<p> The purpose of this study was to determine wellness specific requests of the Baby Boomer population in reference to choosing a skilled nursing facility for self and family members. Participants are any individual born from 1946 &Dot;C 1964 with access to the survey via internet or hard copy. A survey was emailed using various hosting sites, such as corporate emails, social media sites, and forwards to additional contacts, containing questions regarding physical, social, and intellectual wellness preferences in the nursing setting. Returned survey responses through PsychData totaled 462, totaling 436 useable surveys. All data analyses were conducted using SPSS version 21.0, using a significance level of p &le; .05: for all analyses. Results of the study show that the specific demographics of income and education may not significantly determine the extent to which a Baby Boomer will prefer certain dimensions of wellness in a skilled nursing facility. However, gender has a significant impact on both physical and social wellness preferences based on Mann Whitney analysis. Physical wellness questions regarding meal options, walking trails, supervised exercise programs, adapted exercise programs, and overall wellness were all significantly different at p &lt;.001. Mean scores indicate women place slightly greater importance on each measure of physical wellness. Social wellness and gender shows association when measuring (1) distance of facility from family members and potential visiting friends, (2) family proximity to facility (3) animal interaction, and (4) volunteer opportunities. While the differences between genders are statistically significant for four of the five social wellness questions, there is only a noticeable difference for animal interactions. Additionally, intellectual wellness is important to Baby Boomers, exhibited by selections of ongoing educational programs and accessibility to technology and internet communication via Wi-Fi availability. In conclusion, the majority of Baby Boomers surveyed seek physical and social wellness opportunities in long term care, specifically skilled nursing despite income and education levels.</p>

<p> Although there are ample studies confirming that memory self-efficacy (MSE) declines with age, less is known about what factors account for the variation in MSE among older adults. The purpose of this study was to examine the relationship between MSE, diagnostic and clinical characteristics, and subsequent episodic memory performance in older adults. A nonprobability sample of 200 cognitively normal and older adults with mild cognitive impairment (MCI) participating in a longitudinal population-based study investigating the incidence, prevalence and risk factors for MCI completed a questionnaire about self-referent beliefs of MSE. Bandura's (1989) selfefficacy theory and the Integration Model (Whittemore, 2005) informed the descriptive study. Pearson product-moment correlations, a general linear model and a multiple linear regression analysis were conducted. The difference in MSE ratings between the cognitively normal group and the MCI group tested as a whole was significant when adjusting for age, gender and educational attainment (p &lt; .001; ES= 0.585). The overall regression model explained 17 % of the variance of MSE (p &lt; .001) and included age, gender, educational attainment, APOE 4 genotype, family history of dementia, cognitive diagnosis and depressive symptoms. After controlling for age and the other variables of interest, cognitive classification and depression were significant predictors of MSE. Higher MSE ratings were correlated with better episodic memory performance for both groups (r = .273, p &lt; .001). Memory training that capitalizes on the benefits accruing from higher MSE is needed for cognitively normal older adults and older adults with MCI.</p>

<p> Purpose: The purpose of this study is to explain the major barriers to medication access in rural seniors. How seniors access their prescription medications and make choices access helps to explain what seniors consider to be major barriers. This project has five goals: (1) describe what barriers rural seniors perceive that hinder access to their medicines and thus interfere with adherence to prescribed medication regimens; (2) understand what seniors perceive to be facilitators to accessing their prescriptions; (3) learn how or if social support networks play a role in helping rural seniors make decisions about how to use their resources to get their medications; (4) define the process that rural seniors use to move from potential access &mdash; the desire to get their medications, to revealed access &mdash; the actual ability to get their medications; and (5) describe