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Estimates of the number of homeless older adults are highly variable, but the proportion is expected to increase in Western countries as the general population ages. Much of the current literature on homelessness among older adults focuses on the causes of homelessness in later life, along with the health outcomes and service needs of this population. However, there is a dearth of research investigating potential shelter/housing solutions specific to homeless older adults that would meet their unique needs. This scoping review investigated the needs for housing homeless older adults and potential solutions. Based on thematic analysis of findings from 19 sources of primary research, we developed a conceptual model that suggests distinct, senior-specific needs and shelter/housing solutions of both newly and chronically homeless older adults. [ABSTRACT FROM AUTHOR]

Despite widespread use and acceptance of alcohol, discussions of age-related changes that impact alcohol consumption behaviors are rare. The objective of this community-engaged qualitative research study was to gain insight into how to promote knowledge dissemination regarding newly developed low-risk drinking guidelines for older adults. A convenience sample of 66 older adults and service providers participated in three Knowledge Café dialogue workshops and discussed their opinions about alcohol use in later life and ideas for sharing alcohol-related research evidence with the community. Participants discussed (a) low-risk drinking knowledge dissemination, (b) personal choice in drinking alcohol and adherence to low-risk drinking guidelines, and (c) preferences for engaging in discussions about alcohol use. Community dialogues fostered knowledge dissemination while participants engaged in rich conversations about a rarely discussed topic. Sharing evidence-based clinical advice with community stakeholders through dialogue events offers an innovative opportunity for health promotion efforts. [ABSTRACT FROM AUTHOR]

Although moving from institutional to home-like long-term care (LTC) settings can promote and sustain the health and wellbeing of older adults, there has been little research examining how home is perceived by older adults when moving between care settings. A qualitative study was conducted over a two-year period during the relocation of residents and staff from an institutional LTC home to a purpose-built LTC home in Western Canada. The study explored perceptions of home amongst residents, family members and staff. Accordingly, 210 semi-structured interviews were conducted at five time-points with 35 residents, 23 family members and 81 staff. Thematic analyses generated four superordinate themes that are suggestive of how to create and enhance a sense of home in LTC settings: (a) physical environment features; (b) privacy and personalisation; (c) autonomy, choice and flexibility; and (d) connectedness and togetherness. The findings reveal that the physical environment features are foundational for the emergence of social and personal meanings associated with a sense of home, and highlight the impact of care practices on the sense of home when the workplace becomes a home. In addition, tension that arises between providing care and creating a home-like environment in LTC settings is discussed. [ABSTRACT FROM AUTHOR]

Introduction Though hospitals are a common location where older adults experiencing homelessness receive health care, an understanding of the types of supports needed upon hospital discharge is limited. We examined the unique characteristics of older homeless adults and the health and psychosocial supports required upon hospital discharge. Design and Methods Guided by principles of community-based participatory research (CBPR), we conducted 20 in-depth, semi-structured interviews with shelter/housing and health care providers in Metro Vancouver. Results Thematic analyses revealed 6 themes: (a) older people experiencing homelessness have unique vulnerabilities upon hospital discharge; (b) following hospital discharge, general population shelters are inappropriate for older adults; (c) shelter/housing options for older adults who have complex health and social needs are limited; (d) shelter/housing for older adults who require medical stabilization and convalescence after hospital discharge is needed; (e) a range of senior-specific shelter/housing options are needed; and (f) unique community supports are needed for older adults upon hospital discharge. Discussion and Implications As the population of older adults increases across North America, there is a parallel trend in the increased numbers of older adults who are experiencing homelessness. Not only is there often a need for ongoing medical care and respite, but there is a need for both shelter and housing options that can appropriately support individual needs. [ABSTRACT FROM AUTHOR]

Using mechanisms of active learning, we developed a Persona project for our undergraduate Introduction to Gerontology course. We conceive of Personas as fictional characters that are created through the amalgamation of physical, social, and psychological traits and have unique lived experiences. This article details the development of this innovative pedagogical tool and describes how Personas are used as part of an experiential learning assignment over the course of a semester. Student-generated Personas act to contextualize the broad course material, ranging from physical and mental health to environments and financial well-being in later life. Student feedback of the Persona project highlights what they learned, how this project was helpful for them, and suggestions for enhancing the experience for students in subsequent semesters. We conclude by recommending that other gerontological and social science educators incorporate Personas into their coursework to provide students an interactive tool to apply information learned through class lectures and readings. [ABSTRACT FROM AUTHOR]

