a driving history
and habits questionnaire.
Preliminary analyses (n = 50) revealed that men
and urban living older drivers make significantly
more trips on average than women and rural
drivers. Men also report higher levels of driving
comfort (day and night) and better perceived
driving abilities, while women report avoiding more
situations. Although not significant, interesting
interaction patterns between area of residence and
gender are observed for the amount of kilometers
driven, as the gap between genders is greater in
rural settings (men drive more than their women).
214
This study contribute to a better understanding of
the habits and needs of older drivers in less
populated areas.
1
2
Tamara Sussman , Sharon Kaasalainen , Olivia
2
1 ,2
Virag , SPA-LTC Team
1
McGill University, Montreal, Quebec, Canada,
2
P257
Mindfulness provided attention regulation
skills when faced with stress
Linda Hunt
Pacific University, Hillsboro, OR, USA
Occupational therapy students participated in a
mindfulness workshop. They then explored
mindfulness practice in healthcare settings to
initiate awareness of stress producers, selfcompassion, inattention, and how these behaviors
may be addressed in the moment with mindfulness
practice. A convenience sample of 29 students
participated in a 75-minute mindfulness workshop.
Students anonymously reported through a twoquestion survey how they used mindfulness
practice during 40-hour week fieldwork and in their
personal lives one week after the workshop.
Reflections emerged based on the contributions of
a range fieldwork sites and personal situations.
Two individuals separately reviewed the data to
find themes across individuals. Furthermore, these
common themes identified were sent to 20
students who returned the survey to verify that
their words matched what was intended and if the
reviewers coded the themes correctly. Common
themes of incidents (stress, inattention, being
preoccupied with the past, and irritability) that
required mindfulness practice are discussed as
well as outcomes (calmness, focus, polite
responses, and ready to act), of practicing
mindfulness in the moment. Teaching mindfulness
practice to students in healthcare education may
transfer to better care for clients, especially those
clients who are most complicated in diagnoses and
living situations such as frail older adults. Older
adults require healthcare providers who bring calm
exploration of best practices; collaborative
communication with clients, multiple healthcare
professionals, and caregivers, focusing on clientcentered options; and compassionate, attentive
listening. Learn how to practice mindfulness in the
moment for improved attention regulation skills.
P258
Strengthening a Palliative Approach in LongTerm Care (SPA-LTC): A New Program to
Improve Quality of Living and Dying for
Residents and their Family Members
Residents living and dying in long-term care (LTC)
homes represent one of society’s most frail and
marginalized populations of older adults. The
average length of stay within LTC has decreased
significantly in recent years making LTC a major
location of death for frail older adults nationally and
internationally. The purpose of this poster
presentation is to provide an overview of the
components of a palliative intervention, called
Strengthening a Palliative Approach in Long Term
Care (SPA-LTC). First, an overview of the state of
knowledge about palliative care in LTC care will be
provided including documented challenges to
providing optimal palliative care at all stages of the
LTC trajectory. Second, key areas targeted by the
SPA-LTC program will be introduced including
direct care components: (a) tools to support
advance care planning; (b) mechanisms to trigger
transitioning to end-of-life (c) family care
conferences to support communication with
residents and families for end-of-life planning; and
capacity building components (a)
interdisciplinary champion teams to support
implementation; (b) data audit and feedback
reflections to raise awareness and staff
engagement and (c) comfort care rounds to
enhance comfort and support team building.
Recommendations for a stepped approach to
implementation will be discussed.
This program has the potential to improve the
quality of life of older adults living and dying in LTC
and provide better support to their families. It is
currently being implemented and evaluated in 4
LTC homes in southern Ontario.
P259
Creating Dementia Friendly Communities:
Translating Knowledge into Policy and Practice
1
2
Nisha Sutherland , Catherine Ward-Griffin ,
3
4
Veronique Boscart , Sherry Dupuis , Marita
2
5
2
Kloseck , Carrie McAiney , J.B. Orange , Jenny
5
1
6
Ploeg , Elaine Wiersma , Cathy Conway , Kay
2
Vallee
1
Lakehead University, Thunder Bay, Canada,
2
3
Western University, London, Canada, SchlegelUW-RIA Conestoga College, Kitchener, Canada,
4
215
5
6
McMaster University, Hamilton, Canada,
Alzheimer Society of Ontario, Toronto, Canada
Medicine, McGill University, Montreal, Quebec,
Canada
Objectives: The demand for community care and
support for people with dementia and their families
is anticipated to increase dramatically. To that end,
the primary objectives of a one day workshop,
Knowledge Translation (KT) in Dementia Care: It
Takes a Community were to: 1) develop an action
plan for an ideal dementia friendly community; 2)
create new and diverse partnerships; and 3)
explore ways to advance practices and policies
relevant to community dementia care.
Context: In 2013, the Quebec Ministry of Health
began implementing the Alzheimer Plan (AP) in 42
selected family medicine groups (FMG) to improve
the ability of the primary care professionals to
better detect, care and follow-up patients with
dementia and their caregivers.
Method: In order to meet these objectives, a
number of innovative KT activities enabled us to
successfully foster collaborations among 72
workshop participants, including persons with
dementia, family members, professionals, and
researchers. Through an iterative process of small
and large group interactions, the participants used
their deepened understanding of community
dementia care to envision new possibilities and
make recommendations.
Design: Cross-sectional, observational study.
Results: Learnings from the workshop led to the
development and wide dissemination of three
products: an Action Framework, Educational
Guide, and Policy Brief. Sharing these products
using multiple methods of dissemination will
enable persons with dementia, care partners, and
community members in education, policy, and
program development to advance practices and
policies in the development and sustainability of
dementia friendly communities. Successful
partnerships between and within multiple and
diverse communities are essential to this process.
Conclusion: This KT project aimed to facilitate the
uptake of knowledge into practice and policy and
address the challenges of dementia care now and
in the future. Translating knowledge into policy and
practice is integral to creating dementia friendly
communities.
P260
Primary care clinicians' knowledge, attitude,
and practice participating in the Quebec
Alzheimer Plan
1
1 ,2
Geneviève Arsenault-Lapierre , Nadia Sourial ,
1
1 ,2
Marine Hardouin , Isabelle Vedel
1
Lady Davis Institute, Jewish General Hospital,
2
Montreal, Quebec, Canada, Department of Family
Objectives: To describe the knowledge, attitudes,
and practices of the clinicians in the FMG
implementing the AP.
Participants: All family physicians and nurses who
work more than once a week at the FMG and who
have older adults in their clientele.
Instrument: Two questionnaires were built based
on existing, validated questionnaires: one 84-item
questionnaire for family physicians and another 79item questionnaire for nurses. The questionnaire
items were in the form of a 4-point Likert scale.
The questionnaires were distributed and collected
via mail between May 2014 and May 2015 (2nd
year after the beginning of the AP).
Main Outcome Measures: Level of Agreement
with statements regarding primary care clinicians'
knowledge, attitude and practices on dementia and
the AP.
Results Clinicians showed excellent clinical
knowledge. They had positive attitudes toward the
disease, patient care, and the AP, although they
were somewhat less satisfied with the training
received. The clinicians strongly support,
appreciate and use interdisciplinary approach.
They reported having good access to their
colleagues within their FMG. They were, however,
more critical about delays to access memory
clinics and home care services.
Conclusions: The clinicians of the FMG
participating in the AP had excellent knowledge,
positive attitudes and good practice toward
dementia and the AP.
P261
Access to assistive devices across Canada
216
1
2
3
Daphne Schreiber , Winnie Sun , Michael Wilson ,
2
Rosalie Wang
1
2
March of Dimes, Toronto, Canada, University of
3
Toronto, Toronto, Canada, McMaster University,
Hamilton, Canada
Objectives With an aging population, there is a
growing need for assistive devices that can help
persons with disabilities live their lives to the
fullest. Despite high needs, many Canadians with
disabilities report having unmet assistive device
needs. To understand how assistive devices are
currently accessed or procured in Canada, and to
identify funding and service gaps, we are mapping
the programs and policies across Canada.
Method To ensure a systematic approach our
jurisdictional scan was based on the key stages of
scoping review methods (identifying a question,
conducting searches, charting and synthesizing
data). The first author reviewed, charted, extracted
data from the identified policies and programs. The
team then summarized the results for each
province and territory by describing the range of
programs available, including the types of devices
and services available, the funding available for
them and the criteria used to determine eligibility.
Results Preliminary findings indicate that assistive
devices are made available through a patchwork of
over 100 programs provided by government
agencies and not-for-profit organizations. This
large number of programs poses challenges to
users, caregivers and healthcare workers who are
seeking access to assistive devices given the
complexity in identifying, understanding and
applying to programs.
Conclusions Given the patchwork of programs
identified across the country there is a need to
provide a more coordinated and streamlined
approach that allows users, as well as their
caregivers and healthcare providers to more easily
identify and apply to programs for which they are
potentially eligible.