what health care providers believe are the barriers that rural seniors face to getting their medicines. </p><p> Methods: I interviewed 19 low-income seniors in five towns in the San Luis Valley using semi-structured interviews, along with one pharmacist from each of seven pharmacies. A card study was conducted in nine clinics of the Valley Wide and Rio Grande systems. The interviews were coded using the grounded theory method. The card study survey was administered to primary care providers in eight clinics to gauge understanding of elderly patients' potential for barriers to access of medications. </p><p> Results: The primary finding is that poor structural health literacy (SHL) is the major barrier to access of medications, and to healthcare access generally. SHL is a factor in the more widely discussed barriers such as cost and transportation. </p><p> Discussion: SHL increases the chances that seniors will have access to healthcare by helping seniors learn how to take advantage of programs that enhance their ability to afford medications. Public Health agencies must work with community leaders to ensure that seniors are aware of their options for accessing medications, including financial and transportation options.</p>

Previsões da Organização Mundial de Saúde (OMS) apontam que entre os anos de 2006 e 2030, o número de pessoas idosas nos países de baixa e média renda está projetado para aumentar em 140% em relação ao aumento nos países de renda alta que será de 51% e, pela primeira vez na história, em 2050 haverá mais idosos do que crianças (0 14 anos), configurando-se um novo panorama demográfico. A assistência à saúde do idoso, em conjunto com a prevenção de doenças crônicas e degenerativas, e o preparo adequado de quem presta cuidado são imprescindíveis para a manutenção da autonomia e qualidade de vida do idoso. O presente estudo foi realizado com 113 cuidadores não familiares de idosos, que prestam cuidado no âmbito domiciliar, residentes na zona urbana do município de Taquaritinga (SP). Teve como objetivo identificar o perfil dos cuidadores na prestação de cuidados domiciliares, bem como suas principais dificuldades, responsabilidades e tarefas assumidas, perante o paciente e a família, no ato de cuidar. Foram aplicados questionários, contendo perguntas abertas e fechadas, a 113 cuidadores, em locais diferentes de onde exerciam a função, após contato prévio, no período de julho a setembro de 2011. Os cuidadores eram predominantemente do sexo feminino (85%), casados ou viviam em união consensual (57.5%), na faixa etária de 19 a 59 anos (90,3%); em menor proporção apareceu a população de cuidadores idosos (9,7%). Entre os cuidadores do sexo masculino, predominaram os na faixa etária de 19 a 59 anos (94,1%). Quanto à escolaridade referida pelos cuidadores, 24,8% possuíam apenas o nível fundamental, 21,2% o nível médio, 31% o nível técnico, 6,2% o nível superior e 16,8% sem escolaridade. Os profissionais de enfermagem constituíram 35% dos cuidadores, e somente um cuidador se auto avaliou como bem preparado. A profissão de cuidador não foi a principal atividade para 77% dos entrevistados, que exerciam outras atividades. Declararam não possuir qualificação para o exercício da função, 87,6% dos entrevistados e 45% referiram pouco preparo. Embora 94,7% dos cuidadores declarem ser capazes de cuidar, todos referiram possuir dificuldades e necessidade de um apoio profissional, independentemente do nível de escolaridade, formação profissional, ou nível de dependência do idoso. A família do idoso não auxilia no trabalho do cuidador em 35% dos casos, e frequentemente (55%) delega serviços domésticos ou externos para serem realizados além do ato de cuidar. A carga horária de trabalho semanal é superior a 30 horas e a grande maioria não possui vínculo empregatício formal; 33% dos cuidadores referiram que raramente são remunerados. Os resultados evidenciam a necessidade de um olhar diferenciado a esses profissionais, principalmente na elaboração de políticas públicas, sociais e de saúde voltadas à formação de recursos humanos para este fim, para manter uma pessoa idosa saudável ou minimizar seu grau de dependência. / World Health Organization (WHO) projections pointed that between 2006 and 2030, the number of old people in low and middle income countries will increase 140% in relation to high income countries where it will increase 51% and , for the first time in the history, in 2050 the number of elderly will exceed the number of children (0-14 years), showing a new demographic profile. Health care for old people, together with the prevention of chronic and degenerative diseases, and the adequate training of carers are necessary for the maintenance of the autonomy and quality of life of the