Abstract
Influenza persists as a common communicable disease and remains a significant cause of disease burden across the world. Despite preventative therapies, such as influenza vaccination to ...reduce its spread and transmission, influenza continues to be a source of morbidity and mortality, even in developed countries. For the population over the age of 65, the effects of influenza virus may be more severe when they are compounded by pre-existing conditions and reduced natural immune function.In light of plateauing vaccination rates, a scoping review was conducted to map the literature and determine why seniors aged 65 and above refuse or fail to receive seasonal influenza vaccination. Nine peer-reviewed academic databases covering both social sciences and medical research were searched, along with the grey literature. A total of 6562 references were identified; after the screening process, 118 references were included in the final review. Thematic analysis focused on the broad areas that positively or negatively influence older adults’ decision-making regarding influenza vaccination, and this resulted in five main themes: (1) barriers to obtaining vaccination; (2) social factors; (3) personal characteristics; (4) individual subjectivity; and (5) direct clinical interventions.This review aims to identify gaps in knowledge and synthesize currently available information to make recommendations for future research, policy development and clinical practice. Increasing the vaccination rate among Canadian older adults will contribute to ongoing efforts to reduce the spread of the influenza virus among the population, reducing influenza-associated hospital admissions and deaths.
Abstract
Older adults prefer to live in their own homes for as long as possible — to 'age in place' — but for myriad reasons, may be unable to do so. To address this, a number of housing alternatives ...have been explored, including homesharing, or homeshare, an exchange-based shared housing approach with the potential to empower older adults to age in place by enabling them to obtain additional income, companionship, and assistance with completing household tasks in exchange for renting out a room in their home.An intergenerational homesharing pilot program in Toronto matched older adults (55+) with postsecondary students. With limited research in the area, a mixed methods research study was embedded within the pilot project with the goals of: 1) conducting a scoping review to map and synthesize the literature related to outcomes of homeshare participation for this population, 2) conducting in-depth interviews with homeshare participants (N=22) to learn about their experiences, and 3) conduct a full evaluation and exit survey to better understand the implications of the project. Results were organized around the following themes: (1) benefits and challenges of participating in homeshare for older adults; (2) intergenerational engagement as social exchange; and (3) the key role of agency facilitation as a determinant of the experience of homesharing for older adults. Results spoke to the unique benefits and challenges of participating in homeshare for this population. Findings were used to derive implications for policy and practice, as well as highlight areas for future research.
Abstract
Isolation has been flagged as a major health and social problem for seniors. Yet, many seniors themselves, their friends/family, and carers for seniors may not recognize risk factors for ...isolation or know what to do if a senior is isolated. Results from the 2016 General Social Survey noted that 27% of seniors reported they were not socially connected with others, with 20% reporting that they lacked support to carry out chores, and 17% reported feeling isolated. However, there has yet to be a comprehensive review of the evidence to suggest what has emerged as best practices and key policy enablers. To address this, seniors and other key stakeholders (n=200) in the community were interviewed on their perspectives and experiences of social isolation. Additionally, three focus groups (n=24) were conducted, along with a consensus meeting, to identify top priorities, best practices and develop implementation strategies. The priority areas identified were: 1) opportunities for seniors to network and be part of the social fabric; 2) initiatives promoting inclusive community development; 3) programs that promote education related to social isolation; 4) develop services that place an emphasis on partnerships/collaborations; 5) services that are sustainable over the longer term. By mapping the best, emerging practices and policies for social isolation, the ability to synthesize the evidence on social isolation and co-create knowledge translation tools with seniors and other stakeholders will be possible. This will help identify solutions and policies that can be used by governments, health systems, and individuals to comprehensively target social isolation.
Abstract
Most global cities, like Toronto, have rapidly aging populations who want to remain in homes and communities of their choice. Concurrently, seniors face vulnerabilities associated with low ...income, ageism, social isolation and loneliness. These vulnerabilities inhibit many seniors’ desires to age-in-place. The Toronto HomeShare Program, an intergenerational homesharing program facilitates aging-in-place by matching seniors with post-secondary students. The program, with an implementation focus and a research study, was developed to address and understand the needs of seniors seeking assistance, light supports and companionship at home, in exchange for reduced-rent housing for students. A mixed methods research design was employed. Seniors and students (n=22) completed a 167 question survey (n=22) and in-depth interviews (n=18). Quantitative data yielded descriptive statistics and qualitative data was subject to thematic content analysis. Participants agreed that homesharing programs could address risk for social isolation (95%), the need to move from their community (96%), and reduce risks of economic and social exclusion for young and old (97%). From the qualitative data, six benefits were apparent for all participants: (1) reduced social isolation and loneliness, (2) increased intergenerational exchange, (3) increase financial security, (4) household assistance, (5) increased general wellbeing; (6) enhanced companionship/safety. In 2020, Toronto HomeShare (now Canada HomeShare) was recognized by the World Health Organization as an age-friendly best practice, and has been scaled nationally in 16 cities. Intergenerational homesharing programs could be a catalyst for policy and cultural reform and to support older adults to not only remain in their communities, but to thrive-in-place.
