OBJECTIVES: To examine the rates and correlates of depressive symptoms and syndromal depression in people with self-reported heart failure participating in a community study of people aged 70 and older. DESIGN: Cross-sectional. SETTING: Community-based epidemiological study of older people from the continental United States. PARTICIPANTS: Six thousand one hundred twenty-five older people participating in the longitudinal study of Assets and Health Dynamics. Participants had to be born in 1923 or earlier. MEASUREMENTS: The short-form Composite International Diagnostic Interview assessed syndromal depression, and a revised version of the Center for Epidemiologic Studies - Depression scale assessed depressive symptoms. Medical illness was based on self-report. The authors compared the rates of syndromal depression and individual depressive symptoms in people with self-reported heart failure (n = 199) with those in people with other heart conditions (n = 1,856) and with no heart conditions (n = 4,070). RESULTS: Eleven percent of those with heart failure met criteria for syndromal depression, compared with 4.8% of people with other heart conditions and 3.2% of those with no heart conditions. The association between heart failure and depression held even after controlling for disability, reported fatigue and breathlessness, and number of comorbid chronic illnesses. CONCLUSION: Community-living older people with self-reported heart failure were at approximately twice the risk for syndromal depression of the rest of the community. Although fatigue and functional disability were also related to depression in this sample, these variables did not account for the association between syndromal depression and self-reported heart failure.

Living arrangements play a key role in affecting participation of people with intellectual disabilities (PwIDs) in the community. Yet, the role of living arrangements in affecting participation has received relatively scant attention, especially from the insider's perspectives. This qualitative study sought to gain an insider's perspective from PwIDs in understanding the meaning of community participation, and the role of different community living arrangements in promoting community participation. Five adults with intellectual disability who were living independently with support were interviewed for this study. A model of full participation was developed to address the relationship between community living and community participation constituting four themes; level and type of support, learning experiences, freedom and choice, and privacy and safety. No gold standard for ideal community participation emerged from the study. Community participation of PwIDs was identified as involvement in meaningful and learning activities as required by the person. / October 2015

I am a community support worker who supports people with intellectual disabilities to live full lives with dignity in the community. This is a role that can trace its heritage to the 1980s when large institutions in BC closed in favour of community group homes. Current scholarship suggests that the requisite full lives promised at the time the institutions closed have not materialized in the years since. Further, this scholarship suggests that it is the community support worker who has failed to deliver on important social goals. As a worker I can attest that I do at times feel unsettled in my work, like my mere presence is problematic, as if I fail by showing up. Based on the premise that I can learn about the worker of present by looking at how she was first imagined, in this genealogical study I explore how the community support worker of the 1980s was produced in archival documents of groups involved in the development of community group homes after the closure of Woodlands in New Westminster, BC. My findings suggest that the community support worker role served many interests, and that her purpose was not solely trained to the social needs of the people she supported. A confluence of economic rationalities, family concerns, and regulatory demands shaped her as an invisible domestic idealized as a temporary solution to a problem that was expected to dissipate through the increased independence of people with disabilities, and the participation of a welcoming community that steps up to help when needed. The ongoing presence of the worker calls into question her original mandate. / Graduate / 0630 / 0452 / pcambiazo@telus.net

This study was performed as the result of gaps in the literature in the area of transition to independent living (IL) using secondary data from the National Longitudinal Transition Study 2 (NLTS-2). Its findings identify individual, skills, family, and school factors that predict postsecondary living status and moderators of the relationships between predictors and the outcome. Specifically, results indicated the following factors as predicting postsecondary living status: individual factors (ethnicity and disability label), skills (self-care, functional mental, personal autonomy, self-realization, and social), family factors (parental expectations and parental involvement in school), and school factors (student’s role in transition planning and having IL as the primary IEP goal). The following factors also emerged as moderators: ethnicity, disability label, mental skills, social skills, personal autonomy, and having IL as the primary goal. Performing analyses on secondary data, although providing the advantage of large numbers of participants, also result in limitations that were considered when making recommendations. Future research should investigate the accuracy of findings regarding skills predictors, and probe for better understanding of decision making during transition planning and participants’ experiences. Policy should include transition planning specifically for IL and postsecondary follow-up for this outcome, while practice should focus on incorporating planning for IL during transition planning, addressing cultural diversity in transition, and helping parents develop high and realistic expectations for their children.