P262
Rapid review to develop a Decision box to
support decision making of cognitively
impaired seniors presenting symptoms of
agitation, aggression or psychotic symptoms
and their caregivers
1
1 ,2
2 ,3
B Valera , É Fortier-Brochu , M Morin , F
1 ,8
1 ,8
4 ,2
2 ,5
Legaré , H Witteman , P Voyer , E Kröger ,
6
7
1 ,3
C Rodriguez , B Martineau , AMC Giguere
1
Laval University Department of Family medicine
and emergency medicine, Quebec, Canada,
2
Quebec Excellence center on aging, Research
Centre of the CHU de Québec, Quebec, Canada,
3
University Laval Department of Medicine, Quebec,
4
Canada, University Laval Faculty of Nursing,
5
Quebec, Canada, University Laval Faculty of
6
Pharmacy, Quebec, Canada, McGill University
Department of Family medicine and emergency
7
medicine, Quebec, Canada, Sherbrooke
University Department of Family medicine and
8
emergency medicine, Quebec, Canada, Research
Centre of the CHU de Québec, Quebec, Canada
Introduction: In a Delphi survey, choosing a
treatment for agitation, aggression and psychotic
symptoms was ranked as one of the most
important decisions made by cognitively impaired
seniors and their caregivers. We thus conducted a
rapid review of the best evidence and developed a
Decision box to facilitate shared decision making
when selecting a treatment.
Methods: We identified secondary sources of
literature about treatments' effectiveness to reduce
these symptoms: scientific summaries, clinical
practice guidelines, systematic reviews. A second
search for primary studies filled the gaps in
evidence. For inclusion, we prioritized systematic
reviews, followed by randomized controlled trials
(RCT), then other study designs. We extracted
study design, sample and the benefits/harms of
each intervention. A single reviewer conducted
literature search, study selection, extraction, and
quality assessment (GRADE approach). We
converted all probabilities to absolute risk
reductions (ARR). This synthesis was then
included in a Decision box.
Results: We screened 137 citations and included
15 systematic reviews. Agitation was reduced by
simulated contacts, manipulations, music therapy,
gardening, cooking, or atypical antipsychotics
(risperidone, olanzapine, aripiprazole) (ARR=1092%). Aggression was reduced by animal-assisted
therapy, risperidone or olanzapine (ARR=30-38%).
Psychosis was reduced by risperidone or
aripiprazole (ARR=36 and 40%). Adverse effects
of atypical antipsychotics comprised somnolence
(ARR=10-18%), extra-pyramidal effects (ARR=1016%), gait abnormalities (ARR=5-9%), and stroke
(ARR=3%). In contrast, non-pharmacological
217
treatments presented less severe harms (e.g. cost,
time).
Mackenzie Martin, Megan Strickfaden
Conclusion: When facing these symptoms,
patients and their caregivers should weight the
benefits and harms of the available options,
including the option to abstain, before making a
decision.
With a view of advancing ‘design as therapy’, this
project aims to explore how the design of the built
environment of long-term care facilities (and the
material culture within) impacts the quality of life of
persons (residents) with dementia. Using a human
ecological framework, a multiple method approach
that is ethnographically-oriented, and a feminist
research methodology, this project focuses on the
world-renowned dementia-village in the
Netherlands called ‘de Hogeweyk’. The project
involves analyzing existing film footage collected in
the Netherlands by my supervisor and conducting
an ethnographic investigation of how the residents,
staff, and family/friend caregivers at de Hogeweyk
identify, assess, and resolve the tension between
physical safety/risk and quality of life. This project
fills a research gap in the area of design as
therapy and the results will shed light on solutions
to issues that are relevant to residents, families,
formal/informal caregivers, and policy makers.
P263
Innova: A Digital App to Collect Existing
Assistive Technologies (AT) for Older Adults
Mackenzie Martin, Megan Strickfaden, Carlos
Fiorentino, Hui (Tori) Ren, Eleni Stroulia, Janet
Fast
University of Alberta, Edmonton, AB, Canada
This presentation reports on the interdisciplinary
design and development of a digital app (tool and
data-base) called Innova. It is designed to collect
and analyze assistive technologies (AT) that are
available for purchase or have been innovated
towards manufacture. The AT are objects and
services that support caregivers and care
recipients in various aspects of health care, daily
living, being entertained, mobility and more. The
premise of the app is built upon the notion that
precedent-based research is valuable to design
innovators, and as such the primary objective for
the tool is to have a data-base that highlights
detailed characteristics of various AT
objects/services in order to design future
objects/services. Additionally, the app is designed
for the layperson to peruse when they are looking
for AT solutions to caregiving issues. As such, the
objects/services become a kind of ‘materialized
knowledge’ that is a significant kit of information
that acts as inspirational sources and resources to
draw upon. The tool and data-base reported here
consists of smart phone and tablet applications
and a website that contains comprehensive
surveys and feedback features. The details of the
surveys and feedback features provide a
framework that collects in-depth information
including material and immaterial product/service
attributes. This presentation promises an in-depth
account of the rationale, design/development, and
design solution of Innova as a digital tool and database of assistive technological objects/services for
older adults.
P264
P265
Impact on readmissions within 90 days postdischarge in older patients of a Family
Medicine based Virtual Ward
1
2
Geneviève Arsenault-Lapierre , Bernardo Kremer ,
2
2
1 ,3
Mina Ladores , Hanane Saad , Nadia Sourial ,
3
2
2
Justin Gagnon , Geneviève Gray , François Filion ,
2
1 ,3
Vinita D'Sousa , Isabelle Vedel
1
Lady Davis Institute, Jewish General Hospital,
2
Montreal, Quebec, Canada, Herzl Family Practice
Center, Jewish General Hospital, Montreal,
3
Quebec, Canada, Department of Family Medicine,
Context: Transitional care programs to reduce
readmissions have had mixed impact.
Interventions led by primary care physicians may
have better impact.
Objective: To evaluate the impact of a Family
Medicine-based Virtual Ward (VW) intervention at
the Jewish General Hospital in reducing the
emergency department (ED) visits, readmission
and the length of stay of older patients.
Design: A quasi-experimental study with a
historical control group.
Design as Therapy
218
Patients: All 42 patients who received the
intervention between July 1st 2014 and June 30th
2015 were included. These patients were
compared to 68 historical controls discharged from
the hospital one year prior. Inclusion criteria were:
65 years or older, having a family doctor at the
clinic, a high risk of readmission (LACE score ≥ 10)
and being discharged to home/senior residence.
Outcomes: Patients' charts were reviewed to
determine rates of ED visits and readmission at 30,
60, and 90 days after discharge and cumulative
length of stay (LOS) for any readmission within 90
days.
Results: Clinically meaningful decreases in ED
visits, readmission rates and LOS were observed
in the VW group compared to the control group
were observed, although these differences were
not statistically significant. ED visits at 30, 60, and
90 days were decreased by 8%-38%.
Readmissions were decreased by 22%-26%. LOS
at 90 days was decreased by 34%.
Conclusion: While clinically meaningful
improvements were seen in VW patients, this study
did not show statistically significant results due to
the limited sample size. Replication in a larger
sample is warranted to confirm these findings.
other countries provide elder care. This paper
outlines a comparative outcomes approach to
three different healthcare systems – the United
States, Norway, and Canada. Although each of
these countries are developed and high-income
countries, their healthcare systems differ and
reflect a global continuum of healthcare structure,
with Norway’s ‘welfare state’ approach at one end
and the US’ ‘controlled market-based’ system at
the other. These three nations’ healthcare
systems make for a valuable comparison because
of their similarities, differences and varying
approaches to elder care, including both homecare
and nursing home care. As such, each of these
countries faces challenges to providing quality
elder care, some shared between them, such as
the provision of homecare services in rural areas.
Other challenges are unique, such as health
disparities, ubiquitous in the United States and less
prevalent in Canada and Norway. Similarities and
differences in the cultural influences which impact
policy and care delivery, funding and provisions of
elder care, and innovations for improving costeffective care are discussed. This international
comparison of healthcare systems and elder care
between Canada, Norway, and the United States
provide insights about similarities and differences
in how these countries provide care to their
increasingly ‘silver’ populations.
P267
P266
What is Elder Care Like Elsewhere? A Cross
National Comparison of Canada, Norway, and
the United States’ Healthcare Systems
1 ,2
5 ,6
Sarah Balcom , Brandi Cotton , Ellen
3 ,4
Svendsbo
1
University of Calgary in Qatar, Doha, Qatar,
2
3
Brunswick, Canada, Department of Nursing,
Stord/Haugesund University College, Stord,
4
Norway, Department of Neurobiology, Care
Sciences and Society, Karolinska Institute,
5
Huddinge, Sweden, Dartmouth College, Centers
for Aging, Lebanon, New Hampshire, USA,
6
University of Rhode Island, Kingston, Rhode
Island, USA
The global population is aging and the future
trajectory of health care services for the elderly is
critical in light of the worldwide shortage of
healthcare providers. International comparisons of
healthcare systems can inform policymakers,
administrators and healthcare providers about how
Active Aging for LIFE-A Public Health Initiative
Emily Roberts, Mary Ruppert-Stroescu, Mihyun
Kang, Greg Clare, Alex Bishop, Aditya Jayadas
Oklahoma State University, Stillwater, Oklahoma,
USA
The World Health Organization (2015) defines
active aging as the process of optimizing
opportunities for health, participation and security
in order to enhance quality of life as people age.
