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Obesity is an important public health concern, and large studies of rural-urban differences in prevalence of obesity are lacking. Our purpose is to compare body mass index (BMI) and obesity in Canada using an expanded definition of rurality.A cross-sectional analysis of self-reported BMI across diverse communities of Canadians aged 45-85 years was conducted using data from the Canadian Longitudinal Study on Aging (CLSA), a national sample representative of community-dwelling residents. Rurality was identified in the CLSA based on residential postal codes, which were divided into 4 categories: urban, peri-urban, mixed and rural. Logistic regression models were constructed to calculate adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs) between obesity (BMI ≥30 kg/mTwenty-one thousand one hundred and twenty-six Canadian residents aged 45-85 years, surveyed during 2010-2015, were included. 26.8% were obese. Obesity was less prevalent amongst urban (25.2%) than rural (30.3%, P0.0001), mixed (28.7%, P0.0001) or peri-urban communities (28.1%, P0.0001). When compared to urban areas, the aOR (95% CI) for obesity was 1.09 (1.00-1.20) in rural regions and 1.20 (1.08-1.35) in peri-urban settings. In areas of mixed urban and rural residence, the aOR was 1.12 (0.99-1.27).One in four Canadian adults were obese. Living in a non-urban setting is an independent risk factor for obesity. Rural-urban health disparities could underlie rural-urban differences, but further research is needed.

Purpose To document the prevalence of functional impairment in middle-aged and older adults from rural regions and to determine urban-rural differences. Methods We have conducted a secondary analysis using data from an ongoing population-based cohort study, the Canadian Longitudinal Study on Aging (CLSA). We used a cross-sectional sample from the baseline wave of the "tracking cohort." The definition of rurality was the same as the one used in the CLSA sampling frame and based on the 2006 census. This definition includes rural areas, defined as all territory lying outside of population centers, and population centers, which collectively cover all of Canada. We grouped these into "Urban," "Peri-urban," "Mixed" (areas with both rural and urban areas), and "Rural," and compared functional status across these groups. Functional status was measured using the Older Americans Resource Survey (OARS) and categorized as not impaired versus having any functional impairment. Logistic regression models were constructed for the outcome of functional status and adjusted for covariates. Findings No differences were found in functional status between those living in rural, mixed, peri-urban, and urban areas in unadjusted analyses and in analyses adjusting for sociodemographic and health-related factors. There were no rural-urban differences in any of the individual items on the OARS scales. Conclusions We found no rural-urban differences in functional status.

Background Androgen deprivation therapy (ADT) improves outcomes in unfavorable-risk prostate cancer (PCa) treated with radiation therapy (RT). It was hypothesized that replacing luteinizing hormone-releasing hormone (LHRH) agonists with a 5-α-reductase inhibitor (5-ARI) would improve hormonal health-related quality of life (HRQOL) without differentially suppressing androgen-responsive (AR) gene expression. Methods Patients with localized unfavorable-risk PCa, aged ≥70 years or Charlson Comorbidity Index score ≥2 were treated with oral ADT (oADT), consisting of 4 months of bicalutamide, a 5-ARI, and RT at 78 Gy. The primary end point was Expanded Prostate Cancer Index Composite HRQOL at 6 months ≤30%, and improvement compared with a synchronous standard of care (SOC) cohort receiving 4 months of bicalutamide and long-term LHRH agonist with RT. RNA sequencing was performed from matched pre-/post-ADT prostate tumor biopsies in a subset of men. Differential gene and pathway expressional changes were examined using gene set enrichment. Results Between 2011 and 2018, 40 and 30 men were enrolled in the oADT and SOC cohorts, respectively. Median follow-up was 40 months. Those with ≤30% decline in hormonal HRQOL at 6 months was 97% (oADT) and 93% (SOC). The average 6-month hormonal decline was 1% (oADT) versus 12% (SOC; P = .04). The 4-year freedom from biochemical failure was 88% (oADT) versus 81% (SOC; P = .48). RNA sequencing (n = 9) showed similar numbers of downregulated and upregulated genes between the treatment groups (fold-change = 2; false-discovery rate-adjusted P ≤ .05). Both treatments comparably decreased the expression of 20 genes in canonical androgen receptor signaling. Conclusions For men with PCa undergoing RT, oral versus standard ADT may improve 6-month QOL and appears to have a similar impact on androgen-responsive gene expression.

