Objective The objective of this project was to examine factors reported to affect changes in antipsychotic medication prescription and use in long-term care during the COVID-19 pandemic.Design Qualitative descriptive study.Setting Continuing care (CC) facilities in Alberta, Canada.Participants Participants were staff from CC who had worked during the pandemic, recruited from homes stratified by change in antipsychotic usage (decreased use, no change or increased use based on the Canadian Institute of Health Information (CIHI) quality indicator for potentially inappropriate antipsychotic medication use). Virtual interviews were conducted using a semi-structured guide. Data were inductively coded then mapped into the components of the Capability, Opportunity, Motivation—Behaviour system, which served as our lens to understand the factors influencing change in medication use over the pandemic.Results 44 staff members participated. Half worked at sites that experienced change in antipsychotic medication use. Many factors affected medication use. Primary motivations driving use included the need for staff to protect themselves and residents and increased staff stress. Opportunities to appropriately use antipsychotics were affected by policies requiring physical and social isolation and use of personal protective equipment. However, respondents demonstrated their capability of enacting appropriate use when describing their perspectives toward these medications.Conclusion Staff attempted to provide quality care to residents aligned with antipsychotic medication guidelines while simultaneously complying with the restrictions and policies imposed during the COVID-19 pandemic. These findings highlight the factors influencing antipsychotic medication use among CC residents during the pandemic and may inform future planning or outbreak responses.

BACKGROUND:Urinary incontinence (UI) is common in older adults. The construct of intrinsic capacity (IC) provides a multidimensional framework to assess functional reserves. This cross-sectional study examined the association between IC and UI in community-dwelling octogenarians from the Ageing and Longevity in the Sirente (ilSIRENTE) study. METHODS:IC was computed as the mean of standardized (0-100) scores across five domains (locomotion, cognition, vitality, psychological well-being, and sensory function) derived from Minimum Data Set for Home Care (MDS-HC) instruments and supplementary tests. UI was defined as a score of 3 or more on MDS-HC item I1. Associations between IC and UI were examined using logistic regression models adjusted for sociodemographic and clinical covariates. Restricted cubic splines tested linearity. RESULTS:Among 320 participants (median age 83.9 years [81.7-88.5]; 67.2% women), 35 (10.9%) had UI. Incontinent individuals had a lower total IC score (60.2 [51.5-69.7] vs. 85.2 [76.1-92.7]; p < 0.001) and lower scores in the locomotion, cognition, vitality, psychological well-being, and sensory domains. In fully adjusted models, higher IC score was associated with lower odds of UI (per 10-point increase: OR 0.34, 95% CI 0.24-0.48). High IC score was associated with markedly lower odds of UI compared with low IC score (OR 0.07, 95% CI 0.02-0.20). Restricted cubic spline analyses supported linearity (p for non-linearity = 0.701). CONCLUSIONS:Lower IC scores were associated with higher odds of UI, particularly in locomotion, cognition, vitality, and sensory domains. These findings support UI as a marker of multidimensional vulnerability and highlight the value of IC-oriented assessment to guide multidomain interventions in geriatric care.

OBJECTIVES:Human papillomavirus (HPV) is a common sexually transmitted infection linked to several cancers, including cervical cancer, which ranks fourth in cancer incidence and mortality among women globally. Despite its significance, awareness of HPV and the HPV vaccine remains limited across many populations. This project assessed HPV and HPV vaccine awareness among Indigenous adults in Northwest Territories communities in Canada and explored factors influencing HPV vaccine utilization; such data have never been available or explored. METHODS:Using a community-based participatory research approach, quantitative and qualitative data were collected in 11 Indigenous communities in Northwest Territories. Indigenous adults aged 18 years and older were invited to complete a semi-structured questionnaire administered by trained local research assistants. Multiple logistic regression was used to examine potential associations among age, gender, education, and awareness of HPV and the HPV vaccine. A thematic analysis of qualitative data explored reasons for non-vaccination. RESULTS:Among the 221 participants (66.5% women; mean age 43.6 years (±13.9)), approximately half had heard of HPV, and fewer than one-third had heard of the HPV vaccine. Education emerged as a key factor, with individuals with lower educational attainment being significantly less aware of HPV (p < .000). Age (p < .033), gender (p < .019), and education (p < .004) predicted vaccine awareness, with women, individuals with higher education, and younger adults being more likely to have heard about the vaccine. Only 26.3% of participants aged up to 26 years had received the HPV vaccine. Qualitative data revealed that limited awareness and insufficient information about HPV and the vaccine are the main barriers to vaccination. Participants recommended enhancing vaccine promotion by raising awareness about the connection between HPV and cancer, as well as increasing educational efforts in schools and communities. CONCLUSIONS:Limited awareness of the HPV vaccine may contribute to low vaccination rates. Tailored and targeted interventions are crucial to increasing HPV vaccine utilization in Indigenous communities in Northwest Territories.

