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Aim: The aim was to understand the emerging sector of long term care (old age homes, OAHs) in India through the voices of facility administrators as they see the imminent issues of importance in this new sector and care for the elderly.Methods: Sixty five administrators, representing 55 OAHs located in Chennai, India, were interviewed using a semi structured interview guide by two trained research assistants. The interview guide elicited information related to the current status of OAHs and the recommendations to improve the standards and quality of care of the elderly. The interviews informed the thematic areas highlighted in the results section.Results: The emerging OAH sector is managed by individuals with diverse professional and disciplinary background without any aging-specific qualifications. The OAHs operate for profit or as a charity with often unreliable funding. The administrators felt that they were unable to provide the services they wanted at a level they felt appropriate. Staffing and training issues were common concerns impacting level of care. Lack of government leadership was cited as a reason for lack support for the OAHs. No standards of care and quality assurance mechanisms currently exist for OAHs and the elderly these institutions serve.Conclusion: Existing policies and schemes pertinent to aging care must be reviewed, adjusted, and coordinated to reflect the emerging sector in India, and the government must take leadership in providing guidance and addressing the needs of the residents of OAHs. Effective multi-sector and multi-level partnerships and communication are urgently needed to inform both on appropriate steps and policies required moving forward. [ABSTRACT FROM AUTHOR]

In the context of an aging population, both the need for home care services and its complexity of care have increased in many high-income countries. Yet, the definition of what constitutes complex care is largely elusive. This systematic review examined the conceptual definition of complex care within the home care environment using several social and health science databases for research published from 2000 to 2017. Of the 25 articles and reports identified, only 16 addressed complex care specifically and included older adults, aging, and/or home care. The results showed that complex care for older adults is primarily defined from a biomedical approach focusing on chronic disease and management and less commonly from the perspective of the social determinants of health. Future studies should consider the importance of the continuum of care needs from both the biomedical and the social determinants to adequately plan and provide care for older adults. [ABSTRACT FROM AUTHOR]

This qualitative study examined the falls and fall-related injury experiences of community-dwelling rural seniors. 42 senior men and women living in two rural areas in Saskatchewan, Canada were recruited, and in-depth interviews were conducted. Analysis revealed three main themes among responses: nature of falls and injuries, causes of falls and injuries, and consequences of falls and injuries. Men and women expressed a fear of falling, which led to activity limitations; however, women were more reflective on their potential to fall and showed an increased level of preparedness compared to men. The causes of falls included activities at the time of a fall, functional limitations, chronic diseases, and personal factors such as type shoes worn. While men and women downplayed the seriousness of their falls or injuries, indicating a level of hardiness, this trend was stronger among men. None of the participants discussed the role of health care professionals or the health care system in relation to fall risk and ways of preventing falls, despite reporting adaptations to prevent and deal with consequences of falls. Overall, these findings may allude to the scarcity of health care services provided in rural communities, highlighting a need to focus on falls prevention for community-dwelling rural seniors. [ABSTRACT FROM AUTHOR]

The aim was to determine the prevalence of work-related musculoskeletal disorders (WMSDs) and health profile among urban versus rural continuing care aides (CCAs) in Canada. This cross-sectional study of 42 urban and rural CCAs assessed WMSDs and health profiles using the Nordic Musculoskeletal Questionnaire (NMQ), Cornell Musculoskeletal Discomfort Questionnaire (CMDQ), and a health background questionnaire. CCAs were generally unhealthy, with rural CCAs somewhat healthier. Greatest WMSD complaint was reported at the neck. Urban CCAs were more likely to report foot complaints (p < .05). No other statistically significant differences were found. Back and shoulder scores were correlated with poorer nutrition status, higher body mass index, and more years worked. Workplace wellness programs should address the health issues faced by CCAs through active surveillance and practical interventions to improve CCAs’ health status, prevent and manage WMSDs, and lost workdays. [ABSTRACT FROM AUTHOR]

The article discusses an attempted study on the impact psychopathology, explanatory models of illness and clinical outcome on insight over the long-term course of first-episode schizophrenia in Vellore, India. Topics discussed include the study conducted in the Department of Psychiatry, Christian Medical College, Vellore, Tamil Nadu, India and an urgent need to develop and refine instruments that can capture diverse beliefs on mental illness and elicit local explanatory models of illness.

