Download 1 - University of Manitoba

Centre on Aging
25 Spring Symposium
May 5, 2008
Poster Session
th
1. Unpaid Caregivers in Rural and Urban Canada: Their Perspectives on Services for
People with Dementia
P. Hawranik, University of Manitoba; D. Forbes, University of Western Ontario; D. Morgan,
University of Saskatchewan; B. Leipert, University of Western Ontario; M. Morkle-Reid, S.
Henderson and D. Kingston, McMaster University; S. Peacock, University of Alberta; L.
Jansen, University of Western Ontario; and S. Normand, University of Saskatchewan.
Abstract
Limited research examines the differences in use and non-use of services between rural
and urban unpaid caregivers. It is known that there are unique challenges to accessing
services in rural areas and that there are distinct issues that influence the accessibility and
availability of services in rural compared to urban areas. However minimal information
exists on these differences from the perspective of the unpaid caregivers. A descriptive
interpretative study was conducted to identify the issues unpaid caregivers caring for
someone with dementia experience (N=39). Two focus groups, one with rural caregivers
and one with urban caregivers were held in each of the participating provinces of Ontario,
Manitoba, and Saskatchewan. Rural caregivers (n=13) spoke of challenges related to their
physical environment, the isolation and the limitations of home care services, as well as
their reluctance to request services and the lack of knowledge of formal service providers.
The urban caregivers (n=26) also expressed frustration with the lack of knowledge of formal
service providers and the policies/actions of the home care program. In contrast to the rural
caregivers, they spoke of feeling ‘lost’ after the diagnosis was made and the delay in
obtaining a diagnosis.
2. Challenges to Delivery of In-Home Services in Rural Manitoba
P. Hawranik, C. Lengyel, and P. St. John, University of Manitoba.
Abstract
Purpose/Objective: To describe the challenges/barriers to the planning and delivery of inhome services to older adults in rural Manitoba.
Method: The project consisted of two components: i) analysis of the regional reports of two
rural health regions on the health status of the population, current programs and the
identified needs of older adults; ii) two focus groups with 19 program managers who plan
and are responsible for the delivery of community services for older adults in the two
regions.
Results/Findings. Unique and common barriers/challenges to the delivery of in-home
services were identified by both regions in their community needs assessments. Access to
health services and transportation difficulties were described by both regions as important
concerns. Housing, rapidly increasing senior population, low incomes, and unpaid caregiver
stress were unique to each region. The focus groups revealed a number of common
challenges such as: limited human resources; limited other resources (supportive housing,
adequate means of communication); geography affecting disparity of resources within
regions; challenging working conditions; and unpaid caregiver support in jeopardy. A
number of challenges were identified that were unique to each region and included:
competing priorities; lack of resources leading to inappropriate use of other services;
expectations/demands that do not match with regional services/resources; and rapidly
increasing number of seniors. A number of strategies were described by each region to
address these challenges which included: take into own hands; partnerships; and go to
where the people are.
Conclusion: The regions responded to their challenges using strategies that were creative
and also unique to their region. The results of this phase of the project will determine the
next steps in the project and will be outlined.
3.
Mindreading Abilities in Healthy Elderly
Andrea S. Piotrowski and Lorna S. Jakobson, Department of Psychology, University of
Manitoba.