Active aging allows people to realize their potential
for physical, social and mental well-being
throughout the life course, aiming to extend
healthy life expectancy and quality of life for all
people as they age (WHO, 2015). Oklahoma State
University has initiated an Active Aging for
L.I.F.E. public health framework representing a
commitment to working toward improved
perceptions and behaviors regarding Longevity,
Independence, Fitness, and Engagement for active
aging across the lifespan. A mixed-method pilot
study took place in 2016 with a participant
demographic of college age students age 18-25
219
(N=21) and older adults age 65-85 (N=23)
attending four consecutive weekly events together
covering the domains of Longevity, Independence,
Fitness, and Engagement. Participants were given
pre/post event surveys in order to test perceptions,
lifestyle choices and behaviors before and after the
sessions. A follow-up study participant focus group
took place 4 months after the L.I.F.E. events, and
attendees were asked open-ended questions on
changes in their life style choices and behaviors in
the four domains. The student participants showed
the greatest degree of change in their perceptions
about the concept of active aging, and the older
adults regarded the initiative domains as reminders
of important lifestyle choices and behaviors which
they had been practicing, as well as some which
were newly formed as a result of the four active
aging events.
P268
Current Partnerships and Future Collaboration
in Research at York Care Centre: Leading
Excellence in Aging Care
Jennifer Donovan
York Care Centre, Fredericton, Canada
The Canadian population is aging at an
exponential rate. In 2011, an estimated 5 million
Canadians were age 65 years and older, 14.4% of
the population, a number that is expected to
double in the next 25 years, representing 24% of
the population. By 2051, approximately one in four
Canadians is expected to be 65 or over (Statistics
Canada, 2015). New Brunswick's population
currently has one of the largest provincial
percentages of people aged 65 years and older.
York Care Centre, located in Fredericton, NB, is
known as a Centre of Excellence in Aging Care,
who has been continuously committed to the
quality of care and service provided to their
residents. York Care Centre recognizes the
importance of research and evidence-based
practice by being involved with various research
projects that directly impact many aspects of care.
As well, the implementation of RAI: MDS 2.0
provides vast opportunities for even more cutting
edge research not only in New Brunswick, but
provincially and nationally. With the vested interest
and collaboration with New Brunswick Health
Research Foundation and Université de Moncton,
the role of Clinical Research Coordinator was
established to further the potential of research
growth in York Care Centre and New Brunswick.
The Clinical Research Coordinator will provide
insight to current research projects being
conducted and potential future endeavours on the
horizon. This poster presentation will provide
nurses, educators and researchers the opportunity
to learn about these initiatives as well as promote
future collaboration with CAG, educational
institutions and researchers.
P269
The Integrated Model for Dementia Care in
Saudi Arabia (IMDC-SA): A Suggested Solution
to Challenges Faced by People with Dementia
and their Family Caregivers
1 ,2
3
Eradah Hamad , Sultan Alamri , Andrew
4
Johnson
1
Department of Psychology, Faculty of Arts and
Humanities, King Abdulaziz University, Jeddah,
2
Saudi Arabia, Health and Rehabilitation Sciences
Graduate Program, Faculty of Health Sciences,
3
Faculty of Medicine and King Abdulaziz University
Hospital, King Abdulaziz University, Jeddah, Saudi
4
Arabia, School of Health Studies, Faculty of
Health Sciences, Western University, London,
Ontario, Canada
In support of a current local discussion in public
media about the need to improve the health care
services and formal supports for people with
dementia and their families in Saudi Arabia (SA),
the aim of this paper is to examine the challenges
faced by family (in-home) caregivers in the current
eldercare system in SA. It considers informal
(family) caregiving in the current context of formal
(medical and health care system) and semi-formal
(organizational and community-based services)
care provided to support the Saudi Arabian
eldercare system. It also compares the current
health care services for people with dementia in
SA to popular systems of long-term care (LTC)
worldwide, particularly in North America (e.g., the
United States and Canada). The integrated model
for dementia care in SA (IMDC-SA) is suggested
along with recommendations to inform decisionmaking and health service planning for people with
dementia and their family caregivers in SA.
P270
Developing a Bereavement Intervention for
Family/Friends Following Resident Death
1
1
Gilbert Primeau , Jessica Welik , Calliope
1
2
3 ,1
Gikopolous , Pamela Duperos , Pam Orzeck ,
220
1
2
Tamara Sussman , Sharon Kaasalainen
1
McGill University, Montréal, Québec, Canada,
2
McMaster University, Hamilton, Ontario, Canada,
3
CIUSSS West-Central Montreal Health/CLSC
René-Cassin, Cote Saint-Luc, Quebec, Canada
Background: Family and friends of residents in
long-term care (LTC) may experience grief when
the service recipient they are supporting dies.
In addition to the challenges associated with
bereavement (loss of purpose, mourning,
redefinition of self), caregivers face the sudden
withdrawal of contact from LTC staff which can be
experienced as an additional loss. Most
LTC homes fail to address the well-documented
challenges of bereaved caregiver grief.
Objective: This poster reports on the development
of an evidence-informed intervention for bereaved
caregivers whose relative/friend has died after
living in LTC.
Methods: The intervention was developed
following a series of steps including (a) a review of
the published and grey literature documenting the
risks and challenges associated with bereavement
following prolonged caregiving (b) an
environmental scan of existing materials for
service providers to address bereaved caregiver
grief in a number of health settings; (c) consultation
with informants in LTC.
Results: Few practices or tools exist to help LTC
home staff address grief and bereavement in the
post-caregiving period. Sympathy cards and
monthly memorials are the most common forms of
bereavement support offered. Building on the
literature and expressed needs of LTC staff, we
developed a multi-faceted post bereavement
intervention that includes informational materials, a
risk assessment and a telephone follow-up call for
individuals identified as at risk of complicated grief.
1
3 ,1
Tracey Veldhuis , Marta Zaharia
1
2
Zoom In & Redefine, Ontario , Canada, DeafBlind
3
Ontario Service, Ontario, Canada, Canadian
Helen Keller Centre, Ontario, Canada
Hearing and visual impairments are commonly
viewed separately in research and service
provision, but they often occur together as dual
sensory loss in the older population. Age-related
dual sensory loss is a unique combination of
varying degrees of vision and hearing loss as a
result of age. This dual sensory loss presents
limitations in activities, cognitive decline,
communication challenges, isolation and reduced
quality of life such that specialized services and
accessible environments are required. With the
growing seniors' population in Canada, age-related
loss of vision and hearing is becoming an
increasingly frequent disability that will place strain
on long term care and other social services
systems.
In this interactive workshop, participants will be
introduced to dual sensory loss compounded by
other conditions as a result of aging. Participants
will gain insight into the dimensions and
ramifications of age-related dual sensory loss on
all aspects of a person's life. Simple solutions are
available, including supports which can improve a
person's quality of life, including their ability to
socialize with others, engage in activities and
maintain independence.
Through the use of case studies and simulation,
participants will gain an idea of what it is like to
have dual sensory loss.
This workshop will provide practitioners and
researchers with a knowledge base to a subject
area and trend that will be of significance to the
field of gerontology currently, and moving forward.
P272
Conclusion: We are currently piloting our
bereavement intervention in four LTC homes in
southern Ontario. Early findings indicate that the
interventions may be acceptable and feasible to
implement in LTC environments.
P271
Improving Quality of Life Outcomes through
Service Delivery for Persons with Age-Related
Dual Sensory Loss
Use of Professional Gerontology Competencies
for Workplace Alignment & Use in Practice
1 ,2
5
Birgit Pianosi , JoAnn Damron-Rodriguez , Jan
4
3
Jukema , Eric Schoenmakers
1
Huntington University, Sudbury, Ontario, Canada,
2
Ontario Interdisciplinary Council for Aging and
3
Health, Toronto, Ontario, Canada, Fontys
University of Applied Sciences, Eindhoven, The
4
Netherlands, Windesheim University of Applied
221
5
Sciences, Zwolle, The Netherlands, UCLA, Los
Angeles, CA, USA
residents living with dementia across the
continuum of care.
The workshop is offered in partnership between
the Ontario Interdisciplinary Council for Aging and
Health (OICAH; affiliated with the Council of
Ontario Universities) and the Association for
Gerontology in Higher Education (AGHE). It will
focus on translating the gerontology competencies
for the use in practice and at the workplace
specifically, including profiling job descriptions in
alignment with the AGHE Competencies. This is of
help in further professionalization of practice
gerontology. The workshop is designed, developed
and delivered by internationally recognized
teaching/learning and practice experts from US,
Europe and CA including those instrumental in the
development of the AGHE Competencies.