elderly. This study was carried out with 113 nonfamily related home carers of old people, living in urban area of the city of Taquaritinga, SP. The objective was to identify the profile of the home carers, their difficulties, responsibilities and tasks carried out for the patient and family. Interviews with open and closed questions were performed with 113 carers, in different place of their usual work, after previous contact, from July to September, 2011. Female carers predominated (85%), and the majority were married or in a stable union (57,5%) and in the age-group 19-59 years (90,3%); aged home carers appeared in a small proportion (9.7%). Among male carers, the majority was in the age-group 19-39 years. According to school attendance reported by the carers, 24.8% had elementary school, 21.2% high school, 31% technical level, 6.2% university degree and 16.8% never went to school. Nursing professionals were 35% of the carers, and only one carer had self-evaluation as well prepared for their task. The activity of carer was not the main activity for 77% of the interviewers, that have other job. The lack of training to carry their activities was reported by 87.6% of the carers. In spite of 94.7% of the carers mentioned that they were able to give home care, all of them reported that they have difficulties and need professional support, and this was independently of educational level, profession or level of dependence of the elderly. The family of the elderly do not help according to 35% of the interviewers and frequently (55%) delegate domestic or external work to be carried besides the care of the elderly. The weekly working time is more than 30 hours and the great majority do not have formal work contract and 33% of the carers reported that rarely they receive some payment. These results highlighted the need to a different vision to these professionals, mainly in the elaboration of public, social and health policies towards the formation of human resources to this activity, to keep aged persons in healthy conditions or to minimize their dependence.

A preocupação em compreender o indivíduo de forma holística está gradativamente aumentando na área da saúde. Neste cenário os Florais de Bach consolidam-se, buscando suprir as necessidades emocionais dos indivíduos, incluindo a auto-estima, degradada em muitos idosos pela falta de auto-confiança e auto-respeito que vivenciam. Acreditando que as essências florais são capazes de estimular comportamentos e atitudes positivas e aumentar a percepção e compreensão dos sentimentos, optou-se por avaliar a efetividade dos Florais de Bach na melhora da auto-estima de idosos. Desenvolveu-se um estudo experimental, tipo ensaio clínico, triplo-cego, com idosos atendidos em dois ambulatórios de geriatria de São Paulo. Para avaliação da auto-estima utilizou-se o instrumento de Dela Coleta e para caracterização dos idosos uma anamnese de dados sócio-culturais-demográficos. De Abril/2008 a Julho/2009 abordou-se para avaliação da auto-estima 665 idosos. Desses, 15,9% (106) apresentou escore de auto-estima referente à baixa/média auto-estima, porém somente 80 preencheram também os outros critérios de inclusão do estudo. Ao fim, com as desistências, obteve-se 67 idosos, 35 alocados no Grupo Experimental e 32 no Grupo Placebo. Estes idosos participaram de três atendimentos em Terapia Floral, um a cada 45 dias nos quais se avaliou a auto-estima e se registrou os relatos de evolução dos problemas e sentimentos relacionados à auto-estima. Em todos os atendimentos os idosos escolheram seis Florais de Bach através da técnica de escolha das fotos das flores correspondentes. A cada idoso forneceu-se dois frascos com solução base, sendo que aos do Grupo Experimental acrescentou-se as essência florais escolhidas. Somente no último atendimento os idosos souberam dos significados das flores escolhidas durante o estudo, e todos os participantes receberam mais dois frascos, agora com os Florais escolhidos, permitindo o contato de todos os participantes ao tratamento. Para a verificação estatística da efetividade dos Florais sobre a auto-estima realizou-se o Teste de Tukey-HSD, observando-se que não houve diferença estatística entre os Grupos Experimental e Placebo. Houve melhora da auto-estima em ambos os grupos de estudo, porém no Grupo Experimental observou-se tendência progressiva de melhora enquanto que no Grupo Controle a auto-estima sofreu melhora imediata e manteve-se inalterada. Acredita-se que o relacionamento terapêutico estabelecido durante os atendimentos foi capaz de melhorar a auto-estima dos idosos do Grupo Placebo, porém somente os Florais forneceram subsídios ao individuo trabalhar sua auto-estima efetivamente. Reforçando isto, somente no Grupo Experimental