Abstract
Understanding mental states of others is integral to the establishment and maintenance of
positive relationships between individuals (e.g., patients and caregivers). The ability to make
inferences about the full range of mental states that cause action (beliefs, intentions, emotions,
etc.) requires that one have a “Theory of Mind” (ToM; Premak & Woodruff, 1978). Whether or
not this “mindreading” (mentalizing) ability is affected by healthy aging is not clear. In some
research (Happé et al., 1998) ToM abilities were actually found to improve with age; this result,
however, may have been related to participants’ level of education. After accounting for
differences in cognitive ability, Maylor et al. (2002) found significant age-related deficits in
performance on verbal and visual ToM tasks in individuals aged 75-89 compared to young
adults. Age-related deficits have also been described when participants have had to make
ToM judgments based on information provided in silent video clips (Slessor et al., 2007;
Sullivan & Ruffman, 2004). These stimuli require the analysis of nonverbal cues signalling
other people’s intentions, motivations, and beliefs that are present in natural social interactions
(e.g., changes in facial expression or body posture). In these videos, participants viewed clips
depicting common social situations and were asked to choose which of two presented words
best described what the actor in the clip was thinking or feeling. The researchers demonstrated
that young adults performed significantly better than healthy elderly even after controlling for
fluid and crystallized intelligence. It was suggested that the poor performance of the healthy
elderly participants in their study, however, appeared to reflect a general impairment in
decoding cues rather than a specific problem with ToM. In the current study, we examined the
impact of healthy aging on participants’ ToM abilities. Young adults (n=14) and healthy elderly
participants (n=14), matched in education level, Mini Mental State Examination scores, WAISIII Vocabulary (crystallized intelligence), and visual memory viewed silent video clips depicting
two or more people in a social situation and then answered questions designed to assess (a)
their visual memory, and (b) their ability to infer second-order false beliefs (a sophisticated
ToM skill). Young adults outperformed healthy elderly participants on this task, F(1,24) = 11.55,
p = .002, η2 = .325, even after controlling for group differences in performance on the Token
Test and in WAIS-III Digit Symbol-Coding (a measure of fluid intelligence and processing
speed that requires visual working memory). Possible reasons for this group difference are
discussed, along with suggestions for future research examining the effects of healthy and
pathological aging on mindreading skills.
4.
Effects of Ankle Power Training on Movement Time, Reaction Time, Strength and Power
in Older Women
Sandra Webber, Department of Physiology, University of Manitoba.
Abstract
Power declines earlier and to a greater extent than strength with age. Loss of muscle power is
associated with declining function in older adults. Longer reaction times, coupled with a
reduced ability to generate torque quickly, put older adults at risk in situations that demand fast
movements. The purpose of this study was to compare the effects of two ankle power training
programs (weight machines and bands) on movement time and secondarily, to look at the
effects on reaction time, strength, and power. Fifty women, (70-88 years) with self-identified
mobility limitations attended training sessions twice per week for 12 weeks after being
randomized into one of three groups (Weights, Bands, Control). Movement time improved in
the Weights group (14 ms faster, p = 0.04) and the Bands group (24 ms faster, p < 0.01). DF
strength and power improved in all groups, with the greatest change occurring in the Weights
group. Changes in PF strength and power were largely limited to the weight-trained subjects.
5.
Persistent Good Health as a Predictor of Later Self-Rated Health
Pascal Lambert, Madelyn Hall, & Barbara Payne, Faculty of Medicine, Department of
Community Health Sciences, University of Manitoba
Abstract
Self-ratings of health have been found to be a reliable predictor of both morbidity and mortality
in older adults. This study investigated “persistent good health” (PGH), defined here as the
same ‘good’ or ‘excellent’ self-rating of health over two or more consecutive interview waves of
the Aging in Manitoba study (AIM). The objective was to examine predictors of self-rated
health after controlling for PGH. A regression model included variables of function, health,
demographics, leisure activities and socioeconomic status from 3 waves of data (1990, 1996,
and 2001) from 582 older adults. A lagged variable of self-rated health was included to control
for PGH throughout all three waves. Results indicated that past self-rated health was highly
predictive of current self-rated health (OR = 2.39, p < .0001). In addition, good or excellent
self-rated health was predicted by factors such as having a lower number of chronic conditions
(OR = 2.70, p < .0001), greater functional health (OR = 1.57, p < .01; OR = 1.36, p < .05; for
ADL and IADL respectively), and participating in more leisure activities (OR = 1.76, p < .0001).
Implications for future research using PGH are discussed.
6.
Staying Well in Later Life: Patterns and Predictors of Persistent Good Health
Barbara Payne, Pascal Lambert, Madelyn Hall, Faculty of Medicine, Department of Community
Health Sciences, University of Manitoba.