Furthermore, group and individual interaction with
workshop presenters will be guaranteed. Finally,
networking and the creation of ongoing mentorship
opportunities with individuals will be offered
through:
LIVING the Dementia Journey was developed in
partnership with residents, family members, team
members, volunteers and community partners,
including the Murray Alzheimer Research and
Education Program (MAREP), the Schlegel-UW
Research Institute for Aging (RIA) and Schlegel
Villages.
o Hands on activities and assistance with
analyses and development of job descriptions and
job profiles.
o Hands on activities and assistance in
assessment and development of competencies for
practice application.
A workshop course book with tools for reference
and ongoing assistance in the translation of
competencies to practice will be available.
A LIVING the Dementia Journey Advisory group
worked over several months to envision and
describe a more ideal future for residents living
with dementia and to identify values,
understandings and practices to achieve this
vision.
Currently, LIVING the Dementia Journey is being
offered as part of new staff training at Schlegel
Villages and is being extended to residents, family
members and all staff.
The three main goals of the training program are
to:
1. Increase understanding and awareness about
dementia and the experience of living with it from
the perspectives of persons living with dementia
2. Build on the strengths, skills, and experiences of
those involved in dementia care and services
3. Create and support a new philosophy of care
that supports the well-being of people with
dementia and all who care for them
Workshop objectives include:
P273
LIVING the Dementia Journey Training
Program: A New Philosophy of Care
1 ,2
1 ,3
Lisa Loiselle , Josie d'Avernas , Jessica Luh
4
Kim
1
2
Canada, Murray Alzheimer Research and
Education Program, Waterloo, Ontario, Canada,
3
Schlegel University of Waterloo Research Institute
4
for Aging, Waterloo, Ontario, Canada, Schlegel
Villages, Kitchener, Ontario, Canada
LIVING the Dementia Journey is an organizational
philosophy and corresponding training program
that focuses on supporting the well-being of
-Exploring the underlying philosophy of the
program
-Describing the training and reviewing components
of the program (Learning, Improving, Validating,
Interpreting, Nurturing and Greeting)
-Experiencing at least one learning activity
-Describing the evaluation results
-Discussing the public rollout
P274
How do older men define frailty?: The Manitoba
Follow-up Study
Robert Tate, Philip St John, Susan McClement
222
Background: The definition of frailty has been
debated in academic circles, but there has been
limited research how older persons define frailty.
Methods: The Manitoba Follow-up Study is a
cohort study of 3,983 male aircrew members of the
Royal Canadian Air Force in the Second World
War, who have been followed since 1948. We
added open-ended questions to the 2015 annual
survey: "What is YOUR definition of frailty?;" "Is
the notion of frailty important to YOU? Why or why
not;" and "Do you think that people can accurately
rate their frailty level? Why or why not?"
Investigators reviewed the responses, and
emerging themes were tabulated.
Results: Surveys were returned by 160 surviving
members (mean age 94 years). Among 145 selfrespondents (15 responses from proxies excluded)
64% responded that frailty was an important issue
to him and 42% thought that people could not rate
their own frailty. Domains of frailty which were
identified include: limitations in activities of daily
living (35%); poor physical performance/poor
mobility/falls (31%); weakness/fatigue (18%);
impaired cognition (14%); vulnerability (7%); deficit
accumulation (3%); other domains were noted by
17%. When the themes of frailty were mapped
onto common existing theoretical models of frailty,
the most common model was the traditional model:
Frailty as Disability. About 30% of the themes of
frailty reported these men did not map onto any
contemporary model of frailty.
perspectives of older adults on age-friendly food
and nutrition community programs.
Objective: To examine older adults’ perceptions of
whether their communities provide age-friendly
nutrition programs and services.
Methods: Data was analysed from previously
collected photovoice data examining perceptions
of age-friendly communities from one urban and
three rural areas in Manitoba. Thirty individuals
(Female=77%) with a mean age of 69 years (age
range= 54-81) participated in the study.
Participants used digital cameras to capture
features in the community that they felt were either
age-friendly or not age-friendly. Data included
photographs, journal entries, participant interviews
and focus group discussions. The qualitative data
was transcribed, organized using NVivo 8 QSR
software and coded for themes.
Results: Three major themes were found: the
accessibility of the community nutrition
services/programs, availability of age appropriate
nutrition services and capability of older adults to
attend and participate in these programs.
Conclusions: Providers of community-based
nutrition services need to better assess the needs
of older adults and work closely with community
planners to design appropriate facilities that are
accessible to older adults given their abilities and
changing environmental conditions.
Conclusions: There is heterogeneity in the
definitions of frailty of older men. The most
commonly noted theme was disability.
P275
P276
Older Adult’s Perspectives on Age-friendly
Communities with emphasis on Nutrition
Services and Programs
The association between social support,
mobility factors, and older drivers’ readiness
for mobility transition
Christina Lengyel, Kari Manary, Verena Menec
Canada
Arne Stinchcombe , Hillary Maxwell , Nadia
1
1 ,2
3
Mullen , Bruce Weaver , Holly Tuokko , Gary
4 ,5
7
6
Naglie , Mark Rapopport , Shawn Marshall ,
1 ,8
Michel Bédard
1
Centre for Research on Safe Driving, Lakehead
University, Thunder Bay, Ontario, Canada,
2
Northern Ontario School of Medicine, Thunder
3
Bay, Ontario, Canada, Centre on Aging, University
of Victoria, Victoria, British Columbia, Canada,
4
Department of Medicine and Rotman Research
Institute, Baycrest Health Sciences, Toronto,
5
Ontario, Canada, Department of Medicine and
223
Introduction: Nutrition programs are important in
ensuring healthy aging for older adults residing in
the community. Age-friendly communities promote
the optimization of resources, safety features,
adaptive structures and programs that encourage
the participation of older adults in their
communities. Little is known about the
1
1 ,8
Institute of Health Policy, Management and
Evaluation, University of Toronto, Toronto, Ontario,
6
Canada, Ottawa Hospital Research Institute,
7
Ottawa, Ontario, Canada, University of Toronto,
8
Toronto, Ontario, Canada, Centre for Applied
Health Research, St. Joseph’s Care Group,
Thunder Bay, Ontario, Canada
Many older drivers will eventually stop driving.
Drivers’ increased readiness to transition to nondriving status helps to reduce some of the adverse
consequences of driving cessation. Availability of
social support and alternative transportation are
also important factors in mitigating these negative
consequences. Meuser et al. (2011) developed
the Assessment of Readiness for Mobility
Transition (ARMT) tool to measure attitudinal and
emotional preparedness to transition to nondriving. The objective of this study was to examine
whether availability of social support and
community mobility variables were related to
ARMT scores.
A sub-sample of drivers from the Candrive cohort
was recruited from 4 Canadian sites (N=312, mean
age = 75.63 years, SD=4.51). Participants
completed the ARMT tool as well as
questionnaires pertaining to social support and
community mobility variables.
The results showed positive associations between
community mobility variables and ARMT scores.
Participants who resided further from public
transportation reported more anxiety in regards to
mobility transition (r=.141, p=.014). The distance
from participants’ dwelling to the nearest
convenience store (r=.157, p=.006) and the
nearest health care centre (r=.137, p=.016) was
associated with ARMT total scores such that
greater distance was associated with less
readiness to transition. Participants who reported
support from others reported less concern about
mobility transition (r=-.238, p<.001).
The results highlight the importance of social
support and community mobility factors in
determining older drivers’ readiness to cease
driving. The results will be discussed in the context
of programs that allow for former older drivers to
maintain mobility following driving cessation.
P277
A Scoping Review of Evidence-Based Methods
for Engaging Cognitively/Physically Impaired
and Intact Older Adults in Aging and
Technology Research, Design and
Development
1
1
Ellen T. Crumley , Izabela Panek , Judith
2
3
4
Sixsmith , Pia Kontos , Kieran O'Doherty , Yoko
1
2
4
Ishigami , Lupin Battersby , Karli Stroud , Susan
1
Kirkland
1
Dalhousie University, Halifax, NS, Canada,
2
3
University of Toronto, Toronto, ON, Canada,
4
University of Guelph, Guelph, ON, Canada
Objective: To conduct an evidence-based scoping
review to compare engagement methods for
cognitively/physically impaired and intact older
adults (OAs) in aging and technology research,
design and development.
Methods: Six databases were searched. Articles
were independently assessed for inclusion. Data
collected included: age, cognitive ability,
disease/condition, type of technology, method
(e.g., interview), who participated (e.g., caregiver,
OAs), length of time (e.g., 20 minute interview),
where method occurred (e.g., home), what
participants did (e.g., discussed prototype) and
how the research process was evaluated, including
lessons learned.
Results: A total of 61 articles met inclusion criteria
and were analyzed. Methods for
cognitively/physically impaired OAs included
shorter: interviews, home visits and observations of
daily activities. Their informal caregivers or
relatives often participated in research and
participants may become overwhelmed or fatigued.
The literature suggests re-consenting these OAs at
every engagement and visiting them in their own
environment. Methods for OAs without
cognitive/physical impairment included focus
groups, vignettes, meetings, instruction booklets,
schedules, visualizations, testing, questionnaire,
workshops, phone calls, storyboards, cartoons and
cards. They liked the social aspects of research
engagement.