BACKGROUND: We explored the safety and efficacy of ablative doses of stereotactic body radiation therapy (SBRT) for unresectable pancreatic cancer. METHODS: This phase I/II trial included patients with unresectable pancreatic cancer previously treated with any number of cycles of induction chemotherapy. Patients were enrolled according to a 3+3 dose escalation design at 10, 12.5, and 15 Gy ×3, with subsequent patients at the maximally tolerated dose (MTD). Treatment was delivered to gross tumor delineated with MRI fusion using image-guidance to fiducial markers. Dose-limiting toxicity (DLT) was defined as grade 3+ toxicity within 30 days. Secondary endpoints included late gastrointestinal (GI) toxicity, freedom from local failure (FFLF), and survival. RESULTS: Fifteen patients received a median 10 cycles of chemotherapy. There were no DLTs, and the MTD was 15 Gy ×3. Thirty-day toxicity included grade 2 nausea (46%) and grade 2 diarrhea (7%). Median survival after SBRT was 12.8 months (23 months after diagnosis) and median relapse-free survival was 7 months. At 1-year, FFLF was 80%. Four patients had grade 3+ GI bleeding after 30 days (median 6 months). Grade 3+ GI bleeding was associated with tumor volume (P=0.01), heterogeneity of dose within the planning target volume (PTV) (V120, P=0.03), and duodenal dose (V26–30 Gy, P

Working from an asset-based perspective, this exploratory, qualitative study examined local community strengths and capacities to support healthy aging in a rural community in Western Canada. The r...

Introduction: Understanding rural-urban differences, and understanding levels of life satisfaction in rural populations, is important in planning social and healthcare services for rural populations. The objectives of this study were to determine patterns of life satisfaction in Canadian rural populations aged 45-85 years, to determine rural-urban differences in life satisfaction across a rural-urban continuum after accounting for potential confounding factors and to determine if related social and health factors of life satisfaction differ in rural and urban populations. Methods: A secondary analysis was conducted using data from an ongoing population-based cohort study, the Canadian Longitudinal Study on Aging. A cross-sectional sample from the baseline wave of the tracking cohort was used, which was intended to be as generalizable as possible to the Canadian population. Four geographic areas were compared on a rural-urban continuum: rural, mixed (indicating some rural, but could also include some peri-urban areas), peri-urban, and urban. Life satisfaction was measured using the Satisfaction with Life Scale and dichotomized as satisfied versus dissatisfied. Other factors considered were province of residence, age, sex, education, marital status, living arrangement, household income, and chronic conditions. These factors were self-reported. Bivariate analyses using χ2 tests were conducted for categorical variables. Logistic regression models were constructed with the outcome of life satisfaction, after which a series of models were constructed, adjusting for province of residence, age, and sex, for sociodemographic factors, and for health-related factors. To report on differences in the factors associated with life satisfaction in the different areas, logistic regression models were constructed, including main effects for the variable of interest, for the variable rurality, and for the interaction term between these two variables. Results: Individuals living in rural areas were more satisfied with life than their urban counterparts (odds ratio (OR)=1.23; 95% confidence interval (CI): 1.13-1.35), even after accounting for the effect of confounding sociodemographic and health-related factors (OR=1.32, 95%CI: 1.19-1.45). Those living in mixed (OR=1.30, 95%CI: 1.14-1.49) and peri-urban (OR=1.21, 95%CI: 1.07-1.36) areas also reported being more satisfied than those living in urban areas. In addition, a positive association was found between life satisfaction and age, as well as between life satisfaction and being female. A strong graded association was noted between income and life satisfaction. Most chronic conditions were associated with lower life satisfaction. Finally, no major interaction was noted between rurality and each of the previously mentioned different factors associated with life satisfaction. Conclusion: Rural-urban differences in life satisfaction were found, with higher levels of life satisfaction in rural populations compared to urban populations. Preventing and treating common chronic illness, and also reducing inequalities in income, may prove useful to improving life satisfaction in both rural and urban areas. Studies of life satisfaction should consider rurality as a potential confounding factor in analyses of life satisfaction within and across societies.