The aim of this thesis was to study food, eating and meals in the everyday life of 32 women and men with intellectual disabilities (IDs) who require varying levels of supervision. They lived in supported living (rather independently) or group homes in community-based home-like settings. Observations during 3 days, assisted food records and anthropometric measurements were used to collect data. Dietary intake on the group level showed a varied diet and sufficient intake of all micronutrients, but a low dietary fibre intake. On the individual level, inadequate intake of micronutrients was observed, with many participants being obese, overweight or underweight. Everyday support with food, eating and meals was seen in four praxis: foodwork by oneself for oneself, foodwork in co-operation, foodwork disciplined by staff and foodwork by staff. These four practices resulted in large variations in dietary intake. The first praxis entailed more convenience food and less vitamins, the second and third, more fresh ingredients and high energy intake, and the fourth, low energy intake but rather high intake of vitamins. Sharing of meals was least common in supported living and more common in group homes and daily activity centres. The participants’ social eating spheres consisted mostly of other people with ID and staff members, and seldom other people. Whereas some preferred solitary eating, many participants considered eating together as important, but required staff support in establishing commensality. However, disturbing behaviour, as determined by the staff, could result in solitary eating. In conclusion, supporting the group rather than the individual sometimes created less favourable dietary, eating and meal outcomes. This problem needs to be addressed in order to establish food security at the individual level. In addition, actions should be taken to ensure that people with intellectual disabilities receive sufficient support to meet their individual needs and aspirations.