Abstract
Persistent good health (PGH) is a label that has emerged from ongoing discussions and
workshops with colleagues, policy makers and the lay public in efforts to gain a better
understanding of what it means to ‘always be well’. Here we explore the prevalence and
predictors of the concept, persistent good health, defined as the same ‘good’ or ‘excellent’ selfrating of health over two or more consecutive interview waves of the Aging in Manitoba study
(AIM). AIM is a unique 30-year population based longitudinal study of aging. Only those
participants with complete data from 1983, 1990, and 1996 and 2001 waves were included in
these analyses (n=582). In total, 16 occurrences of PGH patters were identified and included
consistency of high ratings over two (8), three (3) or four (1) waves of data. Predictors of the
various patterns varied according to the pattern and time period examined. Future research
employing the PGH concept to predict self-reported successful aging, health services
utilization, homecare and nursing home use, and death, will be discussed along with the
applications of the measure in clinical settings.
7.
Relationship Between Socioeconomic Status and Psychotropic Drug Use Among the
Elderly: A Review of Literature
B. Songul, Department of Community Health Sciences, University of Manitoba; J. Mignone,
Department of Family Social Sciences, University of Manitoba; A.L. Kozyrskyj, Department of
Community Health Sciences, University of Manitoba.
Abstract
The purpose of this literature review was to provide an updated review of the empirical
evidence of the association between psychotropic drug use among the elderly and SES. Each
article was examined for its purpose, methods, measures of SES and medication employed,
findings, and limitations.
Most studies were conducted in community settings in Canada and the USA. There were
methodological differences among the reviewed studies such as sources of data, SES and
medications measures employed. High use of psychotropic drug among the elderly was
associated with certain SES characteristics in the majority of studies: female, white, low
education level, being widow in men and divorced in women, having been blue collar workers
before retirement, poor health perception and low income. Notwithstanding the above
mentioned evidence, some studies demonstrated there were no significant differences by
gender, marital status and education.
High psychotropic drug use among the elderly is not only influenced by symptoms but also by
low SES among the elderly population. Nonetheless, more research is needed to better
identify the relationship between SES and psychotropic drug use among the elderly.
8.
Differential Effects of Aging on a Visuomotor Paradigm
Lee A. Baugh and Jonathan J. Marotta, Perception and Action Lab, Department of Psychology,
University of Manitoba.
Abstract
Objectives. The present study describes the use of a viewing window paradigm to examine the
effects of aging in a complex visuomotor adaptation scenario. The natural process of aging has
been shown to have detrimental effects on the ability to synthesize cross-modal information (a
requirement in visuomotor transformations), but an in-depth examination using complex,
realistic, goal driven tasks has yet to be performed. Method. Two groups of participants, a
young adult control group (Age: 18-25) and an older adult group (Age: 60-80) completed a
viewing window task that was controlled by the user via a touch screen. Four visuomotor “flip”
conditions were created by varying the relationship between the participant’s movement, and
the resultant on-screen movement of the viewing window: 1) No flip 2) X-Axis and Y-Axis body
movements resulted in the opposite direction of movement of the viewing window. In each of
the 3) Flip-X and 4) Flip-Y conditions, the solitary X- or Y-axes were reversed. Response times
(ms) and movement of the window (represented by a series of x-axis and y-axis coordinates)
were recorded. Results. A significant main effect of aging was found (p < .05), with the older
participants requiring more scanning of the image than the younger control subjects to
correctly identify it. Additionally, a Flip by Age interaction effect was observed, with the older
participants demonstrating much higher scanning times during all of the visuomotor flip
conditions. Examining the complexity of scan-paths revealed the aged participants had
considerable difficulty in adapting to all of the flip conditions, and a tendency to revisit regions
of the image previously explored. Conclusions. The present study demonstrates that task
performance in viewing window paradigm decreases as part of the natural aging process. Not
only did our aged participants require significantly more time scanning the presented object to
identify it, but they also were differentially affected by the requirement of a visuomotor flip.
Qualitative examination of scan-path revealed the aged participants demonstrated a repetition
not seen in the younger controls. The results provide additional evidence that the mechanisms
involved in visuomotor transformation are negatively affected by age.
9.
