Elevated Hospitalization Risk of Assisted Living Residents With Dementia in Alberta, Canada.

Objectives: Assisted living (AL) is an increasingly used residential option for older adults with dementia; however, lower staffing rates and service availability raise concerns that such residents may be at increased risk for adverse outcomes. Our objectives were to determine the incidence of hospitalization over 1 year for dementia residents of designated AL (DAL) facilities, compared with long-term care (LTC) facilities, and identify resident- and facility-level predictors of hospitalization among DAL residents.

Methods: Participants were 609 DAL (mean age 85.

High rates of hospital admission among older residents in assisted living facilities: opportunities for intervention and impact on acute care.

Background: Little is known about health or service use outcomes for residents of Canadian assisted living facilities. Our objectives were to estimate the incidence of admission to hospital over 1 year for residents of designated (i.e.

Predictors of Nursing Home Placement from Assisted Living Settings in Canada.

We sought to estimate the incidence of long-term care (LTC) placement and to identify resident- and facility-level predictors of placement among older residents of designated assisted living (AL) facilities in Alberta, Canada. Included were 1,086 AL residents from 59 facilities. Research nurses completed interRAI-AL resident assessments and interviewed family caregivers and administrators.

Facilitators and barriers to safe emergency department transitions for community dwelling older people with dementia and their caregivers: a social ecological study.

Background: Internationally, older adults visit the ED at a rate higher than other age groups. Little attention has been given to ED care for older people with dementia, although concern for such care is growing with the increasing number of individuals worldwide affected by this significant disabling problem. It is critical to understand ED transitional processes and consequences because the complexity of dementia care poses multiple challenges to optimizing safety, effectiveness and quality of care during admission, assessment, and treatment in this setting.

Comparing frailty measures in their ability to predict adverse outcome among older residents of assisted living.

Background: Few studies have directly compared the competing approaches to identifying frailty in more vulnerable older populations. We examined the ability of two versions of a frailty index (43 vs. 83 items), the Cardiovascular Health Study (CHS) frailty criteria, and the CHESS scale to accurately predict the occurrence of three outcomes among Assisted Living (AL) residents followed over one year.

Operationalizing frailty among older residents of assisted living facilities.

Background: Frailty in later life is viewed as a state of heightened vulnerability to poor outcomes. The utility of frailty as a measure of vulnerability in the assisted living (AL) population remains unexplored. We examined the feasibility and predictive accuracy of two different interpretations of the Cardiovascular Health Study (CHS) frailty criteria in a population-based sample of AL residents.

Does a rural residence predict the development of depressive symptoms in older adults?

Objective: We sought to determine whether adults aged 65 years or older living in rural areas who are without depressive symptoms have a lower risk of developing depressive symptoms over 5 years than their urban counterparts, and to determine the factors that predict the development of depressive symptoms in older adults in rural and urban areas.

Methods: We conducted a secondary analysis of an existing data set, the Manitoba Study of Health and Aging (MSHA.) We studied a population-based random sample of 807 people without depressive symptoms or cognitive impairment who were residing in Manitoba communities in 1991/92 and 5 years later in 1996/97.

Patient and informal caregivers' knowledge of heart failure: necessary but insufficient for effective self-care.

Aims: Self-care of heart failure (HF) is a process that is important, complex, and challenging. Little is understood of the contextual factors influencing self-care. We aimed to examine the individual and contextual factors perceived by patients and their informal caregivers' to influence their willingness and capacity to undertake effective HF self-care.

Video programming for individuals with dementia: assessing cognitive congruence.

The effect of cognitively congruent video programming on attentional engagement, as measured by the average look duration and the proportion of the video viewed, was examined among long-term care facility residents with Alzheimer's disease. Over a 2-week period, 24 residents viewed 4 cognitively congruent videos and 1 control video (ie, a recorded episode of a local news program) at least once. Level of attentional engagement was significantly higher for cognitively congruent video programs compared to the News.

Indicators of home care use in urban and rural settings.

This study employs a longitudinal design to examine rural-urban differences in home care service use over time, drawing on data from the Manitoba Study of Health and Aging (MSHA). Characteristics of community-dwelling, cognitively intact adults aged 65 years or older not receiving home care services in the province of Manitoba ( n = 855) were collected in 1991/1992. Place of residence was categorized as urban/small-town zone or predominantly rural area .

Giving voice to informal caregivers of older adults.

This study focused on the experiences of informal caregivers of older adults and explored whether employment, use of home-care services, or other factors influence the health of caregivers and their ability to manage their caregiving and other responsibilities. Focus groups conducted with 26 caregivers and personal interviews with 4 caregivers identified 12 themes under 5 conceptual areas: caregiver health, relationships, independence, employment, and use of home-care services. The findings reveal that caregiving coupled with other responsibilities can have serious health effects.

Depressive symptoms among older adults in urban and rural areas.

Objectives: To determine if there are differences in depressive symptoms between residents of urban areas, small town zones, and predominantly rural regions and to determine factors associated with depressive symptoms among these groups of residents.

Method: The study was set in the Canadian province of Manitoba amongst a community-dwelling population of older adults who were cognitively intact. The design of the study was a cross-sectional survey and measures included age, gender, education, living arrangements, number of persons providing companionship, perceived adequacy of income, functional impairment, self-rated health and the Center for Epidemiologic Studies-Depression (CES-D) scale.

Quality of life of adults with unhealed and healed diabetic foot ulcers.

Background: Diabetic foot ulcers cause major treatment morbidity and cost of care. This study evaluated quality of life in patients with unhealed and healed diabetic foot ulcers.

Methods: This was a cross-sectional study of adult diabetic patients (age 45 years or older) treated in a tertiary care foot clinic who had foot ulcers within the preceding 2 years.

Estimating the incidence of dementia: the impact of adjusting for subject attrition using health care utilization data.

Purpose: To estimate incidence rates for dementia and the impact of subject attrition on these rates.

Methods: Crude, age- and gender-specific incidence rates of dementia and Alzheimer's disease were calculated using person-years analysis and Cox proportional hazard models in a population-based cohort study of 1952 adults aged 65+ years in Manitoba, Canada. Rates were standardized to the nondemented population using the direct method.

Cognitively impaired older adults: risk profiles for institutionalization.

Background: This study focused on the identification of risk profiles for institutionalization among older adults diagnosed with cognitive impairment-not dementia or dementia in 1991/92 and subsequent institutionalization in the following 5-year period.

Methods: Data were from a sample of 123 individuals aged 65+ and their unpaid caregivers in Manitoba, Canada. Cluster analysis was conducted using baseline characteristics of age, cognition, disruptive behaviors, ADLs/IADLs, use of formal in-home services, and level of caregiver burden.

Continuing and ceasing leisure activities in later life: a longitudinal study.

Purpose: This study examined changes in leisure activities of older adults over an 8-year period, and associated sociodemographic and health characteristics.

Design And Methods: Data were from a longitudinal study conducted in Winnipeg, Manitoba, Canada; 380 respondents were interviewed in-person in both 1985 and 1993. Changes in ten specific activities and the overall number of activities continued were examined.