Being homeless has a negative effect on health and the health needs of individuals experiencing homelessness are complex and challenging to address. As a result of limited access to and use of primary healthcare, the main point of entry into the healthcare system for individuals experiencing homelessness is often hospitals and emergency departments. Persons experiencing homelessness are commonly discharged from hospital settings to locations that do not support recovery or access to follow‐up care (e.g. shelters or the street). This can be costly to both the healthcare system and to individuals' health and quality of life. We conducted a scoping review of the literature published between 2007 and 2017 to identify the types of health supports needed for persons experiencing homelessness who are discharged from the hospital. Thirteen literature sources met inclusion criteria and thematic data analyses by two researchers resulted in the identification of six themes related to the types of health supports needed for persons experiencing homelessness who are transitioning (i.e. being discharged) from the hospital. Using a community consultation approach, the scoping review themes were validated with 23 health and shelter service providers and included in our integrated findings. Themes included: (a) a respectful and understanding approach to care, (b) housing assessments, (c) communication/coordination/navigation, (d) supports for after‐care, (e) complex medical care and medication management, and (f) basic needs and transportation. These themes were found to resonate with participants of the community consultation workshop. Recommendations for trauma‐informed care and patient‐ or client‐centred care approaches are discussed. [ABSTRACT FROM AUTHOR]

Background and Objectives The digital revolution has resulted in innovative solutions and technologies that can support the well-being, independence, and health of seniors. Yet, the notion of the "digital divide" presents significant inequities in terms of who accesses and benefits from the digital landscape. To better understand the social and structural inequities of the digital divide, a realist synthesis was conducted to inform theoretical understandings of information and communication technologies (ICTs); to understand the practicalities of access and use inequities; to uncover practices that facilitate digital literacy and participation; and to recommend policies to mitigate the digital divide. Research Design and Methods A systematic search yielded 55 articles published between 2006 and 2016. Synthesis of existing knowledge, combined with user-experience elicited through a deliberative dialogue session with community stakeholders (n = 35), made visible a pattern of privilege that determined individual agency in ICT access and use. Results Though age is consistently centralized as the key determinant of the digital divide, our analyses, which encompassed both van Dijk's resources and appropriation theory and intersectionality, appraised this notion and revealed that age is not the sole determinant. Findings highlight the role of other factors that contribute to digital inequity among community-dwelling middle-aged (45–64) and older (65+) adults, including education, income, gender, and generational status. Discussion and Implications Informed by results of a realist synthesis that was guided by intersectional perspectives, a conceptual framework was developed outlining implications for theory, policy, and practice to address the wicked problem that is the digital divide. [ABSTRACT FROM AUTHOR]

Objective: Research has repeatedly shown that reminiscence affects the mental health and well-being of older adults contemporaneously and over time. Cross-sectional research also points to a link between reminiscence and physical health. The direction of this relationship is unclear, however. Does physical health affect how and why older adults think of themselves in the past? Or conversely, do various functions of reminiscence affect both mental and physical health now, and in future? Methods: Online responses were collected from a primarily Canadian sample of 411 older adults at three time points, separated by eight months on average. Participants responded to the Reminiscence Functions Scale at baseline and reported their health conditions, perceived state of health, life satisfaction, and psychological distress at subsequent points of measurement. A structural equation model was computed to identify direct and indirect associations between reminiscence functions and health over time. Results: Self-negative reminiscence functions at baseline (T1) predicted physical health 8 months later (T2), whereas self-positive reminiscence functions at T1 predicted both physical health and psychological distress at T2. The associations among self-positive functions and subsequent physical and mental health were maintained over time. Additionally, longitudinal crossover was observed in which psychological distress at T2 predicted physical health at T3, controlling for physical and mental health at T2. Conclusions: Findings confirm longitudinal associations among reminiscence functions and subsequent indicators of health. For older adults, this extends to both physical and mental health. Future research should examine the physiological mechanisms by which autobiographical memory affects health over time. [ABSTRACT FROM AUTHOR]