Conclusions: Involving cognitively/physically
impaired OAs in research can be different from
OAs without such impairments. To prevent attrition
and fatigue, cognitively/physically impaired OAs
could be given a choice of methods to select from.
Both sets of OAs found reviewing previous
engagement information helpful. Both groups also
preferred to have multiple (paper), take-home
sources which explain the study and technology.
224
Researchers may need to adjust processes and
find different ways to accommodate OAs
throughout the research.
P278
1
Errance nocturne: limiter la déambulation et
l'inquiétude de l'entourage
1
1 ,2
R. R Radziszewski , V. G. Grégoire , H. N.
1
1 ,2
1 ,2
Ngankam , D. L. Lorrain , H. P. Pigot , S.G.
1 ,2
Giroux
1
2
Canada, Centre de recherche sur le viellissement,
Sherbrooke/Québec, Canada
Semble égaré, désorienté, immobile, un regard
fixe mais vague reconnaîtriez-vous les signes?
Pourtant selon l'Association canadienne de
l'Alzheimer, 60% des personnes âgées atteintes
de troubles cognitifs s’égarent à un moment ou à
un autre en milieu familier ou pas. Courant chez
les personnes atteintes de la maladie d’Alzheimer,
l’errance nocturne en soi n’est pas un danger mais
peut impliquer de graves conséquences : tomber,
se perdre, se blesser. D’autre part elle apporte des
sources d’inquiétudes chez l'entourage. L’objectif
de notre étude est de concevoir un système
d’accompagnement pour personnes âgées avec
démence d'Alzheimer agissant lors d’épisodes
d’errance nocturne. La méthodologie repose sur
des habitats intelligents contenant des capteurs
(détecteurs de mouvement, débitmètres) et des
effecteurs (lampes, chemins lumineux). Le
système résultant permet d’accompagner la
personne âgée pour lui permettre de satisfaire ses
besoins : aller aux toilettes, boire de l’eau, se
relaxer. Il procède en deux étapes: la collecte des
habitudes nocturnes à l’aide des capteurs suivie,
une semaine plus tard, d’une assistance
personnalisée avec une atmosphère calme
imbibée de musique et de signaux lumineux
indiquant la direction de la chambre lorsque la
personne est apaisée. Les notifications émises
pour alerter le conjoint en cas de persistance de
l’errance, le suivi dans l’espace et l’éclairage
personnalisé rendent l’environnement sécuritaire.
Des pré-tests ont été réalisés dans une résidence
semi-autonome. La prochaine étape consiste à
tester le système chez des couples de personnes
âgées dont l’un des conjoints est atteint de la
maladie d’Alzheimer.
P279
Efficacy of non-pharmacological treatments in
managing wandering, a dementia-related
behavioral symptom, in residents living in longterm care
2
Tina Felfeli , Raquel Meyer
1
Faculty of Medicine, University of Toronto,
2
Toronto, ON, Canada, Centre for Learning,
Research & Innovation in Long-Term Care at
Baycrest, Toronto, ON, Canada
Introduction: Wandering behaviour is prevalent
among 11% to 24% of institutionalized older adults
with dementia and is considered one of the most
challenging behavioral psychological symptoms of
dementia (BPSD) to manage. Traditional
management strategies for wandering have been
comprised of physical barriers, physical restraints
and various neuroleptic pharmacological
treatments.
Objective: To shed light on the availability and
feasibility of non-pharmacological interventions for
dementia-associated wandering behavior.
Methods: A literature search was performed using
six electronic databases (CINAHL, Cochrane,
EMBASE, PsycINFO, PubMed and Scopus) for
articles published from inception to December 6,
2015. A total of 28 peer-reviewed publications
were identified using the following search terms as
either MeSH terms, key words or subject headings:
dementia, wandering, interventions.
Results: Non-pharmacological interventions were
organized into five different categories including
subjective barriers, exercise, specialized
environments, music and alarms. Evidence on the
effectiveness of non-pharmacological interventions
for treating wandering behaviour in dementia
residents is limited. There appears to be little
consistency in the methodologies and
assessments of the various forms of nonpharmacological interventions. Large-scale, longterm cohort studies, which evaluate when and why
wandering occurs are needed to inform future
studies on effectiveness of non-pharmacological
intervening strategies for wandering in dementia
patients.
Conclusions: It is critical to better understand
what views people with dementia have on
acceptability of interventions in order to help guide
the evaluation of such treatments in randomized
control trials. While these interventions are being
225
developed, it is suggested that clinicians treat
problematic behaviours of wandering through
management of coexistent psychopathology.
Elda Savoie
University of New Brunswick, Fredericton NB,
Canada
P280
La présente étude s'inscrit dans le cadre d'études
doctorales. Cette recherche, de nature qualitative,
a adopté la démarche phénoménologique. Elle est
allée à la rencontre de seize femmes acadiennes
âgées de 75 ans et plus qui vivent en régions
rurales francophones. Les entrevues ont été semidirigées avec des questions ouvertes qui
abordaient leur quotidien comme femmes du grand
âge.
Caring for Cancer Patients: Caregiving
Experiences of Family Members of Older
African American Women with Breast Cancer
Shadi Martin
McGill University, montreal, quebec, Canada
Discovery and disclosure of the diagnosis of a lifethreatening illness, such as cancer, can be
stressful for the individual who is diagnosed as well
as for family members who are most likely then
entrusted with new roles as “caregivers”. African
American family caregivers may face particular
challenges as the combination of age and ethnicity
puts older African American women at high risk for
poor cancer outcomes. The primary aims of this
study were to understand the “cancer experience”
of family members of older African American
women diagnosed with breast cancer as they
provided caregiving support throughout treatment.
A qualitative phenomenological approach was
utilized in this study. In-depth interviews were
conducted with 15 family members of older African
American women (45 and older) who had been
diagnosed with and received treatment for breast
cancer. Relationships were: 3 husbands, 4
daughters, 1 daughter-in-law, 3 sisters, 2 nieces, 1
friend and 1 mother-in-law. Interviews were semistructured, audio-taped, transcribed, and data
organized with Atlasti software.
Themes that emerged included: reluctance to
disclose cancer diagnosis to family member;
variations in caregiving support (instrumental,
emotional, financial); religious/spiritual coping;
differential need for information from health
providers; and concerns/fears for self. The
experiences of these family members revealed the
importance of obtaining information that can
support their caregiving role and help incorporate
cancer diagnoses into their lives.
P281
L'expérience sociale de vieillir en région rurale
francophone au Nouveau-Brunswick
Cette démarche visait à comprendre la place
réservée aux femmes âgées dans une société qui
trop souvent dépeint leur réalité selon ses propres
critères liés au vieillissement, sans parfois
considérer l'expérience vécue des femmes âgées.
Les critères sociétales font références à des
notions qui trop souvent exclues la population
vieillissante. Ces critères oscillent entre la
productivité, le quantitatif ou bien comme le dit
Laforest (1999, p.89) : le «faire plus» qui est
valorisé et «le être plus» qui lui est rarement
reconnu.
de Beauvoir (1970) dans son analyse élabore que
«le prestige de la vieillesse a beaucoup diminué du
fait que la notion d'expérience est discréditée»
(p.334). Les femmes âgées possèdent une
longue expérience de vie, mais qui est trop
souvent maintenue dans le silence.
La présente communication donne la parole aux
femmes du grand âge et ces dernières racontent
leur expérience sociale vécue en région rurale
francophone. Ces femmes racontent et décrivent
toute la richesse de leur milieu qui leur permet de
vivre leur quotidien de façon unique et
enrichissante. Certaines ont exprimé autant les
défis que les avantages de vivre en région rurale.
Elles possèdent une grande expérience sociale.
P282
Understanding gambling among older AsianCanadian people through a cultural life course
perspective
Hai Luo
Canada
226
The reasons why older adults gamble include
distraction from life stress or challenging transitions
such as the loss of a spouse, family members, or
friends, chronic diseases, or retirement that often
results in a lack of socialization and boredom (Tse,
Hong, Wang, & Cunningham-Williams, 2012). For
Asian seniors, they may use gambling to reduce or
block out negative moods such as depression or
anxiety caused by the trauma of migration,
unrealistic expectations in making money, un- or
underemployment, and family conflicts (Lai, 2006;
Raylu & Oei, 2004).
It is evident that cognition, personality, and
psychological aspects cannot explain all gambling
behaviors, and cultural and structural variables
also play a role in the development of gambling
among older people (Tse et al., 2013; VCGA,
1999; Raylu & Oei, 2002), as well as their previous
life histories (e.g., maltreatment and trauma before
the age of 18) and their social networks (Petry &
Steinberg, 2005; Kausch, Rugle, & Rowland, 2006;
Lee, Solowoniuk, & Fong, 2007).