The growing issue of housing affordability is an increasing challenge worldwide as the financialization of housing markets undermines housing as a basic human right. One of the most vulnerable segments of the population affected by rising housing costs are older, low-income, females. Drawing on qualitative interviews with older women, we explore lived experiences of housing insecurity using a feminist political ecology perspective. Our findings reveal substantial challenges as well as creative solutions being employed by these women to stay in place. We conclude that more targeted and age- and gender-inclusive housing policies, programs, supports and services are critically needed.

The end-of-life context is imbued with emotions, with death and dying transforming everyday places, like long-term care facilities, into entirely new emotional topographies that can evoke profound effects on those who live and work within these settings. Despite their significant role, healthcare providers' emotions and their interconnections with ‘place’ have received relatively little attention from researchers, including geographers of care and caregiving. This secondary thematic analysis attempts to address this notable gap by exploring the emotional geographies of healthcare providers caring for dying residents in four long-term care facilities in western Canada. By drawing upon interview and focus group data with administrators (n = 12) and direct care provider (n = 80) participants, findings reveal that experiences of caring for dying residents were often charged with negative emotions (e.g., distress, frustration, grief). These emotions were not only influenced by social and physical aspects of ‘place’, but the temporal process of caring for a dying resident, which included: (1) Identifying a resident as in need of a palliative approach to care; (2) Actively dying; and (3) Following a resident's death. Findings indicate that providers' emotions shifted in scale at each of these temporal phases, ranging from association with the facility as a whole to the micro-scale of the body. Broader structural forces that influence the physical and social place of long-term care facilities were also found to shape experiences of emotional labor among staff. With an increasing number of deaths occurring within long-term care facilities throughout the Global North, such findings contribute critical experiential knowledge that can inform policy and programs on ways to help combat staff burnout, facilitate worker satisfaction, and foster resilience among long-term care providers, ensuring they receive the necessary supports to continue fulfilling this valuable caring role.

Across North America, a growing number of older adults have a core housing need and lack access to affordable, suitable or adequate housing. Although federal, state/provincial and local backdrops vary across Canadian and American contexts, seniors’ housing providers in both countries face similar challenges and must develop innovative policy and program responses to help older adults age in place. We hosted an international seniors’ housing conference to create a platform for cross-national collaboration among multidisciplinary seniors housing experts. This event offered an opportunity to exchange best practices, emerging research, and policy solutions, and establish a set of shared priorities for advancing seniors housing that were applicable to two nations with different social systems. This paper will reflect on the exchange of knowledge and best practices related to housing preservation, eviction prevention, and access to supports during COVID-19, and the lessons learned fostering a cross-national collaborative network of seniors housing experts.

Family caregivers play a pivotal role in supporting the functional independence and quality of life of older relatives, often taking on a wide variety of care-related activities over the course of their caregiving journey. These activities help family members to remain in the community and age-in-place for as long as possible. However, when needs exceed family capacities to provide care, the older family member may need to transition from one care environment to another (e.g., home care to nursing home care), or one level of care to another (from less intense to more intensive services). Drawing upon qualitative interview data collected in a populous health region in British Columbia, Canada, this study explores the roles and responsibilities of family caregivers for family members making the care transition from home care to residential care. A thematic analysis of the interview transcripts resulted in the development of a conceptual framework to characterize the "Caregiver Journey" as a process that could be divided into at least three phases: 1) Precursors to transition - recognizing frailty in family members and caregivers prior to transition; 2) Preparing to transition into residential nursing home care (RC) and 3) Post-transition: Finding a new balance - where caregivers adjust and adapt to new caregiving responsibilities. Our analyses revealed that the second phase is the most complex involving a consideration of the various activities, and roles that family caregivers take on to prepare for the care transition including: information gathering, advocacy and system navigation. We conclude that there is a need for family caregivers to be better supported during care transitions; notably through ongoing and enhanced investments in strategies to support caregiver communication and education.

Interpretations of family carer empowerment in much nursing research, and in home-care practice and policy, rarely attend explicitly to families' choice or control about the nature, extent or length of their involvement, or control over the impact on their own health. In this article, structural empowerment is used as an analytic lens to examine home-care nurses' interactions with families in one Western Canadian region. Data were collected from 75 hrs of fieldwork in 59 interactions (18 nurses visiting 16 families) and interviews with 12 nurses and 11 family carers. Generally, nurses prioritized client empowerment, and their practice with families appeared oriented to supporting their role and needs as carers (i.e. rather than as unique individuals beyond the caring role), and reinforcing the caring role through validation and recognition. Although families generally expressed appreciation for these interactions, a structural empowerment lens illustrates how the broad context of home care shapes the interpretation and practice of empowerment in ways that can, paradoxically, be disempowering for families. Opportunities to effectively support family choice and control when a client is being cared for at home are discussed.