observou-se evolução positiva do bem-estar geral relatado pelos idosos. Sugere-se que o tempo de exposição ao tratamento foi muito curto para observação da uma melhora maior no Grupo Experimental e o instrumento utilizado não foi o mais adequado para esta população, visto que não abrangia questões especificas da auto-estima em idosos. Percebeu-se que a Flor de Bach mais relevante foi a Red Chestnut, a única Flor que nos três atendimentos esteve entre as preferidas dos idosos de ambos os grupos. Esta flor evidencia duas das principais queixas dos idosos: o excesso de preocupação, principalmente com os filhos, netos e com a condição financeira / The concern in understanding the individual in a holistic way is gradually increasing in the health field. In this scenario, the Bach Flower Remedies consolidate in an attempt to supply the emotional needs of individuals, including the self-esteem, degraded in many older people due to the lack of self-confidence and self-respect that they experience. Believing that flower essences are able to stimulate positive behaviors and attitudes and increase awareness and comprehension of feelings, we decided to evaluate the effectiveness of the Bach Flower Remedies in the improvement of the self-esteem of older people. We developed an experimental study, clinical trial, triple-blind, elderly assisted by two geriatric clinics in Sao Paulo. To assess self-esteem it was used the instrument of Dela Coleta and the characterization of an old history of socio-cultural and demographic. From April/2008 to July/2009 addressed to assessing self-esteem 665 people. Of these, 15.9% (106) had scores of self-esteem on the low / medium self-esteem, but only 80 also met the other criteria for inclusion in the study. The end, with the dropouts, we got 67 seniors, 35 allocated in the experimental group and 32 in the placebo group. These seniors participated in three appointments to Flower Therapy, one every 45 days during which we evaluated the self-esteem and registered reports of developments on issues related to feelings and self-esteem. At every appointment the elderly chose six Bach Flowers using the technique of choice of photos matching flowers. For every elderly were provided two bottles of base solution, and to the experimental group was added to the flower essence chosen. Only at the last treatment, the elderly had known the meaning of the flowers chosen for the study and all participants received two more bottles, now with the flowers chosen, allowing contact of all participants to treatment. For statistical verification of the effectiveness of Flowers on self-esteem was held to the Tukey-HSD, resulting in that there was no statistical difference between the Experimental and Placebo Groups. There was improvement in self-esteem in both study groups, but in the experimental group there was a trend of gradual improvement while in the placebo group self-esteem has improved immediately and remained unchanged. It is believed that the therapeutic relationship established during the sessions was able to improve self-esteem of older people in the placebo group, but only Bach flowers provided subsidies to improve individuals self-esteem effectively. Reinforcing this, only in the experimental group it showed positive development of well-being reported by the elderly. It is suggested that the exposure time to treatment was too short for the observation of a greater improvement in the experimental group and the instrument used was not the most appropriate for this population, as they did not cover specific issues of self-esteem in the elderly. It was noticed that the more relevant Bach flower was Red Chestnut, the only one that in all appointments was among the favorite flowers of the elderly in both groups. This flower shows the principal complaints of the elderly: over-concern, especially with the children, grandchildren and the financial condition

Previsões da Organização Mundial de Saúde (OMS) apontam que entre os anos de 2006 e 2030, o número de pessoas idosas nos países de baixa e média renda está projetado para aumentar em 140% em relação ao aumento nos países de renda alta que será de 51% e, pela primeira vez na história, em 2050 haverá mais idosos do que crianças (0 14 anos), configurando-se um novo panorama demográfico. A assistência à saúde do idoso, em conjunto com a prevenção de doenças crônicas e degenerativas, e o preparo adequado de quem presta cuidado são imprescindíveis para a manutenção da autonomia e qualidade de vida do idoso. O presente estudo foi realizado com 113 cuidadores não familiares de idosos, que prestam cuidado no âmbito domiciliar, residentes na zona urbana do município de Taquaritinga (SP). Teve como objetivo identificar o perfil dos cuidadores