Urinary incontinence (UI) is defined as involuntary urine leakage. It is a rarely reported common condition that adversely affects quality of life because many consider it a normal part of aging. UI continues to be stigmatizing. This study’s aim was to conduct a systematic review of existing literature on the prevalence and impact of UI in Canadians (≥16 years) and perform a meta-analysis on the prevalence of UI in Canada. A systematic electronic literature search of PubMed/Medline, EMBASE, CINAHAL, Cochrane, ISI Web of Knowledge, and Scopus databases from January 1980 to April 2024 was completed. Papers published on the prevalence and impact of UI were selected. We conducted meta-analysis using random-effects models and pooled prevalence of UI based on study setting, sex, and age. Quantitative studies were examined for internal validity, generalizability, reliability, and objectivity, and qualitative studies for credibility, transferability, confirmability, and dependability. Out of 1089 titles, 34 were included: 16 prevalence, 10 impact, and eight addressing both the prevalence and impact. UI was more prevalent in women than men (meta-analysis: 34%; 95% CI: 25%–44% vs. 19%; 95% CI: 7%–31%; p < 0.001). Women were reluctant to seek medical help and suffered symptoms longer than men. Overall, the prevalence increased with age, reaching as high as 52% among women 85+ years. UI affected individuals socially, emotionally, physically, and financially. Included papers did not consider differences in prevalence or impact across ethnic, cultural, or socioeconomic groups. Increased awareness of management and treatment will improve quality of life.

Background Improving global maternal health is a key goal within the United Nations’ Sustainable Development Goals. In Northwest Territories, Indigenous mothers face significant disparities in maternal healthcare, with higher risks of maternal mortality and healthcare access challenges. Objective To explore Indigenous mothers’ perspectives on opportunities to improve maternal healthcare services in Northwest Territories, Canada, using qualitative data from the Maternal and Infant Health study. Design Qualitative design. Methods Self-identifying Indigenous women of childbearing age (17-49 years) who were pregnant at the time of the interview or had given birth within the last three years were invited to participate. A culturally appropriate, interviewer-administered, semi-structured questionnaire was utilized for quantitative and qualitative data collection. Qualitative data were analyzed using reflexive thematic analysis. Results In total, 156 Indigenous women participated (mean age =29.7 years, SD=6; age range 17-47 years). 93% gave birth in the past three years, and 18% were pregnant. Three themes emerged regarding areas in which to improve maternal healthcare: experiences and challenges with service delivery, support networks, including more connections with Elders, and cultural sensitivity. Specifically, participants reported a preference for childbirth to take place within home communities, aided by midwives and family members and utilizing Indigenous maternal care practices. Participants also voiced the necessity of increasing the provision of mental healthcare, postpartum care, and support group services that incorporate traditional local languages. Conclusion To improve maternal healthcare services within Indigenous communities, building trusting relationships with healthcare professionals that honour Indigenous practices, improving healthcare accessibility, and increasing the delivery of local healthcare services and support are of priority. This paper contributes to the sparse literature currently available, providing Indigenous-informed evidence to guide the conceptualization, practice, and policy of maternal healthcare in Northwest Territories.

Leadership is a critical lever for supporting implementation of practice change ideas intended to improve care. We need evidence-based leadership programmes to help front-line providers meaningfully implement practice change in complex care settings. Part of the SHIFT intervention, this paper describes the development of a leadership programme module (LeaderSHIFT) that provides training and implementation coaching to front-line leaders, as one of several integrated facilitated supports designed to help front-line care teams meaningfully enact practice change. The LeaderSHIFT programme module was developed based on empirical work, relevant facilitation and transformational leadership theories, and principles of co-design and feasible engagement. Early feasibility work, examining several of Proctor’s (2011) implementation outcomes, was conducted to address uncertainties pertaining to intervention acceptability and implementability. LeaderSHIFT includes four interactive workshops plus two one-on-one coaching sessions designed to develop capacity in four areas of implementation leadership: (1) Self-awareness, (2) Motivate and inspire, (3) Facilitate learning capacity, and (4) Support “team-oriented processes”. Feasibility work suggests it can be successfully implemented (it was acceptable, adopted, appropriate, feasible). Fidelity (LeaderSHIFT role enactment) varied across teams. With a strong theoretical and empirical base, LeaderSHIFT highlights important, often overlooked, relational and socio-cultural aspects of successful implementation leadership. As such, the LeaderSHIFT program module has the potential to improve implementation of practice change interventions in nursing homes and other institutional care settings.