Janus, the two-faced, Roman god of beginnings and transitions, is used as a metaphor to explore our personal narratives and our quantitative research on the experiences of older women with dementia in long-term care (LTC). Two research questions are addressed: (a) How do our quantitative data map onto our mothers' experiences? (b) What lessons do our mothers' experiences offer for the care of older women with dementia?Informed by a life-course perspective, we triangulate administrative data on 3,717 women with dementia receiving LTC in British Columbia, Canada, with personal narratives-the stories of our mothers who made the transition from home care into residential (nursing home) care.Our quantitative data reveal that the home care to residential care transition is the most common LTC trajectory for women with dementia who are most likely to be widowed and living alone in suburban areas. On entry into residential care, they exhibit greater frailty in terms of activities of daily living, cognition, aggression, and incontinence. Our personal narrative data on our mothers reveals that the relatively straightforward pathways through LTC for women with dementia, are often considerably more complex in a real-world context. Attention is drawn to the public and private services, hospitalization patterns, and substantial communication gaps experienced by our moms and families.A life-course perspective, and qualitative and quantitative data facilitate understanding the care journeys-health and service trajectories of older women with dementia.

Objective: The objective is to determine the use of health-care services (physician visits, emergency department use and hospitalisations) in rural areas and examine differences in four geographic areas on a rural to urban spectrum. Methods: We conducted a secondary analysis of cross-sectional data from a population-based prospective cohort study, the Canadian Longitudinal Study on Aging (CLSA). Participants included community-dwelling adults aged 45–85 years old from the tracking cohort of the CLSA (n = 21,241). Rurality was classified based on definitions from the CLSA sampling frame and similar to the 2006 census. Main outcome measures included self-reported family physician and specialist visits, emergency department visits and hospitalisations within the previous 12 months. Results were compared for four geographic areas on a rural-urban continuum. Univariate and bivariate analyses were performed on data from the 'tracking cohort' of the CLSA, Chi-square tests were used for categorical variables. Logistic regression models were created for the main outcome measures. Results: Participants in rural and mixed rural and urban areas were less likely to have seen a family physician or a specialist physician compared to urban areas. Those living in rural and peri-urban areas were more likely to visit an emergency department compared to urban areas. These differences persisted after adjusting for sociodemographic and health-related variables. There were no significant rural-urban differences in hospitalisations. Conclusion: Rural-urban differences were found in visits to family physicians, specialists and emergency departments.

Geographers and other social scientists have a longstanding interest in ‘geographies of aging’ focused on the provision of care to vulnerable older populations and the challenges and experiences of caregivers [Skinner, M. W., Cloutier, D., & Andrews, G. J. (2014). Geographies of ageing: Progress and possibilities after two decades of change. Progress in Human Geography, 1–24]. This qualitative research project explores strategies for relationship-building used by home support workers and older residents according to a ‘relational ethics’ framework, enacted in the ‘relational space’ of the home environment. This framework rests on four principles: engagement, embodiment, mutual respect and environment, and argues that ‘relationships’ between care providers and care recipients must be preserved as the real essence or heart of the health care experience. Two linked conclusions are drawn from the research: that the treatment of the environment can be expanded using a social geographic lens to capture the more...

Providing quality of care (QoC) to older adults in residential care settings is an ongoing challenge given the increasingly complex needs of this population and the escalating economic constraints within which health authorities operate. While the implementation of the residential care delivery model in a Western Canadian health authority has contributed to some improvements in QoC, it has also highlighted key challenges that are both interpersonal and organizational in nature; specifically, gaps in leadership, teamwork, mentorship, and communication, as well as staffing mix, staffing consistency, resident complexity, and competing policy and program initiatives and directives. The implementation of a major change in care delivery impacts residents, families, and staff and may, in turn, impact their perceptions of change in QoC. When evaluating a model, therefore, it is important to examine both qualitative and quantitative outcomes: stories from those most affected in their everyday lives and trends in QoC indicator data.

