Aging in Rural Canada: A Retrospective and Review

A qualitative RE-AIM evaluation of an embedded community paramedicine program in an Ontario Family Health Team

BACKGROUND

In 2014, a rural Family Health Team (FHT) in Ontario, Canada embedded a community paramedicine program into their primary care practice to improve care for their complex patients. Community paramedics are health care professionals who extend their role beyond emergency services to provide primary care in home and community settings. The study aims to evaluate the utility of having community paramedics embedded in a rural FHT.

METHODS

In this qualitative study, we conducted 12 semi-structured interviews with the community paramedicine team (n=4) and other staff from the FHT (n=8), including physicians, nurse practitioners, allied health professionals (AHPs), and the program director. We conducted a deductive and thematic analysis using the RE-AIM framework. This allowed us to examine the strengths and challenges of incorporating community paramedics in a primary care model for providers and coordinating patient care in a rural setting.

RESULTS

Reach: The community paramedicine program is primarily used by physicians to target older patients with multiple chronic conditions, frequent health care use, and limited social support.

EFFECTIVENESS

In-home visits by community paramedics yield a detailed picture of patients' health-related behaviours, such as medication adherence and dietary habits, improving the FHT's understanding of patient needs and informing care strategies. Adoption: Community paramedics value the opportunity to build long-lasting patient relationships.

IMPLEMENTATION

The FHT's rural location is a significant external barrier limiting the paramedic program's ability to serve a larger patient caseload. Maintenance: The program aligns with the FHT's mission to improve access to care for vulnerable patients.

CONCLUSIONS

Our findings highlight community paramedics' role in supporting high-needs patients, particularly in rural settings. The average age of patients in the program is 78, and they often have multiple comorbidities, including prevalent dementia. Such health conditions necessitate home visits to gather accurate health information often masked in clinic settings. Embedding community paramedics in a primary care model improves access to care and provides more support for patients with complex needs. Using these findings, we developed a "how to" blueprint for embedding community paramedics in primary care settings to address the care needs of high-risk older adults.

CLINICAL TRIAL NUMBER

Not applicable.

How Community-Based Health and Social Care Professionals Support Unpaid Caregivers: Experiences From One Health Authority in Ontario, Canada

In Ontario, Canada, rising rates of caregiver distress have been the 'canary in the coal mine' for a health system out of balance with the needs of an ageing population. Community-based health and social care professionals are well placed to play an important role in the caregiver support process; however, a gap has remained in the understanding of if and how caregiver support strategies are operationalized or experienced by community service providers (CSPs). The goal of this study was to describe how CSPs interpreted policy and how those interpretations may enable their work in supporting unpaid caregivers. Using a qualitative constructionist design, we interviewed 24 participants and reviewed 92 publicly available documents. Braun and Clarke's method of thematic analysis was used for analysis strategy. Four overarching themes were identified: (1) community care as a priority, (2) sidewalk accountability, (3) creative care planning through partnerships, and (4) challenges to care delivery. We found that the importance of caregivers to the health system was reflected in organizational policy and strategy. There is an opportunity to improve health outcome for caregivers and the population alike through strong leadership and a clear shared vision. Our findings also suggested that social capital was a significant factor in enabling providers in their work, leveraging long-standing relationships, and accumulated local knowledge to implement highly creative care plans.

Mitigating Caregiver Distress in South Western Ontario: Perspectives on Role, Community, and Care

The former South West Local Health Integration Network (SW LHIN) of Ontario, which is in a predominantly rural region, regularly reports the lowest rates of caregiver distress in the province. Caregivers from rural communities regularly face challenges related to the access, applicability, and availability of supports and services, This qualitative case study describes perspectives of caregiving from the region, and explores how role construction and expectations of caregivers might both mitigate distress and influence service support use. Thematic analysis identified five themes: anticipated care, gendered caring, service support assumptions, confidence in community, and the "line in the sand": care decisions for evolving needs. Using the lens of caregiver identity theory, the findings suggest that these caregivers conceptualize identity as an extension of their primary role, to include caregiving obligations and responsibilities. We also noted a steadfast confidence in community and perceived service support assumptions across the region, with no notable rural-urban divide.

Physical Activity and Social Interaction among Rural Older Adults in Saskatchewan during COVID-19

Physical activity and social interaction among rural older adults are important, particularly during the COVID-19 pandemic when restrictions on physical gatherings were placed. The purpose of this qualitative study was to gain a deeper understanding of rural older adults' experience with physical activity and social interaction during the COVID-19 pandemic. An interpretative phenomenological approach was used to explore the experience of 10 older adults, 67-82 years of age, from rural communities throughout Saskatchewan. Findings revealed that many rural older adults acknowledged the health benefits of physical and social activities and experienced loneliness when COVID-19 restrictions were placed, even when living with a partner. For some, the restrictions placed on physical and social activity provided a welcome break from daily responsibilities. Rural communities, often at a disadvantage, were also perceived by participants as being protected against COVID-19. The resilience demonstrated among rural participants to persevere and adapt to their changing environment during the pandemic was evident in the findings.