Background: The sole focus of models of insight on bio-medical perspectives to the complete exclusion of local, non-medical and cultural constructs mandates review. This study attempted to investigate the impact of insight, psychopathology, explanatory models of illness on outcome of first episode schizophrenia. Method: Patients diagnosed to have DSM IV schizophrenia (n = 131) were assessed prospectively for insight, psychopathology, explanatory models of illness at baseline, 6, 12 and 60 months using standard instruments. Multiple linear and logistic regression and generalized estimating equations (GEE) were employed to assess predictors of outcome. Results: We could follow up 95 (72.5%) patients. Sixty-five of these patients (68.4%) achieved remission. There was a negative relationship between psychosis rating and insight scores. Urban residence, fluctuating course of the initial illness, and improvement in global functioning at 6 months and lower psychosis rating at 12 months were significantly related to remission at 5 years. Insight scores, number of non-medical explanatory models and individual explanatory models held during the later course of the illness were significantly associated with outcome. Analysis of longitudinal data using GEE showed that women, rural residence, insight scores and number of non-medical explanatory models of illness held were significantly associated with BPRS scores during the study period. Conclusions: Insight, the disease model and the number of non-medical model positively correlated with improvement in psychosis arguing for a complex interaction between the culture, context and illness variables. These finding argue that insight and explanatory models are secondary to psychopathology, course and outcome of the illness. The awareness of mental illness is a narrative act in which people make personal sense of the many challenges they face. The course and outcome of the illness, cultural context, acceptable cultural explanations and the prevalent social stigma interact to produce a complex and multifaceted understanding of the issues. This complexity calls for a nuanced framing of insight. [ABSTRACT FROM AUTHOR]

Background: The study examined the effects of dietary fasting on physical balance among young healthy women. Methods: This study undertaken involving 22 young healthy women (age = 22 ± 1.5) using a within subject counterbalanced 2-week crossover study design. Participants were asked to refrain from consuming any food or beverage for 12 hours prior to the fasting trial and to maintain their regular diet for the non-fasting trial. Measures included: a background questionnaire, 24-hour dietary recall, and functional reach and timed single-limb stances. Results: Fasting resulted in significant declines in functional reach (p < 0.01), and ability to balance in a single limb stance with eyes open, on both the dominant and non-dominant legs (p < 0.01 and p < 0.01, respectively), and with eyes closed on the dominant leg (p < 0.01). Conclusions: The findings have implications for athletic performance in younger individuals as well as emphasizing the need for health education for young women to avoid skipping meals. [ABSTRACT FROM AUTHOR]

The article discusses how the Canadian government can help reduce health disparities. Five recommendations are presented. They include establishing a national population health framework, an integrated population health-information infrastructure, and a plan to assess population health initiatives. Education and training that help implement strategies for societal action on the determinants of health are also recommended. The availability of data sources for tracking health status is addressed. The need for further assessment and research is mentioned. The authors believe national action along with recommendations from the World Health Organization Commission on the Social Determinants of Health will reduce health inequalities.

Introduction: Older persons living in longterm care facilities are at a high risk of undernutrition and have a heightened risk of experiencing falls. Multiple factors predispose older individuals to a compromised nutritional status and fall events. These factors include poly-pharmacy, social isolation, poor dietary intake due to anorexia, and sarcopenia. The objectives of the present study were to assess nutritional and fall risk of older women (aged 60 years and over) and to study the correlation between these in women living in LTC facilities of New Delhi. Material and Methods: Background profile, MNA, DFRI, and FES-I questionnaires were used to gather data on nutritional and fall history. Results: The mean age of participants was 74.21(±5.52) years. A majority were widowed with poor educational and income level. Findings revealed that 54% of the older women were at a high nutritional risk. Fall risk was observed in 58% of the study participants and a majority of participants reported high fear of falling. MNA scores had a significant negative correlation with Downton Fall Risk Index scores (R= -.419, p<.001). Conclusion: Timely nutritional and fall prevention interventions can help in management of nutritional risk and falls in LTC facilities, and can significantly improve the quality of life of institutionalized older individuals, who are a neglected group in India. [ABSTRACT FROM AUTHOR]