Applying a cultural life course approach (George,
2007; Elder & Johnson, 2003), this research aims
to understand the development and behavior of
gambling among seniors in the Filipino and
Chinese communities in Canada from the
perspectives of lifelong development, human
agency, cohort, timing, and linked lives. Older
gamblers reported varied pathways to frequent
gambling as results of intertwined familial, cultural,
and structural factors. One of the limitations is that
the perspectives of problem gamblers is missing.
Latebreaker Posters / Résumés portant sur des
résultats de dernière heure
LB1
Features of Intergenerational Digital Gameplay
between Young People and Older Adults
Fan Zhang, David Kaufman, Erik Seah, Julija
Jeremic, Robyn Schell
Simon Fraser University, Burnaby, BC, Canada
Intergenerational separation between young
people and older adults has become a social issue
of industrial nations today, leading to
misperceptions between the two age groups. In
recent years, the potential of digital games as a
leisure activity to facilitate intergenerational contact
has been gaining researchers’ attention. The
purpose of this research is to understand the
features of intergenerational digital gameplay
between young people and older adults in
community and senior centres, and how
intergenerational play facilitates interaction
between the two age groups. A total of 12 older
adults (aged 65+) were recruited from assisted
living and community centres, and a corresponding
12 undergraduate students (aged between 18 and
26) were recruited from a variety of departments at
Simon Fraser University. We randomly assigned
12 pairs with each pair consisting of one youth and
one older person. After signing a consent form,
participants completed a survey about their
demographic information. Then, each pair played
two Wii games once a week over seven weeks in
the older participate's centre. Each game session
lasted 45 minutes, and was audiotaped. An
observation protocol was developed and used to
take field notes. The findings showed that
intergenerational gameplay creates a natural
context for young people and older adults to
exchange information and communicate and
coordinate with each other to win the game tasks.
Intergenerational gameplay also reverses the
traditional roles played by the two age groups with
young people as teachers or tutors and older
adults as students.
LB2
L’intimidation comme stratégie de maltraitance
envers les personnes aînées : une étude des
situations soumises aux comités des usagers
1 ,2
1 ,2
Marie-Ève Bédard , Marie Beaulieu , Roxane
2 ,3
1 ,2
Leboeuf , Caroline Pelletier
1
2
Chaire de recherche sur la maltraitance envers
les personnes aînées , Sherbrooke, Canada,
3
Centre de recherche sur le vieillissement du
CIUSSS de l'Estrie-CHUS, Sherbrooke, Canada
Introduction : L’intimidation envers les personnes
aînées est un sujet de préoccupation publique
introduit par le gouvernement du Québec dans le
Plan d’action concerté pour prévenir et contrer
l’intimidation 2015-2018. En l’absence de travaux
scientifiques à ce sujet, une première exploration
est nécessaire.
But : Cerner en quoi l’intimidation peut être une
composante de la maltraitance.
227
Cadre conceptuel : Maltraitance et intimidation,
plus précisément sur leurs similitudes et
distinctions.
Méthode : Suivi de trois comités des usagers du
Réseau public de la santé (avril 2014 à avril 2015)
: observations des rencontres (n= 94 h 15),
entrevues auprès des présidents (n=6) et des
membres (n=5), et analyse des documents
produits par les comités. Les 76 situations de
maltraitance révélées ont fait l’objet d’une analyse
secondaire sous l’angle de l’intimidation.
Résultats : 9/76 situations de maltraitance
comprennent de l’intimidation. Elles se sont
produites dans 4 types de rapports : d’un
personnel à un usager; d’un personnel à un proche
de l’usager; d’un usager à un personnel; d’un
personnel à un autre. L’intimidation se révèle par
l’usage de force, de pouvoir ou de contrôle par de
la violence ou de la négligence, en vue de causer
du tort. Cette intention peut être influencée tant par
des facteurs individuels, qu’organisationnels.
Conclusion : Des situations de maltraitance
perpétrées au moyen d’intimidation chez les aînés
sont soumises aux CU. En exposant en quoi ces
situations sont relatives à de la maltraitance et à
de l’intimidation, cela permet d’en comprendre
mieux la nature et les causes.
LB3
Revealing Fourth Year Nursing Students'
Assumptions, Anticipations and Realizations of
Long-Term Care: Learning Through Critical
Reflection
2 ,3
1
1
Alyssa Indar , Sherry Espin , Karen LeGrow ,
4
Nadine Janes
1
Ryerson University, Toronto, Canada,
2
Bridgepoint Health Hospital, Toronto, Canada,
3
4
University of Toronto, Toronto, Canada, Humber
College, Toronto, Canada
The exponential growth of the aging Canadian
population suggests that older persons will require
more frequent care across the healthcare
continuum. Nurses in a variety of clinical settings
may need to enhance their understanding of the
health needs of older persons. These learning
needs may be addressed in the nursing student
curriculum, as students are exposed to older
persons during their long-term care (LTC)
placement. The aim of this qualitative descriptive
study was to explore the assumptions,
anticipations and realizations of fourth year
undergraduate nursing students regarding aging,
gerontological nursing and LTC, as they actively
engaged in critical reflection during their LTC
placement. Two groups of fourth year
undergraduate nursing students participated in two
critical reflection workshops, theoretically
underpinned by practice development
methodology and critical creativity (McCormack &
Titchen, 2006). Data was collected in the forms of
transcribed audio-taped discussions, as well as
descriptive and reflective field notes. From the
qualitative content analysis, main categories
emerged related to Relationships, Contextual
Factors and Feelings. Key findings identified the
crucial role of the preceptor in the student’s
learning experience, the students’ positive views of
aging and the growing realization of contextual
factors impacting gerontological nursing practice.
The participant use of insightful metaphors and
critical dialogue to describe their experience may
provide educators and clinicians with an alternative
approach to understanding the nursing student
experience. This may uniquely inform nursing
student educational needs related to the care of
the older person in both classroom and practice
settings.
LB4
Effects of a dementia educational intervention
for emergency departments on staff
knowledge, confidence, and self-efficacy in
providing person-centred care
1
2
Victoria C. McLelland , Lori Schindel Martin ,
2
3 ,4
4
Patricia Julian , David Ryan , Jacques Lee ,
5
6
David Cowan , Laura Wilding
1
Advanced Gerontological Education, Hamilton,
2
Canada, Daphne Cockwell School of Nursing,
3
Ryerson University, Toronto, Canada, Regional
4
Geriatric Program, Toronto, Canada, Sunnybrook
5
Health Sciences, Toronto, Canada, Department of
Medicine, McMaster University, Hamilton, Canada,
6
The Ottawa Hospital, Ottawa, Canada
Purpose: Behavioural and psychological
symptoms of dementia (BPSD), including agitation,
repetitive vocalizations, exit-seeking, refusing care,
and aggression are commonly exhibited by people
with dementia. Increasingly, patients with dementia
and BPSD are presenting at emergency
departments (ED), either with acute comorbid
228
illnesses or with BPSD as the primary concern. ED
staff lack training in how to respond to BPSD, and
the stress and unfamiliarity of the ED can intensify
such symptoms; together, these factors increase
the likelihood of injuries to staff and/or patients in
the ED.
Intervention: When staff recognize the underlying
causes of need-driven behaviours and use
validating communication strategies, behavioural
escalation is minimized. Gentle Persuasive
TM
Approaches (GPA) is an educational intervention
promoting person-centred dementia care. Positive
impacts of GPA include increases in staff
knowledge and self-efficacy in managing BPSD as
well as reductions in violence and use of physical
restraints. However, while GPA has been
implemented in long-term care homes, and is
spreading within acute and community care, its
widespread uptake has not yet extended to EDs.
Methods: 55 ED staff enrolled in the online GPA
eLearning program. Demographic information and
quantitative measures of staff knowledge, selfefficacy, and competence in providing personcentred dementia care were collected immediately
before and after the intervention.
Results: Analysis of 15 complete cases revealed
that participants showed significant improvements
in self-efficacy (p=.001), competence (p=.002), and
knowledge (p=.021) in dementia care after
completing the intervention.
Conclusion: Findings suggest that GPA is
relevant and effective for ED staff, warranting its
adaptation and dissemination to this environment.
LB5
Managing Behaviours Associated with
Dementia: Tailoring an Educational
Intervention for Emergency Department Staff
1
1
Patricia Julian , Lori Schindel Martin , Victoria
2
3 ,4
4
McLelland , David Ryan , Jacques Lee , David
5
6
Cowan , Wilding Laura
1
Ryerson University, Daphne Cockwell School of
2
Nursing, Toronto, Ontario, Canada, Advanced
Gerontological Education, Research and
Development, Hamilton, Ontario, Canada,
3
Regional Geriatric Program of Toronto, Toronto,
4
Ontario, Canada, Sunnybrook Health Sciences
5
Centre, Toronto, Ontario, Canada, McMaster
University, Department of Medicine, Hamilton,
6
Ontario, Canada, The Ottawa Hospital, Ottawa,
Ontario, Canada
Purpose: Increasing numbers of people with
dementia are presenting to emergency department
settings (EDs) with behavioural and psychological
symptoms of dementia (BPSD) as a chief
complaint. The hectic pace of EDs can trigger and
exacerbate BPSD. ED staff report difficulties with
BPSD, leading to distress, restraint use and injury
risk.