Physical Activity Among Older Women Living in Rural Areas in Canada: A Scoping Review

Although there is strong evidence linking physical activity in older age with wellbeing and health benefits, these relationships tend to be under-researched in a rural context. A scoping review was conducted to identify what is known about physical activity among older women living in rural Canada. The search strategy was intentionally broad, with eight databases, academic journals, and websites scanned for research and grey literature related to Canada, in English, from 2000 to 2022. 33 studies, reviews, and reports were included in the final selection. These articles indicate that physical activity among older women living in rural Canada is influenced by a multitude of layers, contexts, conditions, and environments, with outcomes dependent on a mixture of personal, relational, community, societal, and governmental factors. In general, the women are committed to creating and maintaining an active lifestyle, and supporting their local rural community to enable these activities. While the social environment can proscribe physical activity through ageist attitudes and restrictive socio-cultural norms, social support from family and community members mitigates against these constraints. Rural infrastructure, geography, climate (seasons and weather), as well as transportation and policy issues may also impede the physical activity opportunities of the women. Some of the problems related to sustaining and resourcing recreational activity in rural communities are partly addressed through the implications presented in the articles. Among others, these suggestions relate to leadership and learning opportunities, public engagement, and the partnership working involved in supporting physical activity in rural areas. However, further research is long overdue.

Functional status in rural and urban adults: The Canadian Longitudinal Study on Aging

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.

Rural Family Caregiving: A Closer Look at the Impacts of Health, Care Work, Financial Distress, and Social Loneliness on Anxiety

Even before the COVID-19 pandemic, earlier acute care patient discharges, restricted admissions to long-term care, and reduced home care services increased the amount and complexity of family caregivers’ care work. However, much less is known about rural caregivers’ experiences. Thus, our aim in this sequential mixed-methods study was to understand how COVID-19 affected rural family caregivers. Thematically analyzed interviews and linear regression on survey data were used to understand family caregiver stress. Fourteen rural caregivers participated in interviews. They acknowledged that they benefitted from the circle of support in rural communities; however, they all reported having to cope with fewer healthcare and social services. 126 rural caregivers participated in the online survey. About a third (31%) of these caregivers had moderate frailty, indicating that they could benefit from support to improve their health. In linear regression, frailty, social loneliness, financial hardship, and younger age were associated with caregiver anxiety. Contrary to the qualitative reports that people in rural communities are supportive, over two-thirds of the rural caregivers completing the survey were socially lonely. Rural family caregivers are vulnerable to anxiety and social loneliness due to the nature of caregiving and the lack of healthcare and social service supports in rural areas. Primary healthcare and home care teams are well-positioned to assess caregivers’ health and care situation as well as to signpost them to needed supports that are available in their areas.

Rural older adults' resilience in the context of COVID-19

Public health and media discourses have often portrayed older adults as a vulnerable group during the COVID-19 pandemic. Yet, some emerging research is showing that older adults are faring better in terms of their mental health when compared to their younger counterparts. Understanding older adults' mental well-being during the pandemic requires in-depth exploration of the different place-based resources and systems around them. In particular, rural older adults face distinct challenges and opportunities related to accessing valued resources to promote their well-being. Drawing together research on aging and multi-systemic resilience, we explored what strategies, resources, and processes rural older adults valued in the initial stages of the COVID-19 pandemic. A series of 51 semi-structured telephone interviews were conducted from May to August 2020 with 26 rural older adults in Manitoba, Canada. Despite adversities, participants drew on and developed resources at the individual, local, community, institutional, and societal level to support their well-being. Specifically, they identified individual strategies (e.g., positivity, acceptance, and gratitude), resources in their immediate environments (e.g., opportunities to keep busy, connect with friends, family and neighbours, and outdoor visits), and community organizations that contributed to their well-being. They also identified broader systems that shaped their resilience processes, such as access to health services, opportunities to volunteer and support others, media stories, reliable information, and public health policies and practices that value older adult lives. Importantly, some resources were less accessible to some participants, highlighting the need to develop strategies that address inequitable resources at different levels. By describing rural older adults’ resilience we seek to advance the growing body of research in relation to social ecological resilience that moves beyond a focus on individual characteristics to include understanding of the role of material, social, and cultural contexts.