Objectives This scoping review examined the question: What community-integrated activities are undertaken in long-term care (LTC) residential homes for older adults? Design Scoping review following the Joanna Briggs Institute method and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist. Setting and Participants LTC settings for older adults, aged 65 years and above. Methods Peer-reviewed English studies on community-integrated activities in LTC were included. Studies involving clinical or therapeutic interventions, mixed-care settings, populations under 65, broad commentary without specific activities, or reviews were excluded. A health sciences librarian assisted with a comprehensive search of MEDLINE, Embase, Scopus, PsycINFO, and SocINDEX. Screening and data extraction were conducted using Covidence. Data extracted included study title, authors (year), country, study design (methods), purpose, participants (sample size), community-integrated activity, duration, outcomes, and author recommendations. Data were analyzed using descriptive statistics and narrative summaries. Results After duplicate removal, 5604 studies were screened, and 46 were included. The number of publications notably increased within the past 5 years. There was a wide diversity in the types of community-integrated activities, including intergenerational activities (n = 25), volunteering (n = 10), on-site services and shared spaces (n = 4), and those involving animals (n = 3). Activity duration varied from permanent, cyclical, or transient. Overarching themes across outcomes included (1) psychosocial and emotional well-being, (2) social connection and belonging, (3) reciprocal intergenerational and community benefits, and (4) structural and implementation factors. Conclusions and Implications Overall, community-integrated activities represent a promising approach to supporting ongoing social connection for older adults in LTC homes. Planning for participant diversity and developing sustainable community partnerships may improve their impact. Policy support for stable funding and clear standards, together with future research examining the feasibility and outcomes of long-term programs, is needed to improve quality of life for older adults in LTC.

IntroductionFailty refers to a state of vulnerability to stressors caused by declines in physiological reserve across multiple systems and is associated with adverse health outcomes. Despite its established importance in medical specialties, frailty assessment remains inconsistently implemented in urology. The aim of this review was to provide an overview of the concept of frailty and summarise the current evidence regarding its relevance to urological practice.MethodsA narrative literature review was performed using PubMed/MEDLINE and Google Scholar. Articles relating to frailty, geriatric and perioperative care, surgical outcomes, and urology were identified and reviewed. Findings were synthesised to provide a clinical overview relevant to healthcare professionals working in urological settings.ResultsFrailty is common among older adults and is increasingly recognised as a marker of vulnerability beyond chronological age alone. Multiple validated assessment tools are available, including the Clinical Frailty Scale and Frailty Index, although no single instrument has demonstrated clear superiority. Existing evidence suggests that frailty is associated with higher rates of postoperative complications, mortality, prolonged hospitalisation, and increased healthcare utilisation in urological patients. Studies further indicate that comprehensive geriatric assessment may identify potentially modifiable risk factors and support frailty-informed care pathways. While most published data relate to elective uro-oncological surgery, emerging evidence from acute urology suggests that integration of geriatric services may improve outcomes such as length of stay and hospital readmission.ConclusionsFrailty is highly relevant to contemporary urological practice and appears to be a stronger predictor of adverse outcomes than chronological age alone. Routine frailty assessment using simple validated tools may enhance risk stratification, perioperative planning, and shared decision-making. Wider implementation of frailty-informed care pathways and greater incorporation of frailty measures into urological research should be prioritised as the population ages.

Objectives To assess the state of the research literature addressing what is known about the quality of continence care from the perspective of older adults in long-term care or in receipt of home care.Design Scoping review of the literature according to the Joanna Briggs Institute method, reported according to Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. Participant: older adults (>65 years of age), either in receipt of home health or social care services or older adult residents of long-term care (nursing homes). Concept: older adult perspectives on quality of continence care (access, care to meet needs, continuity, goals, expectations, delivery, experiences, personalised care, partnerships in care, well-being and social support). Context: older adults in long-term care or in receipt of home care.Results We identified 14 articles from the academic literature. Sources originated from the USA (7), Australia (4), Canada (2) and 1 from Italy. Long-term care residents were the focus of 12 of the articles. Older adults reported limited access and information regarding continence care and services and variable abilities of care staff to deliver care. Older adults wanted to be actively involved in decisions about their care, preserve their autonomy and independence and wanted care to enhance their well-being.Conclusions Studies examining the perspectives of older adults regarding the quality of their continence care are few. Older adults value person-centredness, expert advice regarding their condition, allowing preservation of self-determination and independence where possible. Older people value meaningful relationships with empathetic care providers. There remains a need for education of care providers in continence care and for policies and practices to support continence in a dignity-preserving framework.Registration Open Science Framework (https://osf.io/bprq9/).