Objectives: Most persons with bipolar disorder (BD) misuse alcohol and/or illicit drugs at some point, yet research specific to older adults with BD is nascent. The current study sought an in-depth understanding of the experiences and meanings of substance use in a sample of adults who self-reported substance misuse. Methods: Semi-structured interviews were conducted and thematically analyzed to understand the personal theories of substance use by 12 adults (9 women and 3 men; M = 49 years old) who self-reported diagnoses of BD and regular alcohol or illicit drug use. Results: Findings provide an in-depth picture of the theories middle-aged and older adults with BD have developed to explain their substance use. Participants’ theories suggest multiple reasons for substance use, including self-medication; increased confidence with substance use; rejection of prescribed medications; easy access to alcohol; early social exposure/use as facilitator; and living in a culture of substance use. Conclusion: Findings suggest multiple theories for the comorbid link between BD and substance use, primarily that persons with BD use drugs and/or alcohol to relieve stress or manage symptoms. It is clinically relevant to incorporate personal reasons for actively and regularly using substances as part of personalized substance treatment and BD symptom management. [ABSTRACT FROM AUTHOR]

Objectives: Across age groups, bipolar disorder (BD) carries the greatest risk of death by suicide of all psychiatric conditions; 25%-50% of those with BD will make one or more suicide attempt. Psychometrically sound instruments are required to reliably measure suicide ideation and risk of self-harm for older adults with BD. For this study, we validate the geriatric suicide ideation scale (GSIS) with adults 50+ years with BD. Methods: We recruited a global sample of 220 older adults with BD (M = 58.50 years of age) over 19 days using socio-demographically targeted, social media advertising and online data collection. To demonstrate the construct validation of GSIS responses by older adults with BD, we computed correlations and performed regression analyses to identify predictors of suicide ideation. Results: Our analyses support a four-factor model of responses to the GSIS (ideation, death ideation, loss of personal and social worth, and perceived meaning in life) measuring a higher order latent construct. Older adults with BD reporting low satisfaction with life and current depressive symptoms, and who misuse alcohol, report significantly higher levels of suicide ideation. Sleep quality and cognitive failures are also correlated with GSIS responses. Conclusions: Results support the factorial validity of the GSIS with older adults with BD. Similar to other populations, the GSIS measures a four-factor structure of suicide ideation. Across BD subtypes, the GSIS appears to reliably measure suicide ideation among older adults with BD. [ABSTRACT FROM AUTHOR]

Abstract: High prevalence rates of alcohol and substance use disorders have been reported among persons with bipolar disorder (BD). In the present study, we explored the daily experiences of middle‐aged and older adults living with BD who reported regular substance use and the ways in which participants expressed ‘control’ in relation to their use of alcohol and other substances. Semistructured, in‐depth interviews were conducted with 12 participants (nine women and three men), aged 36–57 years of age (mean = 49 years). Thematic analyses identified emergent themes and patterns in participants’ life histories. The theme of ‘control’ emerged as central to participants’ reports, and was organized into four categories: (i) substance use to control BD symptoms; (ii) substance use provides a sense of being in control; (iii) methods of controlled substance use; and (iv) not having control: overreliance on substances. Implications of the present study include the need for nurses to openly discuss the use of alcohol and other drugs with persons with BD, provide health information and screening, and determine whether persons with BD feel they have control over their substance use. Several lines of research with persons who have BD and use substances are suggested. [ABSTRACT FROM AUTHOR]