Social Interaction and Physical Activity Among Rural Older Adults: A Scoping Review

Social interaction and physical activity are critical components in supporting health among older adults, yet rates of activity are low in rural communities. There is significant merit in exploring the relationship between these interrelated concepts. A scoping review was conducted to synthesize existing literature. Search results identified 26 studies meeting inclusion criteria. Findings indicated that social interaction and physical activity were important for many older adults to maintain health; however, not all older adults preferred the social aspect of group-based exercise. Opportunities for physical activity and social interaction were limited based on geographical location and other socioeconomic factors. This was evident in rural communities where populations were lower and education and income levels varied. Differences on the defining role and meaning of physical activity also emerged. Increasing physical activity and social interaction must account for negative associations to address the lower rates of participation among rural older adults.

Rural Aging during COVID-19: A Case Study of Older Voluntarism

During large-scale crises such as the COVID-19 pandemic, the precarity of older people and older volunteers can become exacerbated, especially in under-serviced rural regions and small towns. To understand how the pandemic has affected “older voluntarism”, this article presents a case study of three volunteer-based programs in rural Ontario, Canada. Interviews with 34 volunteers and administrators reveal both challenging and growth-oriented experiences of volunteers and the programs during the first wave of COVID-19. The findings demonstrate the vulnerability and resiliency of older volunteers and the adaptability and uncertainty of programs that rely on older voluntarism, as the community and its older residents navigate pandemic-related changes. The article advances a framework for understanding the pandemic’s impacts on older voluntarism in relation to personal, program, and community dimensions of sustainable rural aging. Further, it explores ways that older volunteers, organizations that depend on them, and communities experiencing population aging can persevere post-pandemic.

Importance of collaboration and contextual factors in the development and implementation of social participation initiatives for older adults living in rural areas

INTRODUCTION

To encourage isolated and vulnerable older adults to accomplish meaningful social activities, occupational therapists and other healthcare workers must collaborate with community organisations and municipalities to develop and implement initiatives fostering social participation. In a rural Regional County Municipality in Quebec (Canada), four social participation initiatives were selected and implemented: (1) Benevolent Community, (2) urban transportation system, (3) creation of a website on social participation activities, and (4) social participation workshop. Little is known about contextual factors such as the structures and organisations, stakeholders, and physical environment that influence the development and implementation of such initiatives.

METHODS

Led by an academic occupational therapist, an action research to implement social participation initiatives was initiated by community stakeholders. The 26 stakeholders were involved in a Management and Partnership Committee, two focus groups and an interview with a trainer, which documented and analysed contextual factors and the implementation process.

FINDINGS AND DISCUSSION

Development and implementation were facilitated by stakeholder collaboration, mission of the community organisations, and stakeholders' shared desire to reduce older adults' isolation and vulnerability. The established partnerships and predefined orientations as well as the leadership, motivation, and professional skills of the stakeholders also fostered the initiatives. Among the challenges encountered, the stakeholders' limited involvement in implementation tasks was attributable to important changes in the key stakeholders' organisations and structures and the number of organisations involved. Difficulty reaching a consensus resulting from the different attitudes, vision, and understanding of the stakeholders delayed the development and implementation of some initiatives. Despite regular meetings between stakeholders, geographic distance limited spontaneous exchanges.

CONCLUSION

This action research highlighted the importance of collaboration and contextual factors in developing and implementing social participation initiatives with community organisations and municipalities.

Conversations in Times of Isolation: Exploring Rural-Dwelling Older Adults' Experiences of Isolation and Loneliness during the COVID-19 Pandemic in Manitoba, Canada

Older adults have been described as a vulnerable group in the current context of the COVID-19 pandemic. In Canada, where this study took place, older adults have been encouraged to self-isolate while the rest of the population has been cautioned against in-person contact with them. Prior to COVID-19, social isolation and loneliness among older adults was considered a serious public health concern. Using a series of semi-structured interviews with 26 community-dwelling older adults (65+) living in rural Manitoba, we explore older adults' experiences of isolation and loneliness in the initial stages of the pandemic between the months of May and July 2020. Participants identified a loss of autonomy, loss of activities and social spaces (e.g., having coffee or eating out, volunteering, and going to church), and lack of meaningful connection at home as factors influencing their sense of isolation and loneliness. Although these loses initially influenced participants' self-reported isolation and loneliness, the majority developed strategies to mitigate isolation and loneliness, such as drawing on past experiences of isolation, engaging in physically distanced visits, connecting remotely, and "keeping busy." Our findings call attention to the role of different environments and resources in supporting older adults social and emotional wellbeing, particularly as they adapt to changes in social contact over time.