Newcomers are often healthy when they arrive in Canada, yet experience health declines shortly thereafter, possibly due to lifestyle changes. As part of the Healthy Immigrant Children study, this mixed-methods study aims to analyze possible predictors of physical activity among 300 newcomer children, and explore their lived experiences using a sub-sample of 19 parents and 24 service providers. Data collection involved questionnaires concerning socioeconomic status and physical activity, anthropometric measurements, and in-depth interviews. Participants aged 5 years and older largely met physical activity recommendations (82.9%), while none of the 3–4-year-olds did. Males were more active than females, especially among older ages. Many participants engaged in too much screen time (53.4–90.0%). Age and income predicted physical activity among males, while parents' education level was the only significant predictor among females. Barriers to physical activity included: recreational physical activity being an unfamiliar concept, gender limitations, financial resources, safety concerns, and children's preference for screen time. Schools played a central role in newcomer children's health by providing accessible opportunities for physical activity. Newcomer families preferred to have their children involved in culturally relevant physical activities. Given the growing newcomer population, it is important to support active lifestyle practices among them. Novelty: About 83% of newcomer children aged 5 years and older met physical activity recommendations, while none of the 3–4-year-olds did. Age and income predicted males' physical activity, while parents' education level predicted females' physical activity. Schools provide accessible opportunities for newcomer children to engage in physical activity. [ABSTRACT FROM AUTHOR]

Introduction: Mental health disorders, particularly, depression have been underestimated, sequestered, and neglected in older individuals living in care homes in India. Some studies have reported that 40% of care home residents have depressive symptoms. It is more frequent in widowed or divorced older women who live without their children and have little social support. The present study was undertaken with the objective of assessing the level of depression in older women (aged 60 years and over) living in homes for the aged in Delhi. Materials and Methods: Eighty-five women residing in six long-term care facilities were enrolled for the study. Sample size estimation was carried out using the G Power software using level of significance as 0.05, and effect size as 0.80. Ethics approval was obtained from the directors of these facilities. Women aged > 60 years living in six homes for the aged in Delhi and NCR area, without any serious chronic or terminal illness, who provided informed consent by carefully reading the letters of consent, and were willing to complete the Geriatric Depression Scale questionnaire were included in the study. The researcher assured the participants that confidentiality and anonymity will be strictly maintained. The Geriatric Depression Scale is a 30 item questionnaire, with a simple Yes/No format that is used extensively in health care settings to assess the depressive symptoms, and level of depression present in older adults living in the community, assisted living facilities, and long-term care facilities. Results: Using the GDS Classification scale, it was found that severe depression was experienced by 47% women, and it was also observed that 42.4% women were moderately depressed. Being a widow, lower educational status, poor socio-economic background, and social isolation were significant predictors of depression in older women residing in homes for the aged in Delhi/NCR area. Conclusion: Depression is highly prevalent in homes for the aged in India, but is unfortunately neglected and under-treated due to ignorance of health authorities and lacunae prevailing in the health care delivery systems. If left untreated for extended periods of time, severe depression can lead to high rates of suicide amongst the institutionalized older adults. [ABSTRACT FROM AUTHOR]