Objectives The use of antipsychotics, mainly to address the behavioral and psychological symptoms of dementia (BPSD), remains a common and frequent practice in long-term care facilities (LTCFs) despite their associated risks. The objective of this study was to explore the association between social engagement (SE) and the use of antipsychotics in addressing the BPSD in newly admitted residents to LTCFs. Methods A cross-sectional study was undertaken using administrative data, primarily the Resident Assessment Instrument Minimum Data Set (Version 2.0) that collected between 2008 and 2011 (Fraser Health region, British Columbia, Canada). The data analysis conducted on a sample of 2,639 newly admitted residents aged 65 or older with a diagnosis of Alzheimer's disease or other dementias as of their first full or first quarterly assessment. Multivariate logistic regression analyses were undertaken to predict antipsychotic use based on SE. Results SE was found to be a statistically significant predictor of antipsychotic use when controlling for sociodemographic variables (odds ratio ( OR) = .86, p .0001, confidence interval (CI) [0.82, 0.90]). However, the association disappeared when controlling for health variables ( OR = .97, p = .21, CI [0.97, 1.0]). Conclusion The prediction of antipsychotic use in newly admitted residents to LTCFs by SE is complex. Further research is warranted for further examination of the association of antipsychotic use in newly admitted residents to LTCFs.

Objective: We used latent transition analysis to explore common long-term care (LTC) service trajectories and their predictors for older adults with dementia. Method: Using linked administrative data collected over a 4-year interval (2008-2011), the study sample included 3,541 older persons with dementia who were clients of publicly funded LTC in British Columbia, Canada. Results: Our results revealed relatively equal reliance on home care (HC) and facility-based residential care (RC) as starting points. HC service users were further differentiated into “intermittent HC” and “continuous HC” groups. Mortality was highest for the RC group. Age, changes in cognitive performance, and activities of daily living were important predictors of transitions into HC or RC. Discussion: Reliance on HC and RC by persons with dementia raises critical questions about ensuring that an adequate range of services is available in local communities to support aging in place and to ensure appropriate timing for entry into institutions.

Background and Objectives Little is known regarding the care trajectories older adults experience at the end of life (EOL). We drew on a structural/institutional life course perspective to examine the trajectories evident among older adults transitioning through the Canadian formal long-term care system. The sequence of care transitions as well as the impact of social location, social and economic resources, and health-related factors on these trajectories were examined. Research Design and Methods To identify EOL care trajectories, we used administrative data collected on older adults (aged 65+) who received publicly subsidized long-term care services (e.g., nursing home and home and community-based care) in one health region in British Columbia, Canada from January 1, 2008 through December 31, 2011 and who died by March 31, 2012 (n = 11,816). Multinomial logistic regression analyses assessed the impact of selected covariates on these trajectories. Results The majority of those studied (65.4%) died outside of acute hospital settings. The most common trajectories involved transitions from home care to nursing home/residential care to non-hospital death (39.5%) and transitions from in-home care to hospital death (22.4%). These and other trajectories were shaped by social structural factors, access to social and economic resources, as well as health status and prior hospitalizations. Discussion and Implications Despite calls for minimizing hospital-based deaths and maximizing home-based deaths, older LTC recipients often experience EOL care trajectories that end in death in a nursing home care setting. Our findings point to the value of a structural/institutional life course perspective in informing an understanding of who experiences this and other major EOL care trajectories. In doing so, they also provide direction for policy and practice designed to address inequalities and enhance the quality of EOL care.

To examine the change in cognitive processing as measured by consciousness raising and attitudes toward driving following educational interventions for older adults.Older adults who viewed a research-based applied theater production about older driver safety (n = 110) were compared to those who were exposed to a print-based publication available to all drivers (n = 100).After viewing the play developed with input from older adults and others, older adult viewers' attitudes toward driving shifted in a manner consistent with an increased openness or willingness to consider changing their driving behavior. Conversely, after reading the print-based materials, the older adults felt more empowered to continue drive.Demonstrating that an intervention that takes into account the views of older drivers can lead to attitudinal outcomes that differ from those achieved with typical "just the facts" programs is an important step in understanding how program content and format affect outcomes. Future interdisciplinary work such as this may enhance our capabilities to understand more about the processes involved in influencing change in attitudes and behaviors.