Exploring Daily Activity Patterns on the Typical Day of Older Adults for Supporting Aging-in-Place in China's Rural Environment

Severe aging in rural China is prompting communities to promote support for older people to age in place. The study of the daily life of older adults in rural areas is conducive to understanding their real life and demands, as well as the way they interact with their environment, to develop feasible strategies. In this study, 171 older adults over 60 years old in two different types of villages in Northern Zhejiang Province were investigated and analyzed in terms of the temporal and spatial features of daily activities, as well as their relationship with population attributes, personal competence, and subjective demands. The results show that: (1) significant association can be seen between working hours and the demand for health services, housework hours and gender and age, as well as leisure hours and ADL and the demand for recreational services. (2) The older adults appear to have inter-group homogeneity in some aspects: basic living activities, leisure hours, the gender difference in housework hours, and recreational preference, while they have higher average paid work hours and fewer leisure alternatives than their urban counterparts. Their definitions of paid work, housework, and leisure activities are vague. (3) The definition of home by the older adults in rural places sometimes seems to go beyond the scope of their own house, and the extensive definition of home may change their recognitions of some activities. They also inclined to assign meaning to a place through frequent use rather than through external definitions. (4) The weak consciousness on buying services and deteriorated financial situation hinders the older adults in rural communities from expressing their real demands. Unspoken demands include economic security, recreational choices, and assistance in housework. The results will help to provide references for the improvement of eldercare services and the community environment.

Exploring rural older adult perspectives on the scope, reach and sustainability of age-friendly programs

Research into the sustainability of age-friendly initiatives is important and timely, particularly from the rather neglected perspective of older adults living in non-metropolitan (rural) environments. This paper addresses this gap by reporting on a Canadian rural community case study to understand the perspectives of older adults on the implementation and sustainability of their local age-friendly program. Findings from exploratory interviews with 10 older adults suggest that rural age-friendly initiatives may be limited in their ability to achieve larger-scale outcomes aimed at addressing broad aging issues facing rural communities. Further, our findings demonstrate that those 'aging in place' may continue to do so with the support of age-friendly programing, while those 'stuck in place' are largely unaffected by age-friendly programs. We advocate for additional in-depth examinations of rural age-friendly sustainability, including a greater emphasis on the diversity of older adult perspectives.

Emerging evolution trends of studies on age-friendly cities and communities: a scientometric review

Population ageing, together with urbanisation, has become one of the greatest challenges throughout the world in the 21st century. Approximately one million people turn 60 each month worldwide. By 2050, more than 20 per cent of the global population is predicted to be 60 years old or above. Thus, an increasing need is evident for age-friendly communities, services and structures. Numerous studies on age-friendly cities and communities (AFCCs) have been conducted over the past decade. The large volume literature makes it necessary to figure out key areas and the evolution trends of studies on AFCCs. Therefore, this paper aims to provide a comprehensive review of existing literature pertaining to AFCCs. A total of 231 collected publications are analysed and visualised by CiteSpace. According to the keywords and document co-citation networks that are generated, the foundation, hot topics and domains of AFCC research are grouped. Three major themes, namely the characteristics of AFCCs, the application of the World Health Organization's framework in urban and rural areas worldwide, and the measurement of cities’ and communities’ age-friendliness, are identified. In addition, a roadmap of AFCC research is developed. The results of this research will therefore benefit researchers and practitioners.

A relational ethic of rural home support on two Gulf Island communities, 1978-2018

Since their widespread establishment in the 1970s, home support services across Canada have been subject to shifting state logics, policies, and funding models. The impacts and responses of local actors differ across historical, socio-cultural, and geographical settings. This paper traces the development and evolution of a small home support society on two rural islands off the coast of British Columbia, Canada. Using historical and current data sources, we demonstrate that local actors have consistently engaged a relational ethic that challenges neo-liberal discourses and practices. Our central thesis is that the islands' distinct social, cultural, and rural features set the context for particular constructions of relational care. We identify three themes central to a relational ethic of home support on two rural islands: the strength of intergenerational connections, community-embedded relationships, and care as compassionate civic engagement. Within each theme, we consider how shifting policy structures inform changes over time in the nature and delivery of home support. To conclude, we elaborate on the conditions that allow for relational care to flourish in a particular rural context, and on the potential relevance to other settings.

Rural gerontological health: Emergent questions for research, policy and practice

This article explores what can be learned from the evolution of rural gerontology as a field of study to inform a more critical approach to the health of rural older adults. To counter the prevailing essentialism of highlighting the rural health disparities faced by older adults, there is a need to expand rural gerontological health research beyond deficit and medicalized understandings of health in rural communities. We argue that appreciating the interplay between unique health experiences, the complexity of the rural context and the continuum of older adult care is an important next step to foster advances in the field. Emergent questions for research, policy and practice are discussed and new directions for rural gerontological health are proposed.