L’utilisation des antipsychotiques (AP) pour une indication non approuvée autrement dite off-label, peut être associée avec des effets indésirables graves chez les ainés. Étant donné le peu d’études portant sur le sujet, cette étude vise à déterminer la prévalence et les facteurs associés à l’utilisation off-label des AP chez les ainés âgés ≥ 65 ans vivant dans la communauté au Québec. Des analyses secondaires des données provenant de 2 enquêtes «l’Étude sur la Santé des Aînés» (ESA) et ESA-Services, étaient effectuées sur un échantillon total de 4018 ainés. L’utilisation off-label d’AP était définie par l’absence d’une indication approuvée selon la liste d’approbation publiée par Santé Canada en juin 2016, durant la même année. Les diagnostics ont été repérés dans les registres administratifs des services médicaux et pharmaceutiques de la « Régie de l’Assurance médicale du Québec» (RAMQ) en utilisant les codes internationaux de maladies (CIM-9) validés par d’autres études, et les codes CIM-10 appropriés selon la formule de changement CIM-9/10 fournie par la RAMQ. Le cadre conceptuel d’Andersen & Newman conçu pour expliquer le comportement de l'utilisation des services de santé selon trois catégories de facteurs (prédisposant, facilitants et de besoin) a été utilisé pour étudier, avec des régressions multinomiales, l’utilisation off-label des AP comparée à la non-utilisation et à l’utilisation approuvée dite labeled. La prévalence d’utilisation d’AP dans cet échantillon d’ainés était estimée à 2.5%. Parmi les utilisateurs d’AP, 78% étaient considérés comme off-label. L’utilisation off-label des antipsychotiques comparée à la non-utilisation était associée à l’âge (RC : 0.46; 95%CI: 0.27-0.78) , le niveau de scolarité (RC: 2.68; 95%IC: 1.64- 4.40), le nombre de visites ambulatoires incluant les visites chez le médecin traitant (≥ 6) (RC: 2.39; 95%IC: 1.34- 4.25), l’utilisation d’antidépresseurs ou de benzodiazépines (RC: 5.81; 95%IC: 3.31- 10.21), et la présence d’un syndrome cérébral organique et de la maladie d’Alzheimer (RC: 5.73; 95%IC: 1.74- 18.89). L’utilisation off-label des AP comparée à l’utilisation labeled était associée avec l’insomnie (RC: 0.13; 95%IC: 0.02- 0.91) et la dépression majeure (RC: 0.02; 95%IC: <0.01-0.11). Cette étude a montré une prévalence élevée de l’utilisation off-label des AP chez les ainés vivant dans la communauté au Québec. En résumé, l’utilisation off-label des AP était associée à la présence de visites ambulatoires répétées, l’utilisation d’autres médicaments psychotropes et la présence d’un syndrome cérébral organique, reflétant potentiellement un profil des cas cliniques plus complexes. / Abstract: The risk of using antipsychotics (AP) for off-label indications may outweigh the benefits in older adults. Due to the scarcity of studies describing off-label use of AP in older adults, this study aimed to determine the prevalence of the off-label use of AP in Quebec, and to determine, using Andersen & Newman’s model of healthcare seeking behaviour, the predisposing, enabling and need factors associated with the off-label use of AP. We used data from a socio-demographically (age, sex, and postal code representing population density) weighted sample (n = 4018) of older adults living in the community and who participated in the «Enquête sur la Santé des Aînés» (ESA) and ESA-Services health studies. AP use was identified from the RAMQ pharmaceutical registry. The presence of off-label use of AP (yes/no) was identified from validated ICD-9/10 diagnoses codes found in the RAMQ and MED-ÉCHO medical services and hospitalisations databases. The off-label use of AP was defined by the absence, during the same one-year period, of an approved indication for a delivered AP, according to Health Canada’s approval database as of June 2016. Multinomial logistic regression was used to study the off-label use of AP as compared to both labeled use and non-use as a function of predisposing, enabling and need factors. In this study, the prevalence of AP use reached 2.5%, of which 78% was off-label. Compared to non-use, off-label AP use was associated with age (OR: 0.46; 95%CI: 0.27-0.78); education level (OR: 2.68; 95% CI: 1.64- 4.40), a higher number of outpatient visits including physicians visits (OR: 2.39; 95%CI: 1.34- 4.25), antidepressant or benzodiazepine use (OR: 5.81; 95%CI: 3.31- 10.21), and the presence of an organic brain syndrome & Alzheimer’s disease (OR: 5.73; 95%CI: 1.74- 18.89). Compared to labeled use, off-label use was less likely in those with major depression (OR: 0.02; 95%CI: <0.01-0.11) and insomnia (OR: 0.13; 95%CI: 0.02- 0.91). In summary, off-label use is highly prevalent among community living older adults using AP. Off-label use was associated with the presence of an organic brain syndrome & Alzheimer’s disease, other psychotropic drug use and with increased outpatient visits, suggesting the off-label use of AP in more complex and severe clinical cases. Future longitudinal studies should focus on health related changes among incident off-label users of AP.