Older Adults’ Helpseeking Attitudes and Treatment Beliefs Concerning Mental Health
Problems
Tiffany Scott, MA, Corey S. Mackenzie, PhD, Amber Mather, BA, Jitender Sareen, MD,
Department of Psychology, University of Manitoba.
Abstract
Objectives. Older adults with mental health problems are especially unlikely to seek
professional mental health services. It is not clear, however, whether their helpseeking
attitudes and treatment beliefs contribute to this problem. The objectives of this study were to
compare older adults’ attitudes and beliefs to younger adults’ and to examine the influence of
age on these variables after controlling for other demographic variables, prior helpseeking, and
mental disorders. Methods. We analyzed cross-sectional data from part II of the National
Comorbidity Survey Replication, consisting of 5,692 community-dwelling adults 18 years of
age and older. Participants responded to three questions assessing attitudes toward seeking
professional mental health services and one question examining beliefs about the percentage
of people with serious mental health concerns who benefit from professional help. We used
logistic regression to predict positive versus negative attitudes and beliefs from age, gender,
education, and race/ethnicity, as well as prior helpseeking and mood and/or anxiety disorder
diagnosis. Results. Overall, more than 80% of participants exhibited positive helpseeking
attitudes and more than 70% reported positive treatment beliefs. In contrast to the modest
effect of age on beliefs, adults 55 to 74 years of age were more than twice as likely to report
positive helpseeking attitudes as younger adults. Conclusion. Older adults’ positive attitudes
and treatment beliefs are unlikely barriers to their use of mental health services. This finding,
which is consistent with recent positive views of aging, suggests that enabling resources and
need factors are more likely explanations for older adults’ low rates of mental health service
use.
10.
The Personal Care Home Door Swings Both Ways: The Experience of Older Women
Whose Spouses are in Personal Care
Colette D. Pancoe, Faculty of Social Work, University of Manitoba.
Abstract
This research project is a work in progress intending to serve as partial requirement for a
Master’s Degree in Social Work. This exploratory research project aims to use a socialist
feminist theoretical basis and feminist narrative qualitative methodology based on semistructured one-on-one interviews. The central question to this research is: What are the
experiences of older women whose spouses have been admitted to a personal care home in
Winnipeg, Manitoba, in the past 1-9 months? The research objectives are: 1) to explore how
personal care home placement of husbands affects their wives’ formal support systems
consisting of the PCH, community-based health and social services, finances, banking,
housing and transportation. 2) to explore how personal care home placement of husbands
affects their wives’ informal support systems (consisting of the spousal relationship, other (nonspousal) family, friends and neighbours). 3) to explore the formal and informal support system
needs of older wives whose husbands have been placed in a personal care home. The
proposed research would begin to address a gap in the academic dialogue, as well as in policy
and in social work practice about how formal and informal support structures impact older
women whose spouses have relocated to a personal care facility.
11.
Seniors’ Contributions to Manitoba
Shari Fournier, Verena Menec, PhD, Centre on Aging, University of Manitoba.
Abstract
Seniors are often perceived as the recipients of services. The purpose of this study was to
determine seniors’ contributions across multiple domains, focusing specifically on seniors in
Manitoba. Data sources included: the National Survey of Giving, Volunteering and
Participating; the General Social Survey Cycle 17 – Social Engagement; and, the Survey of
Household Spending.
In 2001, there were 157,191 Manitobans aged 65 and over. Among other findings, the data
showed that 7% were actively employed, two thirds of whom worked full time. In 2000, 32%
spent nearly 8.8 million hours in volunteer activities, and 83% gave charitable donations
totalling nearly $67.5 million, which was more money per capita than any other age group in
the province. In 2003, 88% were politically active in some way including voting, attending
public meetings, signing petitions, and expressing views by contacting a newspaper or
politician. In that year, nearly one-fifth of Manitoba’s voters were seniors.
Our findings highlight the considerable contributions Manitoba seniors make. They spend
much time, effort and money improving their communities through volunteerism, charitable
giving, civic participation, political activism and unpaid care of others. They also contribute
much to the economy through living and personal expenditures and personal taxes.