Objective To gain an understanding of the daily experience of urinary incontinence (UI), its management and impact on community-dwelling people who live with dementia (PLWD) and their care partners (CP). Methods Qualitative description design. Participants comprised community dwelling PLWD, with moderate or severe UI, and their CP (a spouse or family member residing with the PLWD). Dyads took part in interviews using a semi-structured interview guide. Data were analyzed using a content analysis approach. Results Eight dyads, all married couples, were interviewed. Content analysis resulted in 5 themes: What brings it on, Trying to manage, Asking for help, Relationship changes, and Shared burdens. For PLWD and their CP, UI was associated with relationship changes and burdens. Although some dyads found effective UI management strategies, others did not and felt this was due to shortcomings of the healthcare system. Conclusion “In this exploratory study of community-dwelling couples, dementia-related incontinence was experienced as unpredictable, jointly managed through trial-and-error, and a source of both relational strain and shared commitment. Findings underscore the need for dyad-focused, person centered dementia-specific continence support that is practical, coordinated, and mindful of care partner burden”

Overactive bladder (OAB) is a commonly occurring condition in older adults that has significant consequences on health and quality of life. In later life, many older adults also live with frailty, a condition characterized by vulnerability to insult and associated with a lesser probability of a full recovery. Frail older adults comprise a distinct group of older adults, often living with complex comorbid disease. There is a bidirectional relationship between frailty and OAB, though causation has not been established. β3-Adrenoreceptor agonists like mirabegron offer a pharmacological alternative over antimuscarinics, which may be associated with intolerable side effects in older patients. While mirabegron has demonstrated efficacy and tolerability in community-dwelling older adults, prospective studies on its use in frail older adults remain limited. Here, we review available evidence on use of mirabegron in older adults and frail older adults, including safety, tolerability and efficacy. Evidence suggests that mirabegron has favourable safety and side effect profiles, decreases OAB symptoms, and improves quality of life. Mirabegron remains an acceptable alternative to antimuscarinic treatment in older adults and frail older adults.

Background:The motivations and attitudes of caregivers strongly influence the care they provide. Motivation is also a central component in staff retention and care consistency, whereas attitude shapes delivery and degree of person-centeredness in care. Although caregiver attitudes and motivations have been examined separately in dementia care research, these constructs have not been comprehensively mapped together within residential memory care settings or explicitly linked to care quality. Objective:This review aims to assess literature pertaining to attitudes and motivations of formal caregivers in residential dementia care facilities and to examine how these constructs are associated with care quality. This review seeks to generate practical insights to inform workforce training and recruitment strategies to support high-quality, person-centered dementia care. Inclusion Criteria:Literature focused on the attitudes and motivations of formally employed caregivers providing care to residents in a residential memory care setting. Studies published of any design, from any year, country, or language will be considered. Method:This scoping review will follow the Joanna Briggs Institute (JBI) method. A comprehensive search will be conducted across major health, social science, and interdisciplinary databases, along with grey literature sources. Data will be extracted according to a JBI template informed by three theoretical frameworks: the Tripartite Model of Attitudes, the Empathy-Altruism Hypothesis, and Person-Centered Care. Results will be reported in accordance with the PRISMA-ScR guidelines. Registration:Open Science Framework https://osf.io/8yrge.