Introduction: Cognitive decline in senior population is no longer regarded as a consequence of the aging process. Nevertheless, seniors are at an elevated risk of developing cognitive deficits with advancing age. Hence, alterations in cognitive function often call for prompt action. In older individuals, cognitive functioning is likely to decline during transition from the community settings to old age homes. Materials and Methods: The Mini Mental State Examination (MMSE) was used to assess the cognitive status of senior women residing in old age homes of Delhi NCR region. The maximum score obtained on the MMSE is 30. A score of 23 or less suggests the presence of cognitive impairment. Completion of the MMSE takes approximately 5-10 minutes and is therefore regarded as a pragmatic tool which can be utilized for cognitive assessment in seniors. The researcher of this study recruited eighty-five older women after screening two hundred and twelve institutionalized seniors. After obtaining informed consent, the researcher started recruiting subjects randomly from the six old age homes in Delhi NCR. The MMSE was administered to the subjects and scores were recorded by the research investigator. Results: The subjects of this study had a lower level of education as compared to their counterparts in the developed countries. Almost 51% of the subjects had barely studied upto the tenth grade and had found it difficult to complete high school education. The mean MMSE score was found to be 21.7 (5.3). It was observed that on the basis of MMSE cognitive status classification, 4.7% seniors had severe cognitive deficits (score ranging between 0 and 9), 16.5% seniors had moderate cognitive impairment (score ranging between 10 and 19), 49.4% seniors had mild cognitive impairment (scores ranging between 20 and 24), and 29.4% seniors had no cognitive deficits (scores ranging between 25 and 30). Conclusion: The MMSE is useful for assessment of cognitive status in seniors who are educated and at least high school graduates. The low educational level of the women contributed towards poor performance on MMSE. It is recommended to use other tools in combination of MMSE to carry out a comprehensive cognitive status assessment of seniors living in old age homes in India. [ABSTRACT FROM AUTHOR]

Existing cognitive health literature focuses predominately on understanding the pathology and clinical treatment of older adults with dementia rather than cognitive health promotion and preventative activities. In addition, most of the work in the area remains urban-centric with little focus on cognitive health in rural communities. This study examined rural seniors' perspectives of activities that they identified as supporting their cognitive health. Using community-based research and an ethnographic methodology, participant observation and semi-structured interviews were conducted with 42 older adults in rural Saskatchewan, Canada. Participants discussed a variety of activities that they viewed as supporting their cognitive health. In particular, cognitive health promotion was identified as being strongly linked to keeping one's brain active, thinking positively, mingling with others, and managing daily affairs. This study's findings suggest that there is a need to move beyond focusing solely on clinical interventions to including older adults' perspectives of preventative activities and cognitive health promotion. [ABSTRACT FROM AUTHOR]

The article discusses the ill effects of poor food habits on the functional capacity of the body and, suggests regular physical activity and nutritional diet to maintain the health equation of the body.

Nova Scotia's Supportive Care Program (SCP) is an individualized funding program that provides funds for people living with dementia (PLWD) or acquired brain injuries to purchase basic home care services such as personal care, respite, cleaning and cooking. The SCP has the potential to address the Quintuple Aim of enhancing care experience, improving population health, reducing costs, improving provider experience and improving health equity, yet qualitative evidence is lacking. The aim of this study is to use participatory program evaluation methods to evaluate the SCP and consider how effective it is in addressing the Quintuple Aim. The study objectives and corresponding methods are to (1) Co-develop a SCP logic model to guide the evaluation through consultations with a diverse group of stakeholders including PLWD, caregivers, care providers, researchers, government representatives, and nongovernment organizations, with attention to gender; (2) Evaluate the SCP based on the outcomes and outputs identified in the logic model using focus groups with PLWD, caregivers and home care providers, and interviews with PLWD and their caregivers; and (3) Mobilize knowledge about the ways the SCP addresses the Quintuple Aim through integrated knowledge translation activities with public, policy and research audiences. By focusing on clinically and socially vulnerable populations of PLWD and caregivers, the proposed evaluation of the SCP offers a valuable case in assessing the effectiveness of individually-funded home care in addressing the Quintuple Aim including health equity within the context of dementia care. [ABSTRACT FROM AUTHOR]