na prestação de cuidados domiciliares, bem como suas principais dificuldades, responsabilidades e tarefas assumidas, perante o paciente e a família, no ato de cuidar. Foram aplicados questionários, contendo perguntas abertas e fechadas, a 113 cuidadores, em locais diferentes de onde exerciam a função, após contato prévio, no período de julho a setembro de 2011. Os cuidadores eram predominantemente do sexo feminino (85%), casados ou viviam em união consensual (57.5%), na faixa etária de 19 a 59 anos (90,3%); em menor proporção apareceu a população de cuidadores idosos (9,7%). Entre os cuidadores do sexo masculino, predominaram os na faixa etária de 19 a 59 anos (94,1%). Quanto à escolaridade referida pelos cuidadores, 24,8% possuíam apenas o nível fundamental, 21,2% o nível médio, 31% o nível técnico, 6,2% o nível superior e 16,8% sem escolaridade. Os profissionais de enfermagem constituíram 35% dos cuidadores, e somente um cuidador se auto avaliou como bem preparado. A profissão de cuidador não foi a principal atividade para 77% dos entrevistados, que exerciam outras atividades. Declararam não possuir qualificação para o exercício da função, 87,6% dos entrevistados e 45% referiram pouco preparo. Embora 94,7% dos cuidadores declarem ser capazes de cuidar, todos referiram possuir dificuldades e necessidade de um apoio profissional, independentemente do nível de escolaridade, formação profissional, ou nível de dependência do idoso. A família do idoso não auxilia no trabalho do cuidador em 35% dos casos, e frequentemente (55%) delega serviços domésticos ou externos para serem realizados além do ato de cuidar. A carga horária de trabalho semanal é superior a 30 horas e a grande maioria não possui vínculo empregatício formal; 33% dos cuidadores referiram que raramente são remunerados. Os resultados evidenciam a necessidade de um olhar diferenciado a esses profissionais, principalmente na elaboração de políticas públicas, sociais e de saúde voltadas à formação de recursos humanos para este fim, para manter uma pessoa idosa saudável ou minimizar seu grau de dependência. / World Health Organization (WHO) projections pointed that between 2006 and 2030, the number of old people in low and middle income countries will increase 140% in relation to high income countries where it will increase 51% and , for the first time in the history, in 2050 the number of elderly will exceed the number of children (0-14 years), showing a new demographic profile. Health care for old people, together with the prevention of chronic and degenerative diseases, and the adequate training of carers are necessary for the maintenance of the autonomy and quality of life of the elderly. This study was carried out with 113 nonfamily related home carers of old people, living in urban area of the city of Taquaritinga, SP. The objective was to identify the profile of the home carers, their difficulties, responsibilities and tasks carried out for the patient and family. Interviews with open and closed questions were performed with 113 carers, in different place of their usual work, after previous contact, from July to September, 2011. Female carers predominated (85%), and the majority were married or in a stable union (57,5%) and in the age-group 19-59 years (90,3%); aged home carers appeared in a small proportion (9.7%). Among male carers, the majority was in the age-group 19-39 years. According to school attendance reported by the carers, 24.8% had elementary school, 21.2% high school, 31% technical level, 6.2% university degree and 16.8% never went to school. Nursing professionals were 35% of the carers, and only one carer had self-evaluation as well prepared for their task. The activity of carer was not the main activity for 77% of the interviewers, that have other job. The lack of training to carry their activities was reported by 87.6% of the carers. In spite of 94.7% of the carers mentioned that they were able to give home care, all of them reported that they have difficulties and need professional support, and this was independently of educational level, profession or level of dependence of the elderly. The family of the elderly do not help according to 35% of the interviewers and frequently (55%) delegate domestic or external work to be carried besides the care of the elderly. The weekly working time is more than 30 hours and the great majority do not have formal work contract and 33% of the carers reported that rarely they receive some payment. These results highlighted the need to a different vision to these professionals, mainly in the elaboration of public, social and health policies towards the formation of human resources to this activity, to keep aged persons in healthy conditions or to minimize their dependence.