Leveraging a contextually sensitive approach to rural geriatric interprofessional education

Interprofessional Education (IPE) has been recognized on an international and national level as an effective method of preparing health professionals for practice while also improving health system outcomes. In particular, recent research highlights that geriatric IPE initiatives can be mutually beneficial both to learners and older adults in rural communities. Despite this trend, IPE initiatives continue to produce mixed results. Although some scholars have acknowledged that IPE initiatives need to consider the complexity of healthcare contexts, there is a dearth of research that considers the diversity of rural communities or rural older adult health. This paper proposes that leveraging contextually sensitive rural gerontological health research marks a next step in IPE development.

Older Adults' Views on the Repositioning of Primary and Community Care

Older adults are rarely consulted on health care restructuring. To address this gap, our study explored older adults' views on "repositioning", a restructuring initiative to support independent living for older adults with complex chronic disease (CCD). We collected and analysed data from 83 older adults living in one small city and nine rural small towns where "repositioning" of primary and community care was occurring. Average participant age was 75 years; 56 (67%) were women, 44 (53%) had CCD, and 20 (24%) identified as Indigenous or South Asian. The four themes were: unfamiliarity with repositioning; optimism versus skepticism; improving primary and community care (through better home care, improved transportation, and more doctors); and, playing an active role to effect change. For repositioning to be successful, diverse service users must be fully included; rural-dwelling older adults' priorities for primary and community care need to be addressed, rather than using a "cookie-cutter" approach.

Older Immigrants' Access to Primary Health Care in Canada: A Scoping Review

ABSTRACTAging and immigration have significantly shaped the population composition in Canada, where immigrants make up increasingly large proportions of the older adult population. This scoping review examines the existing knowledge surrounding older immigrants' access to, and utilization of, primary care physicians, who play a pivotal role in the delivery of primary care, preventive care, and mental health care. We applied Arksey and O'Malley's five-stage framework to search databases for Canadian-based, peer-reviewed English-language articles on the topic and examined 31 articles in detail. Three focus areas emerged: access and utilization of primary care, health promotion and cancer screening, and utilization of mental health services. Older immigrants face intertwining access barriers related to health literacy, language, culture, health beliefs, spatial inequality, and structural circumstances. The review provides a thorough understanding of the status of access to care among older immigrants in Canada, and yields policy implications to address their unmet health needs.

Collaborative Approaches to Team-Based Primary Health Care for Individuals with Dementia in Rural/Remote Settings

ABSTRACTApplying primary health care (PHC) team-based approaches to diagnosing and treating dementia is considered best practice. Unfortunately, those living in rural and remote areas often have limited access to dementia-specific PHC services. The purpose of this scoping review was to identify and understand PHC team-based approaches for dementia care in rural settings. A search strategy was employed which included only peer-reviewed journal articles that were published from 1997 to 2017. Four databases (Embase, Medline, PsycInfo, and CINAHL) were searched from March 2017 to May 2017. Among the 10 studies included there was a variation in the degree of collaboration and interaction among the care teams. Limited information existed about collaboration strategies among care teams. An adaptation of the socio-ecological model enabled us to categorize key factors influencing collaborative team-based approaches. Combined, these findings can be used to inform both future research and the development of a rural PHC dementia model.

Improving social inclusion for people with dementia and carers through sharing dance: a qualitative sequential continuum of care pilot study protocol

INTRODUCTION

This study examines the potential of dance to improve social inclusion for people living with dementia and carers. Research suggests that arts-based programmes can improve the health of people living with dementia and carers; however, little is known about how these programmes might address barriers to social inclusion. Addressing barriers requires the development and evaluation of accessible, non-stigmatising and affordable programmes that facilitate social inclusion across the continuum of institutional, community and household care settings.

METHODS AND ANALYSIS

The study involves a qualitative sequential pilot study of the innovative Baycrest NBS Sharing Dance Seniors programme underway in non-metropolitan regions of two Canadian provinces. It focuses on the remotely instructed delivery of the programme in care facilities, community centres and households. The study involves five phases of observations, diaries, focus groups and interviews with programme participants (people living with dementia), carers, coordinators, instructors and volunteers as well as critical reflections among research investigators and knowledge users. NVivo-based thematic and narrative analyses of the qualitative data will produce new knowledge about the experiences, effectiveness and challenges of the dance programme that will inform understanding of whether and in what ways it increases social inclusion and quality of life for older people living with dementia and carers. The findings will identify opportunities for programme expansion and support the further development of arts-based approaches.

ETHICS AND DISSEMINATION

The study is approved by the Research Ethics Boards at Trent University and Brandon University, and by participating organisations according to their governance procedures. The perspectives of people living with dementia and carers are incorporated throughout the study (from design to dissemination) and the study adheres to the ethical considerations when including people with dementia. A series of publicly available reports, seminars and symposia will be undertaken in collaboration with knowledge user and collaborating organisation partners.