Most global cities, like Toronto, have rapidly aging populations who want to remain in homes and communities of their choice. Concurrently, seniors face vulnerabilities associated with low income, ...ageism, social isolation and loneliness. These vulnerabilities inhibit many seniors’ desires to age-in-place. The Toronto HomeShare Program, an intergenerational homesharing program facilitates aging-in-place by matching seniors with post-secondary students. The program, with an implementation focus and a research study, was developed to address and understand the needs of seniors seeking assistance, light supports and companionship at home, in exchange for reduced-rent housing for students. A mixed methods research design was employed. Seniors and students (n=22) completed a 167 question survey (n=22) and in-depth interviews (n=18). Quantitative data yielded descriptive statistics and qualitative data was subject to thematic content analysis. Participants agreed that homesharing programs could address risk for social isolation (95%), the need to move from their community (96%), and reduce risks of economic and social exclusion for young and old (97%). From the qualitative data, six benefits were apparent for all participants: (1) reduced social isolation and loneliness, (2) increased intergenerational exchange, (3) increase financial security, (4) household assistance, (5) increased general wellbeing; (6) enhanced companionship/safety. In 2020, Toronto HomeShare (now Canada HomeShare) was recognized by the World Health Organization as an age-friendly best practice, and has been scaled nationally in 16 cities. Intergenerational homesharing programs could be a catalyst for policy and cultural reform and to support older adults to not only remain in their communities, but to thrive-in-place.
Abstract
Influenza persists as a common communicable disease and remains a significant cause of disease burden across the world. Despite preventative therapies, such as influenza vaccination to ...reduce its spread and transmission, influenza continues to be a source of morbidity and mortality, even in developed countries. For the population over the age of 65, the effects of influenza virus may be more severe when they are compounded by pre-existing conditions and reduced natural immune function. In light of plateauing vaccination rates, a scoping review was conducted to map the literature and determine why seniors aged 65 and above refuse or fail to receive seasonal influenza vaccination. Nine peer-reviewed academic databases covering both social sciences and medical research were searched, along with the grey literature. A total of 6,562 references were identified; after the screening process, 118 references were included in the final review. Thematic analysis focused on the broad areas that positively or negatively influence older adults’ decision-making regarding influenza vaccination, and this resulted in five main themes: (1) barriers to obtaining vaccination; (2) social factors; (3) personal characteristics; (4) individual subjectivity; and (5) direct clinical interventions. This review aims to identify gaps in knowledge and synthesize currently available information to make recommendations for future research, policy development and clinical practice. Increasing the vaccination rate among Canadian older adults will contribute to ongoing efforts to reduce the spread of the influenza virus among the population, reducing influenza-associated hospital admissions and deaths.
Abstract
Canada is facing an opioid crisis, with more than 3,900 related deaths occurring in 2017. Almost 30% of those deaths were among seniors; older adults also have the highest rates of opioid ...hospitalization and poisoning. Despite these statistics, little is known about the specifics. A comprehensive scoping review following Arksey and O’Malley’s (2005) framework was conducted to establish the magnitude of the problem, describe treatment approaches alongside prevention, and identify implications for practice, policy and research. Eight major electronic databases in medicine and the social sciences were searched alongside the grey literature, and a stakeholder consultation convened to validate results. A total of 6,814 articles, reports and thesis were identified. Forty-five sources met inclusion criteria, the majority stemming from the United States. Most were literature reviews, cohort and cross-sectional studies, with almost half also taking a gendered approach. Four predominant themes emerged from the thematic content analysis: 1) Medical Applications of Opioids; 2) Problematic Opioid Use; 3) Treatment and Prevention Strategies; and 4) Recommendations. Data highlighted ‘the invisible epidemic’, with treatment strategies to be specifically tailored to this population in light of metabolic differences and drug interactions as part of aging. Seniors are part of the current epidemic, with tailored approaches needed to ensure adequate, evidence-based counteraction – including seniors’ voices alongside further research in this regard. Education and training for prescribers needs to be enhanced alongside cross-jurisdictional drug monitoring programs to avoid drug interactions and misuse/fraud.