Background and Objective Urinary incontinence (UI) is common in women. For up to 77%, the use of absorbent continence products (pads) is central to management. Pad changes are common and reasons for change are not fully described. We hypothesized that women change their pads for many reasons other than wetness and at saturation levels well below advertised capacity.Methods A sample of 11 community dwelling women aged 65-95 (mean 78.1, SD 8.2) years was included. Participants completed a bespoke questionnaire on satisfaction with their current pads; UI severity and quality of life were measured. Participant's pad use and degree of saturation was recorded. Women then participated in a qualitative interview exploring their pad choices and use.Results The sample median ICIQ-SF score was 16/21 (IQR 10-17). Median satisfaction of pad use score was 9/20 (IQR 8-12). Median ICIQ LUTS QoL score was 62/76 (IQR 55-67). The median number of pads used per day was 2.3 (IQR 1-4) The median saturation at pad change was 9.5% (IQR 7-19). Qualitative analysis resulted in 43 codes categorized into 7 categories and collapsed into 3 themes "Product factors," "Lifestyle," and "UI and other health factors."Conclusion Women appear to "overuse" absorbent products and change them for diverse reasons, often simply to fit in with their daily routine. Individualized education and support in usage would be beneficial.

Background: The development and distribution of COVID-19 vaccines were crucial during the pandemic; however, adverse events can affect public perception and vaccine utilization. This project explored COVID-19 vaccine adverse events among Indigenous communities in Northwest Territories, Canada, where overcrowding, limited healthcare access, and historical disparities increase disease risk. Methods: This cross-sectional study surveyed Indigenous adults (18+) in Northwest Territories using intervieweradministered questionnaires. Phase one (Apr-Nov 2021) in ten communities examined adverse events after the first COVID-19 vaccine dose. Phase two (Aug 2022-Jan 2023) in eleven communities assessed adverse events after doses two to five. Results: In phase one (n = 93) and phase two (n = 190), most participants were women (62.4% and 67.9%), with mean ages of 41.6 years (+/- 12.1) and 43.7 years (+/- 14.2), respectively. Adverse events were most frequent after the first dose (97.9%) and declined with subsequent doses (p < .001). Injection site pain/swelling was most common. Severe symptoms after dose one included chills (64.3%), muscle pain (56.9%), and fatigue (51.3%). Fatigue was more frequent in women than men (50.9% vs. 23.5%, p = .04). Younger adults reported higher rates of pain (p = .003), chills (p = .01), headache (p = .02), and fever (p = .003) than adults over 50. Conclusions: Adverse events decreased with each additional dose and were generally mild to moderate after the first dose. Communicating the mild nature of side effects and the protection vaccines offer against severe illness may help increase uptake. Higher rates among younger individuals and women highlight the need for targeted public health messaging and supportive strategies.

Vaccine hesitancy is a persistent global health challenge. This project explored attitudes towards and utilization of COVID-19 vaccination, as well as suggestions to improve utilization within Indigenous communities in Northwest Territories, Canada. Utilizing a cross-sectional design, this project spanned two phases: 10 communities in Phase 1 (April to November 2021), and 11 in Phase 2 (August 2022-January 2023). Self-identifying Indigenous adults (≥18 years) were invited. Quantitative and qualitative data were collected via a semi-structured interviewer-administered questionnaire. In Phase 1 (n = 124; mean age = 41.6 years; 63.7% women) and Phase 2 (n = 221; mean age = 43.6 years; 66.21% women), 78.2% and 87.2% of participants had received at least one dose, respectively. In Phase 1, 67.2% reported not being concerned about the vaccine, and 61.2% believed the benefits outweighed the risks. In Phase 2, 56.2% of participants agreed all eligible individuals should be vaccinated, and 59.2% agreed the vaccine prevented serious outcomes. Bivariate analyses revealed that negative attitudes towards COVID-19 severity, vaccine safety, and effectiveness were significantly associated with lower intention to receive a COVID-19 vaccine in the future. Qualitative insights revealed factors of vaccination hesitancy, including: concerns about safety, efficacy, and necessity; a need for information; and distrust in government. Reasons for utilization included: trust in vaccine safety; perceived necessity; and employment and travel requirements. COVID-19 vaccine utilization in Indigenous communities is high, yet hesitancy persists due to safety and efficacy concerns, and distrust in government. Culturally safe strategies, improved communication, and equitable access are essential to sustaining confidence and future pandemic preparedness.