We Are Caregivers: Social Identity Is Associated with Lower Perceived Stress among Rural Informal Caregivers

ABSTRACTInformal caregivers often experience high stress levels with little support, especially in rural settings. With a mixed-methods approach, this research explored experiences of rural informal caregivers, including how social identification as a caregiver, social interactions, and formal and informal coping support related to perceived stress. Major focus group themes (n = 8) included lacking available services, balancing challenges, unmet practical needs, and strong community identity. Survey data (n = 22) revealed that perceived coping support (e.g., having someone to turn to), social interactions, and caregiver identity (e.g., perceiving the role as important to one's self-concept) were associated with lower life upset stress, but only caregiver identity was associated with managing the personal distress and negative feelings associated with caregiving stress. Results suggest that, although available rural services may fall short, other options might alleviate caregiver stress, including facilitating access to coping support, encouraging social interactions, and enhancing caregiver social identity.

A Scoping Review: Social Participation as a Cornerstone of Successful Aging in Place among Rural Older Adults

Despite obstacles, many rural-dwelling older adults report that positive aspects of rural residence, such as attachment to community, social participation, and familiarity, create a sense of belonging that far outweighs the negative. By being part of a community where they are known and they know people, rural elders continue to find meaning, the key to achieving successful aging in this last stage of life. This scoping review explored factors influencing social participation and, through it, successful aging among rural-dwelling older adults. We sought to answer the question: what factors enhance or detract from the ability of rural-dwelling older adults to engage in social participation in rural communities? The scoping review resulted in 19 articles that highlight the importance of supports to enable older people to spend time with others, including their pets, engage in volunteer and community activities, and help maintain their home and care for their pets. Overall, the lack of services, including local health care facilities, was less important than the attachment to place and social capital associated with aging in place.

Social Isolation in Later Life: Extending the Conversation

Avec le vieillissement de la population canadienne, l’isolement social des personnes âgées constitue une préoccupation croissante et une priorité d’action au niveau national. Bien que les risques individuels de l’isolement social des personnes âgées et les conséquences négatives sur leur santé soient relativement bien connus, les impacts des trajectoires de vie et des expériences collectives sont rarement considérés. Les définitions actuelles et les réponses à cet isolement social se basent sur des programmes qui tendent à privilégier les approches individuelles. Ici nous proposons que la discussion soit élargie afin de considérer les aspects sociaux et culturels de l’isolement social des personnes âgées. En particulier, nous suggérons que les définitions et les approches prennent en compte trois dimensions : les facteurs temporels, les facteurs spatiaux et les liens entre l’isolement social et l’exclusion. Ainsi, nous pensons qu’il serait possible d’élaborer une approche d’intervention plus inclusive face à l’isolement social des personnes âgées, et de développer les capacités en ce sens chez un plus grand nombre d’aînés, en vue de pouvoir répondre, en particulier, aux besoins des personnes âgées les plus vulnérables ou marginalisées.

A far greater sense of community: The impact of volunteer behaviour on the wellness of rural older Australians

This paper builds on place-based research investigating the transformative potential of volunteering for service-deprived, ageing rural communities. Here, we critically explore the relationship between communities of place, voluntarism and wellness for rural older Australians. We draw on data from a large qualitative multi-site study, and utilise Ryan et al.'s (2005) systemic model of community attachment. Findings support the dual perspective of strong community sentiments through social embeddedness in rural communities; and personal interests, associated with rational choice theory, through healthy ageing practices. Both aspects have demonstrated positive impact on wellness, but also risks to wellness associated with over-expectations of volunteers.

An integrative review of the factors related to building age-friendly rural communities

AIM AND OBJECTIVES

To identify the theories and concepts related to building age-friendly rural communities.

BACKGROUND

Global population is rapidly ageing. Creating environments that support active ageing was a catalyst for the World Health Organization to develop Global Age-Friendly Cities guidelines. Although the age-friendly movement has captured the attention of some countries, little is known about the participation of older people in rural settings.

METHOD

An integrative review approach was employed to summarise the research literature on this topic. Using a systematic search strategy, databases including Discover (EBSCO's electronic database system), Web of Science, Scopus, PubMed, CINAHL, PsycINFO, Medline and Google Scholar were searched. Primary, peer-reviewed studies were included if published during 2007-2014 in the English language.

RESULTS

Nine studies were eligible for inclusion. The studies were set predominantly in Canada, with the exception of one from Ireland. The findings were summarised and clustered into main topics which included: theoretical perspectives; geographic and demographic characteristics; collaboration and partnerships; sustainability and capacity; and finally, future research agendas.