This article examines two-decades of progress toward developing ‘geographies of ageing’ as a distinct field of human geography. Reflecting on the last review in this journal by Harper and Laws (1995), we elucidate the longstanding, emergent, and hidden pathways of scholarship involved in the constitution of the field since the mid-1990s. We consider contemporary developments relating to the empirical gap in understanding the contributions of older people and the potential for relational and nonrepresentational perspectives to expand the breadth of the field. The still nascent profile of ageing within the discipline is contrasted with the interdisciplinary spatial turn underway in gerontology.

Local Food Systems (LFS) are a relatively new concept in planning. While there is a growing interest in making transformative change in LFS, the area lacks a solid theoretical foundation to address how change processes in food systems occur. In this study, a classic Glaserian grounded theory methodology was used to investigate LFS planning. The primary goal was the development of theory grounded in the experience of practitioners, elected officials, and members of the public all having some level of experience with LFS initiatives. The data are drawn from interviews with 29 elected officials, public stakeholders, and planning staff working in five communities with LFS planning initiatives. In addition, 10 member checking interviews were conducted to determine the fit and relevance of the findings to the experience of participants in LFS planning. The emergent theory of ‘Transformative Incrementalism’ (TI), was developed from this research to describe the social processes underlying planning initiatives to achieve transformative change in LFS. Consistent with grounded theory principles, the core category identified in the theory was Power, while Values, Praxis, and Outcomes were other main themes. TI suggests that change is achieved through a long process of incremental efforts by actors within the public, political, and bureaucratic groups to achieve convergence and align values and beliefs over time.

To address the highly-complex and emotionally-charged nature of issues concerning older drivers, we engaged in the development and evaluation of a research-based applied theater production. A quasiexperimental pretest–posttest group design was used to assess change in attitudes and beliefs, derived from social science theories, of older drivers and other stakeholders. After viewing the play, older adults showed decreases in their positive attitudes toward driving and intention to continuing driving. The findings for the older adults appeared to be driven by the responses of the women in the group. Stakeholders showed no change in attitudes about older drivers. Data collected two weeks after the play was viewed confirmed that audience members found the play informative and that it promoted discussion about the topic. The findings from this study provide important new information about how exposure to an applied theater production brings about attitude change.

In the aging literature, social isolation has been primarily defined in terms of reduced support network size and low frequency of social contacts. Having a small social support network is associated with social isolation and an increased risk of physical and emotional vulnerability. However, this conceptualization ignores the contributions of a host of other factors, including life experiences, family dynamics, and long-term patterns of socialization. This paper argues that alongside quantitative assessments of support systems, the application of a life course perspective is needed to understand small social networks as lived experience. We report on findings from 28 in-depth interviews with older adults identified as being at risk of social isolation on the basis of the self-reported size of their social networks. We discuss these participants' experiences in the context of significant life course transitions such as marriage and widowhood.

Comprehensive risk assessments are fundamental to effective emergency management. These assessments need to identify the range of hazards (or perils) an entity is exposed to and quantify the specific threats associated with each of those hazards. While hazard identification is commonly, if not formally, conducted in most circumstances, specific threat analysis is often overlooked for a variety of reasons, one of which is poor communication with subject matter experts. This poor communication is often attributable to an adherence to scientific jargon and missed opportunities to simplify information. In Canada, for example, earthquake hazard calculations have been readily available to engineers and scientists for decades. This hazard information, however, is expressed in terms of peak ground accelerations (PGA) or spectral accelerations (SA) that are foreign concepts to most emergency managers, community decision-makers and the public-at-large. There is, therefore, a need to more clearly, simply and effectively express seismic hazard information to the non-scientific community. This paper provides crustal, sub-crustal and subduction interface earthquake shaking probabilities, expressed as simple percentages for each of 57 locations across Vancouver Island, British Columbia, Canada. Calculations present the likelihood of earthquake shaking on Vancouver Island as the probabilities of exceeding each of three shaking intensity thresholds (“widely felt”; onset of “non-structurally damaging” shaking; and onset of “structurally damaging” shaking) over four timeframes (10, 25, 50 and 100 years). Results are based on the latest Geological Survey of Canada hazard models used for the 2010 national building code and are presented in both tabular and graphic formats. This simplified earthquake hazard information is offered to aid local residents, organizations and governments in understanding and assessing their risk and to encourage and facilitate sound earthquake preparedness funding decisions.