People are living longer and this increases the risk of encountering financial difficulties when trying to make fixed retirement incomes stretch over additional years. Increased life expectancies also increase the likelihood of encountering a health issue including cognitive or functional declines that can affect money management capabilities. There are government entitlement programs available to assist retired Canadians but these programs are under review and new policies are being considered in order to reduce fiscal pressures. At the same time, family roles and structures are changing and informal supports available to previous generations may be reduced. As well, if an older person’s money is poorly managed there will be fewer options for maintaining quality of life in the retirement years. This increases the risk of poverty for older Canadians. The goals of this research are to: understand individual risk factors including demographic, clinical and social support characteristics among Canadians age 55 and over who are experiencing poverty; to understand the predictive characteristics for moving into or exiting from poverty; and, to develop a comprehensive description of those who have great difficulty managing their finances. In order to achieve this, data from the interRAI Home Care (RAI-HC) assessment instrument were used. Three regions, Winnipeg Regional Health Authority (WRHA), Nova Scotia and Ontario, were analyzed in order to understand the characteristics of those making economic trade-offs (N=345,678). Data from the province of Ontario was used to understand predictors of poverty transitions (N=47,653) and to develop a profile of those having great difficulty managing their finances (N=321,816). In order to answer each question of interest multivariable logistic regression modeling was used. Results from the analyses found that those most at risk for making economic trade-offs were in the age 55 to 64 group, had three or more depressive symptoms and were separated or divorced. Gender was not a risk factor. Regional differences for poverty risks were also identified showing greater risks for those experiencing mental health issues in WHRA, for those with more clinical indicators in Ontario, and for younger residents (age 55 to 64) in Nova Scotia. The longitudinal analyses on poverty transitions revealed that females who had completed at least a grade eight education were more likely to exit poverty. The younger group (age 55 to 64 years) with three or more depressive symptoms and experiencing unstable health were more likely to enter poverty. Marriage and older age were protective from the risks of entering poverty. Results from the analyses of those likely to have great difficulty with financial management indicated that deficits in cognition, procedural memory and function increased the risk of being unable to manage personal finances. Gender and marital status were not associated with financial management difficulty. The development of a profile of those who are making economic trade-offs and those at risk of having difficulty with financial management provides the opportunity for early intervention. Those who have not reached the traditional retirement age of 65 have an increased risk of poverty. Understanding characteristics of those who exit poverty will help establish policies and programs that will assist older Canadians. These are important issues due to the increased number of post-employment years that Canadians are living and the national focus on fiscal restraints. The management of finances has received minimal scientific research and evidence is needed to understand when changes in capability occur and how these changes may be supported by appropriate levels of assistance and supportive devices.

Suicide in later life is a growing public health concern that is expected to increase as the baby boom generation reach late adulthood. In the general population, older adults have rates of suicide that are higher than any other age group. The rate of suicide is particularly higher for older men. In Canada, older men between 80 and 84 years have rates of suicide approximately six times greater than older women the same age. Older adults living in the community are a sub-set of the population that are at high risk for suicide yet are not typically a focus of suicide research. As a result they remain hidden from the view of mental health promotion and suicide prevention programs until a decline in mental status brings them to the attention of formal mental health care services. Improving our understanding of suicide in later life particularly among community-residing older men can inform suicide prevention strategies. To improve this understanding, the goals of this research were three-fold: to comprehensively describe the sociodemographic and clinical characteristics of community residing older adults who have experienced suicide-related behaviour; to describe the rates, risk and protective factors, and predictors of suicide-related behaviour among this population; and to compare these findings to a subpopulation of community-residing older adults with neurological conditions. To achieve these aims, this research utilized a secondary data analysis approach using health information from multiple linked datasets. The Canadian Institute of Health Information (CIHI) performed record linkages between Ontario hospital administrative data (Discharge Abstract Database, National Ambulatory Care Reporting System, and Ontario Mental Health Reporting System) and Ontario home care data (Home Care Reporting System). Home care data are sourced from the Resident Assessment Instrument–Home Care (RAI-HC) Assessment Instrument, the provincially mandated assessment tool used to identify the strengths, preferences and needs of all long-stay home care clients. The RAI-HC contains over 350 items across a wide range of domains including health, functional status and resource use. Linkages of these data records between home care and hospital sectors enabled the prospective examination of community-residing older adults with recent suicide-related behaviour. This is one of the first national and international studies to use the RAI-HC to examine older home care clients with experiences of suicide-related behaviour. The study samples consisted of Ontario home care clients aged 60 years or older assessed with the RAI-HC between April 2007 and September 2010. Clients’ initial RAI-HC assessment was examined followed by corresponding hospital records for suicide-related behaviour (N = 222,149). The prevalence of suicide-related behaviour for the sample was 1.01% (n=2,077) with higher rates for older men than women. Rates were examined across geographic regions of Ontario. Descriptive analyses demonstrated that older adults with suicide-related behaviour had more indicators of psychiatric distress (including cognitive impairment) and psychosocial dysfunction than the general home care population. Multivariate analyses showed significant effects for age and gender in the prediction of suicide-related behaviour after adjusting for risk and protective covariates. Tangible areas for intervention were revealed that may reduce future suicide risk such as managing alcohol use and dependence, managing pain, increasing positive social relationships, and reducing social isolation. Time-to-event analysis supported the multivariate regression findings. Analyses of two subpopulations of older adults with neurological conditions (dementia and Parkinson’s disease) demonstrated marked differences in suicide risk and protective factors compared to the general home care population. Findings suggest that a one-size-fits-all approach to suicide prevention and intervention is not appropriate for persons with these conditions, as their specific risk and protective factors need to be taken into consideration. This study based on provincial data covering the home care sector in Ontario defined high risk groups of older adults and provided evidence for risk and protective factors associated with suicide-related behaviour. Findings point to several areas that should be assessed by home care professionals to reduce risk in the older home care client population. This multi-dimensional profile of high risk older adults will assist in initiating a policy dialogue regarding the need for targeted suicide prevention strategies in Ontario’s home care sector.

In recent years, research related to older adults and long-term care has been growing. Although much research in the past was focused on biomedical issues, more recent research has examined psychosocial issues faced by older adults within the long-term care setting. Despite the increase in literature and research on aging, long-term care, and dementia, there are still many gaps in our understanding of these phenomena. The concepts of body, self-identity, and place have received some attention over the last decade or so, but little systematic attempt has linked these concepts together, especially with relation to older adults and long-term care. In addition, the adjustment process of older adults into the long-term care facility has been examined, but the socialization processes have not been systematically examined. The purpose of this phenomenological study was to examine the process of socialization for new residents into the long-term care culture and environment, specifically focussing on how identities, bodies, and place are constructed and reconstructed by residents. Three residents were recruited for this study from a home for the aged in northwestern Ontario. Participant observation and three interviews over a six-month period with these residents focussed on concepts of place, self, and the body, as well as adjustment. Fifteen staff were also interviewed initially to gain an understanding of the long-term care environment and culture. Thirteen staff and two family members were interviewed at the end of the six-month period to gain an understanding of their perceptions of the resident’s transition into the long-term care facility. The findings indicate that a dismantling of the self occurs prior to coming into long-term care. Life in long-term care was described as living an altered life. Once admitted to the home for the aged, two types of socialization processes occurred—institutional and (inter)personal. Institutional socialization processes consisted of placing the body, defining the body, focussing on the body, managing the body, and relating to the body. Placing the body refers to the placement within the physical and social environment, residents’ adjustment to a new place, and how space within the facility was used. Defining the body refers to the assessments that were used just after admission which were focussed on the body as dysfunctional and limited. Focussing on the body occurred through the institution’s focus on body care, as well as the residents’ focus on their aging and unpredictable bodies, with a greater awareness of mortality and the immanence of death. Managing the body occurred through routines, risk management, and waiting. Finally, relating to the body referred to the boundaries of relationships that were defined, both resident relationships and staff relationships. The (inter)personal socialization processes capture the ways that residents internalized the institutional socialization processes. Internalizing the body refers to being a number and being a burden. Accommodating the body suggests ways in which residents complied to the institutional socialization processes. Accepting-resisting the body refers to the struggle residents had in accepting and fighting becoming a body, body limitations, and life in the institution. Re-creating the body illustrates ways in which residents reclaimed the body and alternative identities. All of these processes came together to create institutional bodies. These findings lead to a greater understanding of the ways in which body, self and identity, and place are intertwined. The institution served as a container for life, defining each of the lifeworld existentials. Lived space became institutional space, as personal space was redefined by the institution. Lived time also became structured by the institution, as temporal dimensions were defined by institutional time. The lived other became the institutional other, as staff became institutional brokers, attempting to balance the needs of the residents while adhering to the rules and regulations of the institution. The lived body also became the institutional body. The care encounter brought these dimensions together, and was the site for the production of institutional bodies. The findings of this study invite a rethinking of conceptions of the body and old age, particularly within the context of institutionalization, with bodies viewed as repositories of memories and containing both youth and age, rather than age as a ‘mask’. Residents exist within paradoxical rhythms of life, and thus, old age and institutionalization are not easily defined or theorized, but rather, reflect the complexity of lived experience.