TM
Intervention: Gentle Persuasive Approaches
(GPA), is an educational intervention promoting
person-centred dementia care. GPA
implementation has improved staff self-efficacy to
deliver person-centred care in long-term care and
inpatient hospital settings, yet the 7-hour
classroom version has low uptake by ED staff.
Method: This sequential, mixed methods study
explored the clinical and educational relevance of
a 3-hour GPA eLearn program for EDs and
whether ED-specific content revision is needed. In
phase one, ED staff (n=55) completed pre-post
GPA quantitative and qualitative measures to
identify content considered essential for ED
practice and elements requiring revision prior to
broad implementation. Phase one findings guided
the development of interview guides for phase two.
During the second phase, phone interviews were
conducted with a purposive sample of phase one
participants (n=4) to gain deeper insight into GPA's
relevance in EDs.
Findings: Results from responses to open-ended
questions in online measures and from phone
interviews reveal that participants consider GPA
relevant to ED settings, increases job satisfaction
and positively impacts patient outcomes.
Decreasing module duration and adding EDspecific cases were common recommendations to
adapt GPA for ED settings. Conclusions: Findings
suggest that GPA is relevant to EDs, warranting
adaptation and dissemination to this environment.
LB6
Barriers and Facilitators to the Use of
Guidelines for Depression and Anxiety in
Parkinson’s Disease or Dementia
1
2
Zahra Goodarzi , Heather Hanson , Nathalie Jette
,3
4 ,6
5 ,3
, Scott Patten , Tamara Pringsheim , Jayna
1 ,3
Holroyd-Leduc
5
229
1
Department of Medicine, University of Calgary,
2
Calgary, Alberta, Canada, Seniors Health
Strategic Clinical Network, Calgary, Alberta,
3
Canada, Hotchkiss Brain Institute & O'Brien
Institute of Public Health, Calgary, Alberta,
4
Canada, Department of Psychiatry, University of
5
Calgary, Calgary, Alberta, Canada, Department of
Clinical Neurosciences, University of Calgary,
6
Calgary, Alberta, Canada, Mathison Centre for
Mental Health Research and Education, Calgary,
Alberta, Canada
implementation of certain recommendations due
primarily to a lack of evidence.
Purpose: Despite the availability of clinical
practice guidelines for the management of
depression or anxiety in dementia or Parkinson’s
disease (PD), these comorbidities remain underdiagnosed and under-treated.
While many seniors living independently report
good health, others struggle with various chronic
conditions (e.g., cardiovascular diseases, or
physical injuries due to falls). Remote patient
monitoring allows providers to have “real-time”
information on vital signs to detect changes in
patients’ health status early. The objective of this
study was to pilot the integration of wireless
monitoring devices for falls, weight, hydration,
heart rate, oxygen saturation and blood pressure
with an existing electronic record for 30 seniors in
assisted living. The purpose of this session is to
describe the lessons learned throughout the study,
and strategies we used to overcome challenges.
Our primary objective was to understand the
barriers and facilitators associated with the
implementation of high quality CPGs for
depression and anxiety in patients with dementia
or PD.
Design & Methods: Focus groups and interviews
were conducted with participants experiencing PD,
their caregivers and physicians involved in the care
of persons with dementia or PD in Calgary,
Alberta. The Theoretical Domains Framework and
Behaviour Change Wheel were used to guide data
collection and perform a framework analysis.
Evidence from the available guidelines was
compared to reported physician behaviours.
LB7
Integrated eTechnology: Seniors care for the
21st century. Lessons Learned
Omenaa Boakye, Arden Birney, Esther Suter,
Rima C Tarraf
Alberta Health Services, Calgary, Alberta, Canada
LB8
Bien vieillir dans sa maison : la relation entre
l’environnement bâti domiciliaire et la dépense
énergétique des femmes aînées sur l’Île de
Montréal
1 ,2
Results: A total of 33 physicians and 7 PD
patients/caregivers participated. We were unable
to recruit patients/caregivers with dementia. Data
were divided into three categories based on the
barriers and facilitators to the implementation of
guideline recommendations for diagnosis,
management and the use of the guidelines. An
overarching theme was the lack of evidence for
depression or anxiety disorders in dementia or PD.
This was more prominent for anxiety versus
depression. Other themes included the lack of
consistency between guidelines, lack of clarity in
the language used, lack of applicability to the
practice population, and impractical or out of date
recommendations. Patients noted difficulties with
communication of symptoms and access to
services.
Implications: Although there are available
guidelines, physicians have difficulty with the
1 ,2
3 ,4
A Patry , C Vincent , C Duval , M Blamoutier
,4
5
5
, P Boissy , S Brière
1
Centre interdisciplinaire de recherche en
réadaptation et intégration sociale (CIRRIS),
2
Québec, Canada, Université Laval , Québec,
3
Canada, Centre de recherche de l'Institut
universitaire de gériatrie de Montréal (CRIUGM) ,
4
Montréal, Canada, Université de Québec à
5
Montréal (UQAM), Montréal, Canada, Université
de Sherbrooke, Sherbrooke, Canada
3
Introduction : Plusieurs aînés souhaitent bien
vieillir dans leur maison, mais encore faut-il que
l’environnement bâti offre un niveau de défi optimal
pour y entrer et en sortir, s’y déplacer, vaquer aux
tâches domestiques usuelles, tout en permettant
de maintenir ses capacités fonctionnelles et sa
participation. La dépense énergétique et les
déplacements de femmes aînées en santé
résidant sur l’Île de Montréal ont récemment été
mesurées avec une combinaison innovatrice de
230
mesures objectives (accélérométrie et
géolocalisation).
Objectif : En partenariat avec une équipe
regroupant kinésiologues, ergothérapeutes et
ingénieurs, il est proposé d’explorer la relation
entre la dépense énergétique et l’aménagement
domiciliaire et d’identifier les aspects de
l’environnement bâti domiciliaire expliquant le
mieux la variabilité de la dépense énergétique de
femmes aînées en santé.
Méthodologie : Entre juillet et septembre 2015, 35
participantes ont été recrutées via la base des
données rétrospectives de la dépense énergétique
et déplacements (exclusion : travaux,
déménagement). Une prise de mesure
transversale de l’environnement bâti a été réalisée
au domicile des participantes à l’aide de l’outil
d’évaluation Housing Enabler (incapacités, grille
de 161 obstacles environnementaux, accessibilité)
et d’une grille d’évaluation maison (pièces,
escaliers, activités domestiques).
Résultats : Il sera question de la relation entre la
dépense énergétique à l’intérieur du domicile
(kcal/min) et le nombre d'obstacles rencontrés
ainsi qu'avec les caractéristiques de
l’environnement bâti (type de logement, d’accès,
pièces). Ces données sont intéressantes pour les
services publics et promotteurs privés visant le
maintien des capacités à domicile et de
l'accessibilité du logement.
LB9
Compliant Flooring to Prevent Fall-Related
Injuries in Older Adults: A Scoping Review
presented about the biomechanical efficacy,
clinical effectiveness, cost-effectiveness, and
workplace safety associated with CF systems that
aim to prevent fall-related injuries in healthcare
settings? We searched academic and grey
literature databases. Any record that discussed a
CF system and at least one of biomechanical
efficacy, clinical effectiveness, cost-effectiveness,
or workplace safety was eligible for inclusion. Two
independent reviewers screened and abstracted
records, charted data, and synthesized results.
After screening 3611 titles and abstracts and 166
full-text articles, we included 84 unique records
plus 56 companion (supplementary) reports.
Laboratory evidence from biomechanical efficacy
records (n=50) demonstrate CF can reduce fallrelated impact forces with minimal effects on
balance and mobility. Clinical effectiveness records
(n=20) suggest that CF can reduce injuries, but
may increase risk for falls. Preliminary evidence
suggests that CF may be a cost-effective strategy
(n=12), but may also result in increased physical
demands for healthcare workers (n=17). In
summary, CF is a promising strategy for preventing
fall-related injuries from a biomechanical
perspective. Additional research is warranted to
confirm whether CF (i) prevents fall-related injuries
in real-world settings, (ii) is a cost-effective
intervention strategy, and (iii) can be installed
without negatively impacting workplace safety.