Bakgrund: Den globala befolkningen blir allt äldre. Det är även vanligt hos äldre människor att känna ensamhet, vilket kan leda till fysisk ohälsa och lidande. Eftersom sjuksköterskan ska motverka ohälsa och främja hälsa är det av stor vikt att ha kunskap om hur ensamhet i denna ökande befolkningsgrupp kan minskas.  Syfte: Syftet med litteraturstudien var att kartlägga interventioner som kan motverka ensamhet hos äldre över 60 år som bor hemma.  Metod: Litteratursökningar gjordes i Cinahl, Scopus, PubMed, PsycInfo och MEDLINE. Litteraturstudien består av 9 kvantitativa interventionsstudier som har kvalitetsgranskats, analyserats och sammanställts. Resultat: Resultatet visade på att de studerade interventionerna var väldigt olika och involverade olika komponenter: samtalsgrupper, kognitiva övningar, fysisk aktivitet, sociala aktiviteter och information/rådgivning. Samtliga interventioner som innehöll kognitiva övningar var i denna litteraturstudie effektiva. KBT i kombination med Baduanjin qigong sågs vara effektivare än enbart KBT. Resterande komponenter var delvis effektiva. Konklusion: Lösningen på problematik med ensamhet verkar vara högst komplicerad. Samtliga komponenter kan ha potential att kombinerade vara effektiva i att minska ensamhet. Etablerade mätinstrument bör användas på grund av stigmatisering av fenomenet ensamhet. Mer forskning behövs för att kunna dra säkra slutsatser. / Background: The global population is getting increasingly older. Loneliness is common among elderly people and can lead to suffering and decreased physical health. Nurses should promote well-being, which is why knowledge of how loneliness in this rising population can be reduced is important.  Aim: The aim of this literature study was to compile interventions that can counteract loneliness among elderly over the age of 60 who are living at home. Methods: Searches were made in Cinahl, Scopus, PubMed, PsycInfo and MEDLINE. The literature study consists of 9 quantitative intervention studies that have been reviewed for quality, analyzed and compiled. Results: The outcome shows that the studied interventions were very diverse and consisted of different components: therapy groups, cognitive exercises, physical activity, social activities, and information/counseling. All studies that included cognitive exercises were efficient. CBT combined with Baduanjin qigong was more efficient than exclusively CBT. The remaining components were partially efficient. Conclusion: The solution to the problem of loneliness seems to be complicated. All components have the potential of being efficient when combined. More research is needed in order to draw correct conclusions. Established measuring instruments should be used due to the stigma surrounding loneliness.

No description available.

Home and community based services (HCBS) are designed to provide services that meet the increasing and diverse needs of the older adult population who wish to age-in-place for as long as possible in their homes and community. Yet, little is known about the choices people make when selecting services. The purpose of this study was to assess HCBS use among vulnerable older adults. Andersen’s (1995) behavioral model of health services use provided theoretical guidance for selecting and explaining predisposing, enabling, and need-based variables associated with service use within the Community Living Program (CLP) federal initiative. Through consumer direction of services, 18 routine or one-time services were offered to 76 participants enrolled in the Virginia CLP. Two-step cluster analysis identified four distinct profiles of service users, ranging in size from 7 to 34 members. Services used within the groups ranged from 11 to 16 services. Use of personal care services (p=.033) and respite (p=.010) were significantly associated with group membership differentiation. Within each cluster, the percentage of participants using each service varied greatly. The most important variables that differentiated service user membership were caregiver relationship to participant, participant living arrangement, participant disability type, and length of time caregiver provided care. Between-cluster membership was significantly different with regard to average service cost per day for services used (p=.002) and the likelihood of moving to a nursing home if services were not provided (p=.034). Findings inform future research and have implications for practitioners assisting vulnerable older adults in selecting services to meet different care needs. / Master of Science

For nearly 40 years, Sister Karin and the nuns at Alsike Kloster have been giving sanctuary to refugees while also taking political, social and legal action to advocate for their rights. Every day they share their home with 60 men, women and children who are fleeing violence, persecution, looming threats and even death. Unlike many activists, the sisters of Alsike Kloster have turned spiritual activism into daily life. In this thesis, I immerse myself in the process of how the community of nuns and refugees do what they do. The purpose of this thesis is to paint an ethnographic portrait and open a window of understanding into the spiritual activism that this community lives as daily life. As I participate in this community of many faiths, many languages, and people from all over the world, I hope to gain an understanding of how they manage to share meals, chores, immigration hearings, birthday parties, fears, joys and sufferings with such cohesion and acceptance. Seeing how these sisters and refugees all live together gives me hope that we can all work for social change in our own small ways. Learning from these sisters how their faith translates into direct loving action for their neighbors from many countries gives me hope that something else is possible. Spiritual activism entails a worldview that resacralizes life which has implications for every aspect of our interconnected global world: not only religions, but also politics, economics, international relations, social awareness and our global responsibility for everything from climate justice to the refugee crisis.