Research exploring identity in the dementia context reveals that some aspects of personal and social identity persist in dementia while others evolve as persons living with dementia find ways to live with the changes in their lives. Leisure can be a space for developing and expressing identity and a space to resist stereotypical images and social expectations. Leisure may also play an important role in providing meaningful activity and engagement in life. Nonetheless, the meaning and experience of leisure in the context of dementia have received very little attention in the literature. Guided by the personhood movement, this phenomenological study aims to understand the subjective experience of dementia and the meaning and experience of leisure in the lives of persons living with early stage dementia. It explores leisure’s role in identity maintenance and/or development and leisure as a space for slowing down the process of dementia and resisting stigma associated with dementia and identity loss that could occur in dementia. Four persons living with early stage memory loss were recruited through local agencies to participate in this study. Each participant engaged in four conversational interviews following McCracken’s (1988) long interview format. Interviews were recorded and transcribed verbatim. Data were also collected through participant observation. The participants and I engaged in at least one of their favourite leisure activities together. Detailed field notes were recorded following each participant observation session. Using the method of photovoice, participants were given disposable cameras and asked to take photos of objects, places, and subjects that were meaningful for their leisure. These photos were discussed in Interview 2. Data were analysed in a manner consistent with phenomenology. Findings revealed that the participants experienced their journeys of memory loss within a paradox of challenge and hope. Participants juxtaposed the negative aspects of living with memory loss with the positive aspects of their lives. Essences of the experience include struggling with change, in which participants experience a wide variety of challenges as a result of being diagnosed with memory loss, including muddled thinking, fluctuating abilities, draining energy, frightening awareness, and disquieting emotions. However, participants counter these changes with the variety of ways in which they tackle life with dementia, including reconciling life as it is, battling through the changes by being proactive, living through relationships, being optimistic, and prolonging engagement in meaningful activity. Participants also experience threatening assaults on identities. Identity is threatened in terms of disappearing roles, losing independence, struggling with demeaning images and expectations, and losing confidence. However, participants juxtapose these threatening assaults by upholding identities. They do this by emphasizing abilities through leisure, changing perspectives, and engaging in life through leisure. This study deepens our current understandings of the subjective experience of dementia and leisure’s role within that experience. It helps us to understand the experience of leisure within the context of memory loss in terms of four lifeworld existentials: lived time, lived space, lived body, and lived other. The findings also contribute to our understandings of how persons living with dementia use leisure to resist a master status of dementia. Participants in this study used leisure as a space for resisting both the stigma of memory loss and the progression of memory loss. They overcome challenges in their leisure to demonstrate to themselves and others that they have many remaining abilities and are able to maintain valued aspects of their identities. The findings suggest that service providers, family members, and persons living with dementia should carefully consider the meaning of leisure and find ways to facilitate involvement in leisure that is meaningful for persons living with memory loss. In terms of future research, leisure in the context of relationships, including the importance of advocacy work for persons with dementia, should be examined. Although this study provides insight into the possibilities of alternative methods for understanding the experience of memory loss, further exploration is needed in this area.