Nova Scotia's Supportive Care Program (SCP) is an individualized funding program that provides funds for people living with dementia (PLWD) or acquired brain injuries to purchase basic home care services such as personal care, respite, cleaning and cooking. The SCP has the potential to address the Quintuple Aim of enhancing care experience, improving population health, reducing costs, improving provider experience and improving health equity, yet qualitative evidence is lacking. The aim of this study is to use participatory program evaluation methods to evaluate the SCP and consider how effective it is in addressing the Quintuple Aim. The study objectives and corresponding methods are to (1) Co-develop a SCP logic model to guide the evaluation through consultations with a diverse group of stakeholders including PLWD, caregivers, care providers, researchers, government representatives, and nongovernment organizations, with attention to gender; (2) Evaluate the SCP based on the outcomes and outputs identified in the logic model using focus groups with PLWD, caregivers and home care providers, and interviews with PLWD and their caregivers; and (3) Mobilize knowledge about the ways the SCP addresses the Quintuple Aim through integrated knowledge translation activities with public, policy and research audiences. By focusing on clinically and socially vulnerable populations of PLWD and caregivers, the proposed evaluation of the SCP offers a valuable case in assessing the effectiveness of individually-funded home care in addressing the Quintuple Aim including health equity within the context of dementia care. [ABSTRACT FROM AUTHOR]

Background: Existing evidence indicates that dissonance between patients' and professionals' explanatory models affects engagement of patients with psychiatric services in Western and non-Western countries.Aims: To assess qualitatively the explanatory models (EMs) of psychosis and their association with clinical variables in a representative sample of first episode patients with schizophrenia in South India.Method: One hundred and thirty one patients with schizophrenia presenting consecutively were assessed. Measures included the patient's explanatory models, and clinician ratings of insight, symptoms of psychosis, and functioning on standard scales.Results: The majority of patients (70%) considered spiritual and mystical factors as the cause of their predicament; 22% held multiple models of illness. Patients who held a biomedical concept of disease had significantly higher scores on the insight scale compared to those who held non-medical beliefs. Multivariate analyses identified three factors associated with holding of spiritual/mystical models (female sex, low education and visits to traditional healers); and a single factor (high level of insight) for the endorsement of biological model.Conclusions: Patients with schizophrenia in this region of India hold a variety of non-medical belief models, which influence patterns of health seeking. Those holding non-medical explanatory models are likey to be rated as having less insight. [ABSTRACT FROM AUTHOR]

Canada is a highly industrialized multicultural society with nearly 22 percent of its population made up of foreign-born individuals coming through the immigration process. Recent immigrants tend to experience a decline in their health status over time as their years in Canada increase. This phenomenon can be attributed to several factors, including reduced leisure time, changing active lifestyle, and adaptation to the new sociocultural environment. While a great deal of research has focused on children, there is paucity of research in this area among West Africans in Canada. Therefore, the purpose of this study was to gain a deeper understanding of the facilitators and barriers of active living among recently immigrated West African children living in Saskatchewan. Using purposive sampling, thirty-one interviews were conducted with children and their parents separately to reduce social desirability bias. Children between 10 and 17 years were interviewed in each family. A grounded theory methodological approach involving a constant comparative analytical process was utilized. The families identified some sociocultural facilitators and barriers to physical activity for their children. The facilitators included having an enabling environment in close proximity, parental role modeling, peer influence, and school influence. The barriers reported included the Saskatchewan weather, the neighborhood environment, societal norms such as bullying and discrimination, competing priorities for the parents, financial constraints, and the children's passive screen time. This study provides expanded understandings of physical activity among West African immigrant children, which has policy implications for active living in Canada. Physical activity appeared to take a secondary position in the lives of these families and could be significantly improved by reinforcing the facilitators and addressing the identified barriers. [ABSTRACT FROM AUTHOR]