Objectives: This study was undertaken to examine bidirectional effects of well-being over time in long-wed couples. Method: We recruited 125 couples 50+ years of age who had been married 20+ years. Both spouses reported life satisfaction and depressive symptoms independently at three annual points over 2 years. We computed actor-partner interdependence models (APIMs) to identify concomitant and longitudinal bidirectional effects between long-wed spouses. Where parallel associations were found between models of life satisfaction and depressive symptoms, we undertook invariance analyses to compare the relative strength of associations. Results: We observed a significant association between wives' and their husbands' life satisfaction at baseline; a concomitant crossover effect was also evident from wives to husbands at 1- and 2-year follow-up, such that wives' life satisfaction predicted changes in their husbands' life satisfaction beyond that previously and concomitantly reported. Discussion: Our findings suggest that older wives influence their husbands after decades of marriage; the relative effect of this crossover on older husbands is comparatively equivalent for life satisfaction and depressive symptoms. These findings stand in contrast to prior research with younger couples suggesting that long-wed couples may be a distinct subset of the population of all married couples (i.e., those who have not divorced). [ABSTRACT FROM AUTHOR]

Housing First is a model and philosophy for housing homeless people in immediate and permanent housing. In order to implement and deliver Housing First, research is essential to understand the system of support services as they currently exist. Guided by principles of community-based participatory research, this paper presents the findings from a senior-focused deliberative dialogue workshop in Metro Vancouver, Canada. Participants (16 service providers and 1 service recipient) identified services and resources available to support seniors in maintaining housing and barriers and facilitators for accessing services. Broadly, data were organized into seven themes: (1) Housing; (2) Home support; (3) Transportation; (4) Information availability, accessibility, and navigation; (5) Cultural diversity; (6) Discrimination; and (7) Funding and financial support. Results found that affordable housing that adapts to changing health conditions, income supports, health services, homecare, transportation, and culturally appropriate and nondiscriminatory informational resources are among the supports most needed for persons as young as 50 years old to succeed under the Housing First model in Metro Vancouver. Barriers to Housing First service provision, including rigid eligibility criteria for chronically and episodically homeless, should be revised to better support the growing number of older adults who are newly entering homelessness in Metro Vancouver. [ABSTRACT FROM AUTHOR]

Objectives: Bipolar disorder (BD) carries the greatest risk of death by suicide of all psychiatric conditions as 25%–50% of those with BD will make one or more suicide attempt, and about 15% will intentionally end their lives. Among young adults with BD, substance misuse, medication non-adherence, age at onset, and comorbid psychiatric conditions each predict self-harm. It is currently unclear if these same factors or others predict suicide ideation among older adults with BD. Methods: We recruited a global sample of 220 older adults with BD over 19 days using socio-demographically targeted, social media advertising and online data collection (Mean = 58.50, SD = 5.42; range 50 to 81 years). Path analyses allowed us to identify direct and indirect predictors of suicide ideation among older adults with BD. Results: Cognitive failures (perception, memory, and motor function), depressive symptoms, alcohol misuse, and dissatisfaction with life as direct predictors of suicide ideation; duration of BD symptoms and medication non-adherence emerged as indirect predictors. Of note, the significant impact of sleep on suicide ideation is indirect via depressive symptoms, cognitive failures, medication non-adherence and life dissatisfaction. Conclusions: As with young adults with BD, alcohol misuse and medication non-adherence emerged as significant predictors of suicide ideation. In addition, cognitive failures directly and indirectly predict suicide ideation in this sample of older adults with BD. Population aging and treatment efficacy are leading to ever growing numbers of older adults with BD. Both direct and indirect predictors of suicide ideation need to be considered in future BD research and treatment planning. [ABSTRACT FROM AUTHOR]

Objective: Long-term care (LTC) facilities are increasingly intent on creating a “homelike” atmosphere for residents. Although residential staff are integral to the construction of a home within LTC settings, their perceptions have been relatively absent from the literature. Method: Thirty-two LTC staff participants were interviewed about their experiences and perceptions of the physical environment and conceptualizations of home, and thematic analyses were conducted. Results: An overarching category—interpersonal relationships—emerged from our analyses emphasizing the importance of relationships in creating a homelike environment within institutional settings. Sub-themes that inform our understanding include the following: (a) Staff members’ perceptions of home; (b) “Their second home”: Adjustment to and familiarity in LTC; and (c) “We become family”: Relationality makes a home. Discussion: The study provides evidence to inform current policies and practices in LTC. Specifically, enough time and space should be given to residents and staff to create and maintain personal relationships to make residential care homelike. [ABSTRACT FROM AUTHOR]