Abstract
Adult protective services (APS) and other community-based agencies respond to hundreds of thousands of elder abuse cases each year in the United States; however, little is known about what ...constitutes success in the context of elder abuse response intervention. This study explored the meaning of elder abuse intervention success from the perspective of victims themselves toward the development of a victim-centric taxonomy of outcomes. Guided by a phenomenological qualitative methodology, this study conducted in-person, semi-structured interviews with a sample of elder abuse victims (n = 30) recruited from APS in the states of Maine, New York, and California, as well as a community-based elder abuse social service program in New York City. To enhance trustworthiness, two researchers independently analyzed transcript data to identify key transcript statements into themes. Outcomes of success were identified across broad domains related to the victim, perpetrator, victim-perpetrator relationship, family system, and home environment. Specifically, common themes represented outcomes related to victim safety, autonomy, social support, and state of mind; perpetrator independence and accountability; and victim-perpetrator separation. For decades, the field of elder abuse has struggled to understand how to define success in the context of community-based intervention from a client-centered perspective. The taxonomy developed in this study provides a comprehensive and conceptually organized range of successful outcomes to serve as infrastructure for the development of meaningful intervention outcome measures. This study represents one of the largest efforts to understand and integrate the perspectives and needs of victims into elder abuse intervention practice/research to date.
Proper wound healing still remains a clinical challenge. Fibrin is a major component of the provisional extracellular matrix that forms initially after injury, enabling cell infiltration and ...anchoring to the wound site. Fibrinogen, the precursor of fibrin and a blood plasma protein, is also important in inflammation, wound healing, angiogenesis, and other biological functions. Of the many cells present during the wound healing process, macrophages play a key role in modulating the immune response. The plasticity of macrophages permits them to adopt behaviors along a spectrum of phenotypes depending on signals in their microenvironment. While much is known about how chemokines, cytokines, and other soluble mediators influence macrophages, less is understood about the roles of the ECM and the physical properties of the surrounding tissue. In this study, we examined the interactions between fibrin(ogen) and macrophages to gain a better fundamental understanding of how physical and biochemical properties of the provisional matrix together influence immune cell behavior. We separately looked at the roles fibrinogen and fibrin on macrophage inflammatory or anti-inflammatory functions and explored how mechanical properties of fibrin(ogen) such as substrate stiffness and tethering affect macrophage activation and behavior. First, we investigated the differential regulation of macrophage activation by fibrinogen and fibrin. The presentation of fibrin(ogen), either presented in the soluble form or incorporated within an insoluble matrix, plays an important role in regulating macrophage phenotype. In particular, fibrin exerts a protective effect on macrophage inflammatory activation. Additionally, we altered mechanical properties of fibrin by controlling matrix stiffness and explored methods of adsorbing or tethering fibrinogen. Substrate rigidity alters the expression of integrins, proteins receptors that facilitate macrophage-ECM interactions. Adsorption of fibrinogen also inhibits inflammatory activation. Finally, we utilized a light-based crosslinking technique to stiffen fibrin matrices. Increased substrate rigidity enhances inflammatory macrophage behavior. Moreover, macrophages are more motile, both in terms of velocity and distance traveled, on stiffer fibrin matrices. Together, these findings contribute to our understanding of how the extracellular matrix regulates macrophages during wound healing and disease and offer new insight for designing biomaterials that can precisely control the host response and promote proper tissue regeneration.
Abstract
Background and Objectives
“Aging in place” is commonly defined as the ability to remain living safely and independently for as long as possible either in the home or community of one’s ...choosing. Yet, the literature indicates that older adults prefer to remain specifically in their own homes. Homesharing, an innovative exchange-based housing approach, is a means by which older adults can obtain additional income, companionship, and assistance by renting out a room to a home seeker, potentially increasing capacity to remain living independently in their homes. But what is known about their experiences of homesharing?
Research Design and Methods
A scoping review was conducted to map and consolidate the literature related to the experience of homeshare participation for adults aged 55 and older published from 1989 to 2018. Fifteen databases were searched, including 3 medical, 5 social science, and 7 gray literature databases. Following abstract and full-text review, 6 sources were retained for study inclusion. Thematic content analysis was used to identify major themes.
Results
Within included studies, 4 major themes were identified: (i) benefits of homeshare participation for older adults; (ii) challenges of participating in homeshare for older adults; (iii) intergenerational engagement as social exchange; and (iv) the key role of agency facilitation.
Discussion and Implications
Findings were used to derive practice, policy, and research implications. By focusing on older adults and the ways homesharing impacts their lives, we can better determine the viability of homeshare as a means for improving and prolonging experiences of living at home.
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