Background: Musculoskeletal pain alters physiological function, which may be evidenced as early as middle age. Previous research has concluded that middle-aged adults are a high-risk group for musculoskeletal pain and report functional limitations similar to older adults. However, few studies have examined the relationships between musculoskeletal pain and physical function, using objective performance measures in a sample of racially and socioeconomically diverse adults. Thus, this study examined musculoskeletal pain in relation to physical function in middle-aged (30-64 years) White and Black adults and investigated whether the relationship varied by sociodemographic characteristics.Methods: This cross-sectional examination incorporated data from the Healthy Aging in Neighborhoods of Diversity across the Life-Span Study. Participants (n = 875) completed measures of musculoskeletal pain and objective measures of physical performance (ie, lower and upper body strength, balance, and gait abnormalities). Physical performance measures were standardized to derive a global measure of physical function as the dependent variable.Results: Approximately, 59% of participants identified at least 1 pain sites (n = 518). Multivariable regression analyses identified significant relationships between greater musculoskeletal pain and poorer physical function (β = -0.07, p = .031), in mid midlife (β = -0.04, p = .041; age 40-54) and late midlife (β = -0.05, p = .027; age 55-64).Conclusions: This study observed that musculoskeletal pain was associated with poorer physical function within a diverse group of middle-aged adults. Future research should longitudinally explore whether chronic musculoskeletal pain identified at younger ages is associated with greater risk for functional limitation and dependence in later life. [ABSTRACT FROM AUTHOR]

Although rural seniors are important users of health-care services, their perspectives and input remain largely absent from health programs and policies. This article explores rural seniors' perspectives to support their engagement in patient-oriented research. Guided by lay theory and cultural schema theory, participant observation, concept maps, and semi-structured interviews were conducted with 42 rural seniors in Saskatchewan, Canada. Three themes were identified: community outreach through trust and partnership-building; using flexible data collection methods such as moving to open-ended interviews rather than closed-ended surveys; and developing community-relevant dissemination strategies such as local newspaper articles, posters, and community workshops. In moving forward, collaborative research with seniors is essential to improving health programs and policies for older adults in rural communities and beyond. [ABSTRACT FROM AUTHOR]

To date, initiatives to support healthy aging in place have focused primarily on the views of policy makers, researchers, and health professionals. This article explored the meanings, experiences, and perceptions of healthy aging in place among rural older adults. Guided by a community-based participatory research approach, this study sheds light on the perspectives of rural seniors themselves. Through semistructured interviews with 40 rural older adults, the study found that rural older adults' conceptualization of healthy aging in place consisted of factors that policy makers and health professionals would not necessarily consider. In contrast to biomedical approaches, the rural older adults situated healthy aging in place within a more holistic context of health, ranging from social interaction to maintaining an optimistic mental outlook. If policy makers and researchers are to develop more effective interventions that support rural healthy aging in place, then the importance of rural older adults' perspectives, experiences, and input must be recognized. [ABSTRACT FROM PUBLISHER]

This study examines the interventions that enable rural seniors to remain within their homes and communities as they age. Through semi-structured interviews with 40 rural seniors, the findings reveal a number of actions that facilitate rural aging. This study has important implications for a range of stakeholders from policy makers to community leaders by identifying policy, community, and kin-level interventions that support rural healthy aging in place. In identifying interventions that support rural seniors’ needs, this study provides a fundamental basis to better allocate resources, plan programs, and develop policies that reflect the needs of an aging population. [ABSTRACT FROM AUTHOR]

This study was performed to compare the effects of creatine supplementation (CR) before vs. after supervised resistance training (RT) in healthy older adults. Participants were randomized to one of two groups: CR-Before (0.1g•kg−1creatine before + 0.1g•kg−1placebo [rice flour] after RT,n = 11) or CR-After (placebo before + creatine after RT,n = 11). Resistance training (RT) was performed 3 days/week, on nonconsecutive days, for 12 weeks. Prior to and following the study, measures were taken for body composition, maximum strength, muscle protein catabolism, and kidney function. Over the 12-week training period, both groups experienced a significant increase in whole-body lean tissue mass, limb muscle thickness, and upper and lower body strength and a decrease in muscle protein catabolism (p < 0.001), with no differences between groups. There was no change in kidney function over time. Changes in muscle mass or strength are similar when creatine is ingested before or after supervised resistance training in older adults. [ABSTRACT FROM PUBLISHER]