Singlehood may or may not be a choice; but it is often a statement about identity for many women. Historically, singlehood has been a deviant identity. One that signals a personal flaw or eccentricity. However, high divorce rates, and increasing preferences for cohabitation and living alone have made singlehood increasingly common across societies in the Global North. Further, while a large body of research reports on the health benefits that accrue from non-single status, little research has focused on the heterogeneity among single individuals as a growing cohort, and on the ways that singlehood both shapes identity, and influences health and well-being. Moreover, only a limited body of research has explored how this phenomena is changing societally, and how it has affected women of different ages and life stages. Using a life course perspective and a critical feminist lens, this paper draws upon qualitative interviews to understand the ‘lived experience of singlehood’ for women at three different life stages notably as they seek educational opportunities and enter the job market, as middle-aged members of the workforce and mothers, and finally, as persons exiting the workforce or retirees. Our findings suggest that women in each of these stages experiences singlehood in unique ways. From our critical lens, economic well-being is consistently important for singles as is the nature, rather than the number of friendships. This research is a starting point for understanding the implications of growing numbers of single women within a dynamic and historic period in time.

Drawing on interviews with 26 bereaved individuals who provided care to a dying family member at home, the purpose of this article is to identify and explore motivations behind the “nonuse” of home health services. Participants resided in a Western Canadian regional health authority. In their accounts of not asking for help from formal providers, participants highlighted personal reasons, coping needs, and a lack of knowledge. In their accounts of refused help, they placed more emphasis on a perceived lack of need for help (including constructing themselves as capable and coping), as well as their perceptions of the quality and competence of formal services. Findings are compared against existing literature. Implications for health system policy and planning, and for home health nursing practice, training and education, particularly with reference to situations in which responsibility is left with families to ask for help from formal providers, are also discussed.

stajduhar k.i., funk l., roberts d., mcleod b., cloutier-fisher d., wilkinson c. & purkis m.e. (2011) Home care nurses’ decisions about the need for and amount of service at the end of life. Journal of Advanced Nursing 67(2), 276–286. Abstract Aims. We explore home care nurse decision-making about the need for and amount of service by clients and families at the end of life. We identify factors nurses refer to when describing these decisions, situated within contextual features of nursing practice. Background. Home care nurses are often responsible for decisions which have an impact on the access of clients and families to services at the end of life. Understanding how these decisions, are made, factors that are considered, and contextual influences is critical for improving access and enhancing care. Methods. Qualitative data were collected between 2006 and 2008 from two samples of home care nurses: the first group (n = 29) recorded narrative descriptions of decisions made during visits to families. The second group (n = 27) completed in-person interviews focusing on access to care and their interactions with clients and families. Data were analysed with thematic coding and constant comparison. Findings. Participants described assessing client and family needs and capacity. These assessments, at times integrated with considerations about relationships with clients and families, inform predictive judgements about future visits; these judgments are integrated with workload and home health resource considerations. In describing decisions, participants referred to concepts such as expertise, practice ideals and approaches to care. Conclusion. Findings highlight the role of considerations of family caregiver capacity, the influence of relationships and the importance of the context of practice, as part of a complete understanding of the complexity of access to care at the end of life.

The objective of this study was to identify spatial variability in exposure to outdoor traffic-related air pollution with specific emphasis on comparing exposure estimates for working females and males across a metropolitan area. A spatial exposure simulation model was used to estimate annual average exposure to traffic-related nitrogen dioxide for males and females reporting regular work in census tracts other than that of their residence, in Vancouver, British Columbia. The model produced estimates of annual average exposure in six microenvironments (home indoor, work indoor, other indoor, outdoor, in-vehicle to work, and in-vehicle other) using time-activity patterns and work flow data, for males and females in each of 382 census tracts. This allowed for the identification of spatial variations in exposure estimates for each gender, due to mobility within the study region. Indoor sources of nitrogen dioxide were not included in the simulation. No significant differences in estimated total exposure were...