CONCLUSIONS

Rural communities are changing rapidly and are becoming increasingly diverse environments. Community characteristics can help or hinder age-friendliness. Importantly, the fundamental starting point for age-friendly initiatives is establishing older peoples' perceptions of their own communities.

RELEVANCE TO CLINICAL PRACTICE

It is important for nurses, working in primary health care settings, to understand the needs of older people in the communities in which they practice. This includes the community characteristics that can be enablers and barriers to older people being able to remain and age within their own communities.

Developing Navigation Competencies to Care for Older Rural Adults with Advanced Illness

Navigators help rural older adults with advanced illness and their families connect to needed resources, information, and people to improve their quality of life. This article describes the process used to engage experts - in rural aging, rural palliative care, and navigation - as well as rural community stakeholders to develop a conceptual definition of navigation and delineate navigation competencies for the care of this population. A discussion paper on the important considerations for navigation in this population was developed followed by a four-phased Delphi process with 30 expert panel members. Study results culminated in five general navigation competencies for health care providers caring for older rural persons and their families at end of life: provide patient/family screening; advocate for the patient/family; facilitate community connections; coordinate access to services and resources; and promote active engagement. Specific competencies were also developed. These competencies provide the foundation for research and curriculum development in navigation.

Connecting Socially Isolated Older Rural Adults with Older Volunteers through Expressive Arts

Utilisant une approche participative basée sur la recherche dans le domaine des arts, nous avons examiné un programme novateur de l’Ontario rural, Canada, conçu pour répondre à l’isolement social chez les personnes âgées. Les personnes âgées qui étaient socialement isolées ont été jumelées à des bénévoles formés; en dyades, les huit paires ont créées de l’art expressif chez elles au cours des dix visites à domicile. Utilisant une enquête thematique et narrative, nous avons analysé les expériences et les perceptions du programme du chef, des participants plus âgés, et des bénévoles plus âgés à travers leurs créations artistiques, les journaux hebdomadaires, les évaluations et le carnet d’opérations.

Les résultats révèlent une intervention réussie qui influencent positivement le bien-être des participants plus âgés et les bénévoles plus âgés, en particulier en ce qui concerne les relations, le développement personnel, et en la création du sens, ainsi que l’extension de l’impact de l’intervention au-delà de la durée du programme. Nous discutons aussi possibilités pour des programmes similaires pour la politique et permet des services sociaux positifs à l'isolement rural basés dans les communautés.

A Review of Mental Health Approaches for Rural Communities: Complexities and Opportunities in the Canadian Context

Three mental health approaches with potential relevance to rural Canada were reviewed: telepsychiatry, integrated mental health models, and community-based approaches. These approaches have been evaluated in relation to their cost-effectiveness, comprehensiveness, client-centredness, cultural appropriateness, acceptability, feasibility and fidelity; criteria that may vary amidst rural contexts. Collaborative approaches to care, technologies fully integrated into local health systems, multi-sectoral capacity-building, and further engagement with informal social support networks may be particularly promising strategies in rural communities. More research is required to determine rural mental health pathways among diverse social groups, and further, to establish the acceptability of novel approaches in mental health.

Physical Activity Perceptions and Influences among Older Adults in Rural Nova Scotia

This study identified factors that influenced physical activity (PA) participation among older adults from rural settings in Nova Scotia Canada and explored how the rural context may influence PA participation and promotion. Data were collected via individual semistructured interviews with 20 older adults (Mage = 77.5 years) from rural areas of Cape Breton and subjected to thematic analysis procedures (Braun & Clarke, 2006). Four themes representing factors that influence the prioritization of PA were identified: (1) historical context of activity, work, and productivity; (2) already busy with day-to-day activities; (3) being/staying on the go; and (4) cautionary approach. These findings suggest that PA promotion should be contextually salient, and highlight the need for a shared understanding between rural older adults and PA promoters regarding what constitutes being "physically active". Effective promotion of PA among rural older adults may require a shift away from contemporary methods of PA promotion.

Migration and Regional Differences in Access to Local Family Networks Among 60-year olds in Sweden

Regional variations in access to local family networks has implications for future care burdens in different regions as well as the living conditions for both older and younger generations. The geographical distance between family members is a long-term consequence of accumulated migration and non-migration undertaken by the individual as well as other family members. This study contributes to this subject through offering a description of regional disparities in the access to local family networks among 60-year olds in Sweden. Additionally, this paper aims to analyse this pattern as an outcome of long-distance migration processes. The empirical study is based on Swedish register data, with a focus on 60-year olds in Sweden, linking them to their adult children, siblings and parents as well as in-laws. The dataset includes total population, where it is possible to identify family networks in their geographical context on various geographic scales, down to a neighbourhood level. As expected, results indicate that families in metropolitan areas are the most concentrated geographically while the left behind parent, embedded in a local network in their own and older generation, is a small category in urban areas but quite common in some rural municipalities. It is also shown that access to local family networks not only varies on a broad rural–urban scale but also locally, between neighbourhoods within metropolitan areas.