12.
Comparing Perceptions of Elder Care Among Hospital Nurses In Three
Different Settings
Audrey Blandford, BA, Verena Menec, PhD, Jo-Ann McKenzie, MN, Centre on Aging,
University of Manitoba.
Abstract
The Geriatric Institutional Assessment Profile (GIAP) survey, administered in seven Winnipeg
hospitals as part of the Elder Friendly Hospital Initiative, assess a number of dimensions
relating to elder care. In this analysis, responses from nurses in three hospital settings,
geriatric (n=218), community (n=327), and teaching (n=504) were compared using one-way
analysis of variance. Specifically, group differences were examined in three areas: expertise
surrounding care of older adults, institutional commitment to geriatric care, and institutional
obstacles to geriatric care. Nurses in geriatric hospitals were significantly more likely than
nurses in both community and teaching hospitals to have higher ratings of expertise
surrounding the care of older adults. Nurses in geriatric hospitals were also significantly more
satisfied with their institution’s commitment to geriatric care than nurses in community and
teaching hospitals. There were no significant differences between nurses in community and
teaching hospitals in either of these two areas. Conversely, nurses in community hospitals
were significantly more likely to identify institutional obstacles that interfered with geriatric care
compared to nurses in geriatric and teaching hospitals. These findings will guide the hospital
settings in developing targeted strategies to improve these dimensions of elder care.
13.
Use of Delphi Technique to Determine Team Learning Needs
Jenneth Swinamer, MSA (Health), and Leah Weinberg, PhD, School of Medical Rehabilitation
(SMR), Department of Physical Therapy, University of Manitoba; Ruby Grymonpre, PhD,
Faculty of Pharmacy, University of Manitoba; Cornelia van Ineveld, MD, and Elizabeth
Boustcha, MD, Faculty of Medicine, University of Manitoba; Michelle Nelson, MA, Faculty of
Pharmacy, University of Manitoba; and (in alphabetical order) Ann Booth, MBA, SMR
Department of Occupational Therapy, University of Manitoba; Amy de Jaeger, BA, and Rachel
Ines, BA, Faculty of Pharmacy, University of Manitoba; Fiona Jensen, MSN, Faculty of Nursing,
University of Manitoba; and Theresa Sullivan, MA, SMR Department of Occupational Therapy,
University of Manitoba.
Abstract
In recent years a number of Canadian commissioned reports have identified the need to
educate health professionals, both pre-licensure and post-licensure, in teaming skills and
competencies and team effectiveness. These reports outline the need for interprofessional
education for collaborative patient-centred practice (IPECPCP) for health professionals to
prepare these individuals for high quality team delivery of health care. The Delphi method is an
iterative group process that allows individuals to make determinations about a future course of
action on a particular topic. At different times and locations, a group of health professionals
attending a national conference, and Geriatric day hospital clinical team members were polled
using a Delphi method to determine their potential IPECPCP learning needs. Results indicate
that assessment strategies need to consider geographical, experiential, and subjective factors
when using the Delphi method to assess IPE learning needs.
14.
Interprofessional Education (IPE) for Client-Centred Practice
Leah Weinberg, PhD, and Jenneth Swinamer, MSA (Health), School of Medical Rehabilitation
(SMR), Department of Physical Therapy, University of Manitoba; Ruby Grymonpre, PhD,
Faculty of Pharmacy, University of Manitoba; Cornelia van Ineveld, MD, and Elizabeth
Boustcha, MD, Faculty of Medicine, University of Manitoba; Michelle Nelson, MA, Faculty of
Pharmacy, University of Manitoba; and (in alphabetical order) Ann Booth, MBA, SMR
Department of Occupational Therapy, University of Manitoba; Amy de Jaeger, BA, and Rachel
Ines, BA, Faculty of Pharmacy, University of Manitoba; Fiona Jensen, MSN, Faculty of Nursing,
University of Manitoba; and Theresa Sullivan, MA, SMR Department of Occupational Therapy.