LB10
Development and evaluation of a medication
management intervention using an electronic
pill dispenser and tailored to early-stage
Alzheimer Disease patients: A study protocol
1 ,4
1 ,4
Chantelle Lachance , Michal Jurkowski , Ania
1
1 ,2
3
Dymarz , Stephen Robinovitch , Fabio Feldman
,1
4
1 ,2
, Andrew Laing , Dawn Mackey
1
2
Centre for Hip Health and Mobility, Vancouver,
3
BC, Canada, Fraser Health Authority, Surrey, BC,
4
Canada, University of Waterloo, Waterloo, ON,
Canada
Myriam Tellier , Louise Demers , Claudine
2 ,3
Auger
1
University of Montreal, school of rehabilitation,
2
Montréal, Canada, Centre de recherche
interdisciplinaire en réadaptation du Montréal
3
métropolitain (CRIR), Montréal, Canada, Centre
de réadaptation Lucie-Bruneau (CRLB), Montréal,
4
Canada, Centre de recherche de l’institut
universitaire de gériatrie de Montréal , Montréal,
Canada
Compliant flooring (CF) may reduce the incidence
and severity of fall-related injuries in older adults;
however, a lack of synthesized evidence may be
limiting widespread uptake. Informed by the Arksey
and O'Malley framework and guided by a
Research Advisory Panel of knowledge users, we
conducted a scoping review to answer: what is
Medication management is a real challenge for
people with Alzheimer disease (AD) and is a
burden for their caregivers. An electronic pill
dispenser could help improve this activity but
findings relating to the ability of people with AD to
use technologies are inconsistent with, no specific
details about, the theory-driven interventions that
1 ,2
1
231
should be used. This project aims to develop and
evaluate a medication management intervention
using an electronic pill dispenser, tailored to earlystage AD patients and involving caregivers. During
phase 1, a preliminary version will be developed
using evidence-based specific learning strategies
for people having cognitive impairments. It will be
validated using semi-structured interviews with AD
individuals (n=3), caregivers (n=3), and healthcare
professionals (n=3). Content analysis will identify
issues related to pill dispenser acceptance and
intervention coherence in the context of home care
for AD patients. Phase 2 will evaluate the efficacy
of the intervention. An ABA multiple baseline
across participants design (A1= technology, B=
technology and intervention, and A2= technology)
will be used with five dyads (people with AD and
caregivers). Medication management will be
quantified using an observation chart, filmed once
a week, and rated by blind evaluators.
Automatically the pill dispenser will generate other
variables. These will be examined by graphic
analysis and calculation of the least squares
regression. This study could become a proof of
concept that an intervention, integrating evidencebased training strategies engaging people with
mild AD and their caregivers in the use of
technology, can improve task performance in a
home environment.
1
1 ,2
Jonathan Jarry , Julie-Andrée Marinier , Aaron
3 ,4
1
Johnson , Walter Wittich
1
School of Optometry, Université de Montréal,
2
Montreal, QC, Canada, Institut Nazareth et LouisBraille of the Centre intégré de santé et de
services sociaux de la Montérégie-Centre,
3
Longueuil, QC, Canada, Department of
Psychology, Concordia University, Montreal, QC,
4
Canada, MAB-Mackay Rehabilitation Centre /
CRIR of the Integrated Health and Social Services
University Network for West-Central Montreal,
The prevalence of age-related visual impairment is
rising, resulting in more individuals requiring
rehabilitation services for visual tasks such as
reading. Spot reading, the ability to obtain short
pieces of visual information such as a phone
number or price, can easily be rehabilitated with
magnification devices, such as loupes or portable
closed-circuit TVs (CCTVs). However, they have
limitations such as screen size and price and have
previously been shown to be stigmatizing when
used in public. The recent arrival of tablet
computers provides an alternative with greater
magnification at a reduced price. We present
preliminary results on the objective and subjective
comparison of the iPad and a portable CCTV for
spot-reading tasks in 45 elderly, visually impaired
participants.
LB12
Supporting patient and family caregiver
engagement in healthcare research: A
qualitative study
Kristina Chang
The research described in this qualitative protocol,
with a user-centred design, will use personas and
scenarios to explore with older adults and
caregivers the perceived enablers to patient and
caregiver engagement in research, and the kinds
of supports that are required by patients and
caregivers to engage in research. Furthermore,
this study will endeavour to understand how
participants perceive the role of information and
communication technology (ICT) to support patient
and caregiver engagement in health research.
LB13
iPad versus Portable CCTV to Assist the
Visually Impaired in Spot Reading: Preliminary
Results
Seventeen men and 28 women with mean age
82.5 (21.5), with impaired visual acuity (< 20/63)
due to age-related diseases, were asked to
complete spot-reading tasks involving three
common objects (cable bill, food package, box of
eye drops) using the iPad and the CCTV in
randomized order. We measured their ability to
complete each task and the time it took, in addition
to their subjective device assessment.
A Bayesian estimation analysis showed no
statistically significant differences between the
device conditions in the time to complete each
task. Choosing one device over the other may
simply depend on preference which, in our cohort,
was split (21 iPad, 22 CCTV, 2 neither) and which
could be influenced by factors such as device size
and usability.
LB14
The Use of Hospitals by Terminally-ill and
Dying Canadians: Using Current Evidence for
Compassionate and Effective Services for
Older People
232
1
2
1
Donna M Wilson , Stephen Birch , Ye Shen , Gail
1
Low
1
2
It is widely believed that most Canadians die in
hospital, after an escalation in hospitalizations over
the last year of life. Considerable concern exists
over hospital-based end-of-life care, including the
high cost of it and the provision of inappropriate
curative care for older people. As most deaths now
are not sudden or unexpected, compassionate and
effective care at and near the end of life is
essential for good deaths to occur. Current
population-based evidence is needed for health
policy and services planning. A study involving
complete individual-anonymous 2013-14 and
2014-15 Canadian (except Quebec) hospital data
was conducted after research ethics was obtained.
This study found only 3.5% of all hospital
admissions end in death and only 43.7% of deaths
each year take place in a hospital bed; with 49.1%
of all people who died in hospital only admitted
once to hospital in the last year of life and another
46.1% admitted 2 times. Males and younger
people (< age 65) were more likely to be admitted
more often. Before dying in hospital, 67.0% were
living at home, another 3.6% were living at a home
and receiving home care services, and 6.2% were
living in a nursing home. These findings reveal the
importance of evidence for combatting myths
about aging and dying. Moreover, as the
unsupported home was found to be the most
common place of end-of-life care, it reveals a need
for considerable expansion of palliative home care
services to support dying people and their family
caregivers.
LB15
Shape analysis of subcortical structures in
idiopathic rapid eye movement sleep behavior
disorder
1 ,2
1 ,3
1 ,4
S Rahayel , J Montplaisir , C Bedetti , RB
1 ,5
4 ,6
1 ,4
7
Postuma , S Brambati , J Carrier , O Monchi
,8
1 ,2
, JF Gagnon
1
Centre for Advanced Research in Sleep Medicine
(CARSM), Hôpital du Sacré-Cœur de Montréal,
2
Montreal, Canada, Department of Psychology,
Université du Québec à Montréal, Montreal,
3
Canada, Department of Psychiatry, Université de
4
Montréal, Montreal, Canada, Research Centre,
Institut Universitaire de Gériatrie de Montréal,
5
Montreal, Canada, Department of Neurology,
Montreal General Hospital, Montreal, Canada,
6
Department of Psychology, Université de
7
Montréal, Montreal, Canada, Department of
Radiology, RadioOncology, and Nuclear Medicine,
Université de Montréal, Montreal, Canada,
8
Departments of Clinical Neurosciences,
Radiology, and Hotchkiss Brain Institute, University
of Calgary, Calgary, Canada
Idiopathic rapid eye movement sleep behavior
disorder (iRBD) is considered as a risk factor for
the development of Parkinson's disease. Structural
brain abnormalities preceding onset of motor signs
in Parkinson's disease remain poorly understood
and iRBD offers one way to better understand
Parkinson's disease in its preclinical stages. In
iRBD, gray matter abnormalities involve both
volume and cortical thickness. Another technique,
vertex-based shape analysis, allows for
quantification of surface differences in subcortical
structures and overcomes some limitations of
voxel-based measures. No study has yet studied
shape of subcortical structures involved in corticosubcortical loops in iRBD patients. Forty-one
patients with iRBD and 41 controls underwent MRI
examination. Voxel-based morphometry (VBM)
was used to investigate local gray matter volume.
Subcortical structures (i.e., putamen, caudate,
pallidum, and thalamus) were studied for global
volume and shape. VBM shows gray matter
volume reductions in the frontal and cingulate
lobes and the caudate. Surface-based volumetric
analysis shows reduced volume of the right
putamen. Shape analysis shows 2 clusters of
abnormal surface displacement in the left putamen
on the medial and lateral surfaces representing
surface contraction and surface expansion. In
summary, patients with iRBD present with shape
and global volume abnormalities in the putamen,
along with local reductions of gray matter volume
in the frontal lobes. This study was supported by
grants from the Canadian Institutes of Health
Research, the Fonds de Recherche du Québec Santé, and the W. Garfield Weston Foundation.
LB16
Integrated Care Approaches To Care
Transitions For Hospitalized Older Adults: A
Scoping Review
Cara L Brown, Verena Menec
Introduction: More needs to be done to improve
care quality for older adults during the transition
from hospital to the community. Integrated care is
an approach that has promise for overcoming
233
organizational and clinical fragmentation that
impedes these transitions. However, there is
currently a lack of consistent use of the concept of
integrated care that is obstructing research
progress.
Objective: Map the concept of integrated care in
literature on transitions between acute care and
the community.
Methods: A systematic search was designed
using methodology proposed by

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