Determinants of Loneliness among Older Adults in Canada

The purpose of this study was to determine the key determinants of loneliness of older Canadians. We drew on the assumptions concerning the importance of person-environment fit to test the relative importance of personal characteristics, deprived living conditions, social network/social engagement, and satisfaction in explaining loneliness. Data comprised a sample of 3,799 respondents over age 65 drawn from Statistics Canada's General Social Survey, Cycle 22. Personal characteristics, social network size and composition, and satisfaction with network contact were found to be related to loneliness, as were indicators of living in economically and socially challenging conditions. Older adults who had experienced a recent downturn in their financial situation, and who lacked the help needed to cope with a recent personal challenge, reported higher levels of loneliness. A striking feature of our findings is the relatively low scores on loneliness of older Canadians compared to older adults in other countries.

Living Alone During Cancer Treatment: An Exploration of Patients' Experiences

The social environment is an important determinant in the overall experience of having cancer. The purpose of this article is to identify how patients experience living alone during their cancer treatment. Using qualitative methods based on grounded theory techniques, we interviewed a sample of 32 cancer patients. Living alone was an ambiguous experience during cancer treatment: patients experienced both a lack of support as well a gain in privacy, freedom, and know-how. Living alone was also seen as a constitutive element of the patients' identity. Consequently, patients saw living alone as either a threat or as a resource for their adjustment to cancer treatment. These divergent meanings of living alone did share one common attribute, which was that staying independent was their key goal during cancer treatment. Health care providers should be attentive to the heterogeneous aspects of the experience of living alone when critically appraising the independence of patients.

Age-Friendly Rural Communities: Conceptualizing ‘Best-Fit’

La littérature sur les communautés amies des aînés est axé principalement sur un modèle de vieillissement en un milieu urbain, en omettant ainsi de refléter la diversité des communautés rurales. Dans cet article, nous abordons cette lacune en se concentrant sur la notion de la communauté dans un contexte rural et en demandant ce qui crée une bonne adaptation entre les personnes âgées et leur environnement. Cela se fait grace à (1) comptes autobiographiques et biographiqus de deux environnements géographiques très différents de subsistence: les communautés bucoliques et contournées, et à (b) l’analyse des besoins et des ressources différents des deux groupes de personnes: les personnes âgées marginalisées et actives qui vivent dans ces deux communautés rurales différentes. Nous affirmons que la définition originale de 2007 de l’Organisation mondiale de la Santé (OMS), de “amie des aînés” doit être repensée pour tenir compte des besoins et ressources explicitement différents de la communauté, pour être plus inclusive ainsi que plus interactive et dynamique en intégrant les changements qui sont survenus au fil du temps chez les personnes et les lieux.

"Any movement at all is exercise": a focused ethnography of rural community-dwelling older adults' perceptions and experiences of exercise as self-care

PURPOSE

To understand rural community-dwelling older adult participants' shared values, beliefs, and behaviours related to exercise as self-care.

METHODS

We conducted a constructivist-focused ethnography involving semi-structured interviews and participant observation with 17 individuals 65 years and older. Interviews were transcribed and inductively coded to develop themes related to exercise, self-care, and exercise as self-care. Field notes were triangulated with follow-up interviews and dialogue between authors to enhance interpretation.

RESULTS

Participants described exercise broadly as movement and not as a central self-care behaviour. However, awareness of the importance and health-related benefits of exercise increased after a significant personal health-related event. Participants preferred exercise that was enjoyable and previously experienced.

CONCLUSIONS

Prescribing exercise for older adults may be particularly effective if the focus is on enjoyable and previously experienced physical activity and if it incorporates interpretation of exercise guidelines and training principles in relation to chronic conditions and potential health benefits.

Unequal social engagement for older adults: constraints on choice

Although some studies have confirmed positive associations between social engagement and well-being in later life, this study aimed to understand why some seniors cannot be engaged. The authors analyzed the lived experiences of 89 seniors in three rural communities in Canada, from semi-structured interviews and using the constant comparison method. Five factors make choices for social engagement in later life unequal among older adults who differ by gender, class, age, and health status. Profound engagement in care work, compulsory altruism, personal resources, objectively perceived and subjectively available engagement opportunities, and ageist barriers around paid work constrain choices for seniors who lack privilege in the context of a market economy, particularly for low-income older women. To avoid stigmatizing vulnerable older persons, societal barriers to meaningful activities must be addressed - for example, through provision of income security or by reversing inter- and intragenerational ageism in access to the labor market.