Abstract
Interprofessional education prepares clinicians to develop skills and competencies for high
functioning teams. The Delphi method is an effective tool used to identify learning needs of
clinicians for developing teaming skills and competencies. Potential barriers and facilitators
that may affect use of the Delphi method, along with several approaches to addressing
clinician learning needs and lessons learned are presented.
15.
Marital Status, Partner Satisfaction and Depressive Symptoms in Older Men and Women
Philip St. John, PhD, Faculty of Medicine, University of Manitoba.
Abstract
Background: Being married has been purported to have health benefits, including a lower risk
of depression. However, the effect may be different in men than in women, and the effect may
depend upon martial satisfaction. Objectives: To determine if marital status is associated with
depressive symptoms in men and in women, and to determine if partner satisfaction is
associated with depressive symptoms. Setting: The Canadian province of Manitoba.
Population: 1751 community-dwelling adults age 65+. Measures: Age, gender, education and
martial status were self-reported. Satisfaction with living partner was assessed with an item
from the terrible-delightful scale. The Centre for Epidemiologic Studies - Depression (CES-D)
was used to assess depressive symptoms, with a score of 15+ considered depressive
symptoms. Results: Only 3% of the sample was dissatisfied with their partner and those who
were dissatisfied with their living partner had higher levels of depressive symptoms.
Proportions of men with depressive symptoms were: 20.6% for never married; 19.2% for
separated/divorced; 17.3% for widowed; 7.3% for married (satisfied); and 38.1% for married
(dissatisfied) (p < .05, chi-square test). In women the results were different: 11.8% for never
married; 23.1% for separated/divorced; 15.4% for widowed; 14.4% for married (satisfied); and
41.9% for married (dissatisfied) (p < .05, chi-square test). In logistic regression models, a
significant interaction term was seen for marital status*gender. In stratified models, adjusting
for age and education, the effect of marital status on depression was seen in men, but not in
women. Conclusions: The effect of marriage on mood in men and women may be different,
with lower levels of depressive symptoms in married men vs. unmarried men, but higher or
similar rates in married women vs. unmarried women. Dissatisfaction with living partner was
uncommon but highly associated with depressive symptoms. Future studies on the effect of
gender and marital status should consider interaction effects.
16.
Exploring Strategies to Reduce a Person’s Risk of Adverse Events When Transitioning
Between Day Hospital and Community Based Care: The Stakeholders Perspective
C. van Ineveld, Faculty of Medicine, University of Manitoba (U of M); M. Nelson, Faculty of
Pharmacy, U of M; E. Boustcha, Section of Geriatric Medicine, U of M; G. Trinidad, Winnipeg
Regional Health Authority; D. Dyck, Geriatric Program Assessment Team; L. Thompson,
Manitoba Institute for Patient Safety; L. Smyrski, Provincial Patient Safety, Manitoba Health; A.
Katz, Department of Community Health Sciences, Faculty of Medicine, U of M; R. Grymonpre,
Faculty of Pharmacy, U of M.
Abstract
Introduction: Studies have identified that persons discharged from geriatric day hospitals are at
high risk for functional decline. Currently, there is a paucity of literature outlining best practices
at the time of discharge from day hospitals. This project is based at four geriatric day hospitals
in Winnipeg and sets out to examine the communication flow between day hospitals and
community at time of discharge and strengths and weaknesses of the current discharge
process. This three phase project begins with a series of stakeholder interviews, followed by
chart reviews and then multi-disciplinary strategizing. The goal is to develop consistent
processes across the region and identify strategies to reduce risk for adverse events for frail
community dwelling seniors.
Methods: The fist phase of the project consisted of focus groups and interviews with key
stakeholders: Day Hospital clinicians, geriatricians, discharged patients, caregivers of
discharged patients, Home Care coordinators, Geriatric Program Assessment Team clinicians,
family physicians, community pharmacists, Day Hospital administrators and policymakers.
Qualitative methods were used to analyze focus group and interview content.
Results: Participants identified processes that worked well in addition to a broad range of
concerns. Common themes will be presented.
Conclusion: Understanding the issues in the current discharge process in day hospitals as
identified by key stakeholders is vital to developing recommendations for improvement.