Backyard garden sharing projects can be viewed as a small-scale alternative to traditional community gardens. These shared spaces are able to overcome some of the pressures on community gardens such as competing demands for housing and other services and amenities while still providing many of the health-promoting benefits community gardens are noted for. This study is a small-scale participatory qualitative project that explores three backyard garden sharing partnerships. The aim of this study is to explore the benefits and challenges of these shared spaces and to discuss the overall feasibility of shared backyard gardens. Partnerships comprised an older adult homeowner (i.e., greater than age 65) and a non-senior gardener. At an individual level, the results suggest that backyard garden sharing can promote physical activity, psychosocial well-being, and social connectedness for both older adult homeowners and volunteer garden partners. To be successful, partners benefit from an established agreement abo...

This research presents the results of a qualitative study of a small sample of older adults (n = 25), age 55+ who have recently moved to an area that is rapidly changing from a tourist community into a retirement community. The study has two main research objectives: (a) to use Oswald and Wahl's heuristic meaning of home framework to explore the relationships between older adults and their homes and communities, integrating theories from environmental psychology, environmental gerontology and human geography, and (b) to discuss the empirical findings focussing on the core concepts of meaning of home and sense of belonging for new retirees to an area. Findings: For new retirees, there exists a zone between the home and community, that can be viewed as a geographic space comprised of overlapping and interwoven personal, social and physical domains. This zone between the physical house and the surrounding community can be construed as having certain elastic qualities and permeable boundaries that blur the distinctions between home and community. A focus on the micro-environment of the home dwelling and the macro-environment of the neighbourhood and community then appears relevant for understanding place attachment for these persons. This idea of the ‘home beyond the house’ – is one of the most important contributions of this research. Our results view the heuristic framework of Oswald and Wahl as a valuable tool for building understanding about the meaning of home for older adults by drawing attention to the domains themselves, and more importantly, to the interrelationships between them. Consequently, for younger in-migrants, the boundary between home and community blurs into one larger, symbolic entity experienced as ‘home’.

In 2003, the Canadian Federal/Provincial/Territorial Task Force on Seniors identified social isolation as an important issue for further study and policy development given that socially isolated persons are considered to be more vulnerable to both inappropriate use of the health care system and poorer health outcomes. In order to provide adequate support to this vulnerable population, it is critical to untangle the complex web of relationships that influence the need for care, and the health status and service utilization patterns of socially isolated older adults. Using data from the 2000–01 Canadian Community Health Survey (CCHS), this article explores social isolation as a multidimensional social construct examining in particular the axes of gender and geography to try to tease out some of this complexity and its relationship to health status and service utilization. When individual characteristics like gender are considered together with broader contextual variables like place of residence, a more com...

Residential, long-term care serves vulnerable older adults in a facility-based environment. A new care delivery model (CDM) designed to promote more equitable care for residents was implemented in a health region in Western Canada. Leaders and managers faced challenges in implementing this model alongside other concurrent changes. This paper explores the question: How did leadership style influence team functioning with the implementation of the CDM? Qualitative data from interviews with leadership personnel (directors and managers, residential care coordinators and clinical nurse educators), and direct care staff (registered nurses, licensed practical nurses, health care aides, and allied health therapists), working in two different facilities comprise the main sources of data for this study. The findings reveal that leaders with a servant leadership style were better able to create and sustain the conditions to support successful model implementation and higher team functioning, compared to a facility in which the leadership style was less inclusive and proactive, and more resistant to the change. Consequently, staff at the second facility experienced a greater sense of overload with the implementation of the CDM. This study concludes that strong leadership is key to facilitating team work and job satisfaction in a context of change.

Drawing on a structural life course perspective (LCP), we examined the most common trajectories experienced by older long-term care (LTC; home and community-based care, assisted living, and nursing home care) recipients. The overall sequencing of care transitions was considered along with the role of social structural location, social and economic resources, and health factors in influencing them.Latent class and latent transition analyses were conducted using administrative data obtained over a 4-year period for clients aged 65 and older (n = 2,951) admitted into publicly funded LTC in 1 Canadian health region.Four main LTC trajectories were identified within which a wider range of more specific or secondary subtrajectories were embedded. These were shaped by social structural factors (age, gender, rural-urban residence), social and economic resources (marital status, income, payment for services), and health factors (chronic conditions, functional and cognitive impairment and decline, problematic behaviors).Our findings support the utility of a structural LCP for understanding LTC trajectories in later life. In doing so, they also reveal avenues for enhancing equitable access to care and the need for options that would increase continuity and minimize unnecessary, untimely, or undesirable transitions.