Older people are the fastest-growing segment of the population in all developed countries, and in part due to this trend, nursing homes (NHs) are now reserved for people with extensive comorbid physical, cognitive, and social needs. While the challenges related to NH care are well known, strategies are needed to more effectively bridge the transactional gap between what we know from research and what we do in practice. This protocol paper describes how we designed, implemented, and evaluated an innovation called SHIFT (Supporting Healthcare Improvement through Facilitated Training) that helps front-line NH providers incorporate formal quality improvement techniques (e.g., Plan-Do-Study-Act, PDSA cycles) into their everyday care routines. Our goal was to understand how providers received this facilitated support and implemented their quality improvement ideas, assess their ability to use more structured care improvement processes, examine the facilitators and barriers to their success, and describe how SHIFT impacted resident quality of care and staff-related outcomes. SHIFT is a sequential mixed-methods clinical trial guided by key implementation science frameworks and lessons learned from the Translating Research in Elder Care (TREC) research program. It consists of a core module based on the Institute for Healthcare Improvement (IHI) Breakthrough Series framework (e.g., learning congresses interspersed with action periods, various forms of facilitation). From TREC learnings, we added to this core module (i) readiness-for-change activities to help identify suitable intervention environments and team members with requisite skills, and (ii) a leadership program that provides person-level coaching to boost internal facilitation. SHIFT and its components were examined using a suite of quantitative (e.g., team member surveys) and qualitative (e.g., focus groups, quality advisor field notes, research observations) data. Our primary goal was to assess implementation strategies and secondarily measure intervention effectiveness. Ten NH sites involving 65 team members have participated in SHIFT. Recruitment occurred in February 2024, and the study concluded in July 2024. As of January 2026, all data have been analyzed, and four manuscripts are in preparation that discuss participant perspectives on (i) SHIFT team implementation and intervention effectiveness, (ii) the value of R4C and leadership activities and how they impacted innovation success, (iii) challenges teams encountered specific to SHIFT fidelity, and (iv) future innovation directions based on participant input (e.g., creating more targeted quality advisor training sessions, increasing the number of these sessions with fewer cross-team learning congress workshops). SHIFT investigates strategies that help NH front-line care teams embed, with support, quality improvement methodology into their daily care routines. This innovation is positioned as the first in a series of iterative collaborations that aim to achieve this goal while balancing best evidence with the everyday complexities of NH care. ClinicalTrials.gov NCT06106087; https://clinicaltrials.gov/study/NCT06106087

Introduction Pelvic organ prolapse is a common condition and many women seek surgical treatment for prolapse symptoms. However, recurrence of prolapse after surgical treatment is common. A think tank was held at ICI-RS 2025 to discuss how the assessment and indifferent results from conservative and surgical management can be improved.Methods Data were collected and presented on identification of women at risk of prolapse recurrence after surgery, understanding patient goals and expectations, optimising lifestyle interventions, pelvic floor muscle training, pessary management, and surgical care. Discussions identified knowledge gaps and proposed research studies that could advance knowledge to improve treatment outcomes.Results There is insufficient information to understand the assessment of prolapse treatment outcomes; examination findings do not necessarily correlate with symptoms. Further research is needed to understand if patient-reported goal attainment is superior to patient-reported outcome measures, including measures of patient satisfaction. There is insufficient information on the value of lifestyle adjustments and pelvic floor muscle training as prehabilitation to improve surgical outcomes. The place of pessary management in an optimally integrated prolapse treatment pathway is unclear and the role that pessaries may have in anatomical modelling of prolapse is not fully understood. Further research into adjuncts to improve native tissue repair as alternatives to polypropylene mesh is needed to optimise surgical outcome.Conclusion Further research into understanding what represents treatment, cure, and optimising conservative and surgical treatments is of high priority to improve pelvic organ prolapse treatment outcomes. The utility of preoperative rehabilitation requires investigation. Developing an optimised pessary care pathway and continued surgical innovation are required to ensure progress in reducing prolapse symptom recurrence.

Readiness for change (R4C) is an important antecedent of care practice change and is linked to a range of implementation and effectiveness outcomes. We describe the creation, piloting, and evaluation of R4C activities intended to help nursing home (NH) teams implement a quality improvement intervention. We developed and operationalized an R4C module with activities conducted with NH leaders during intervention recruitment. An implementation pilot was conducted in three NHs and evaluated using a mixed-methods process evaluation guided by Proctor’s (2011) implementation outcomes framework. R4C activities were feasible, acceptable, and delivered with fidelity. The approach promoted readiness among senior leaders, but not among front-line teams. Results also showed (1) R4C activities are closely tied to other variables (e.g. NH leadership facilitation) that influence implementation, and (2) core R4C components (i.e. change efficacy) can emerge during an intervention, pending teams’ perceived success. We suggest conducting R4C activities with all of those involved across an organization who have a role to play in change implementation. Findings also reveal challenges associated with isolating the effects of “pre-intervention” R4C activities on intervention implementation and success. Pilot results will inform a larger-scale quality improvement study.

Purpose Despite progress towards Universal Health Coverage (UHC) in high-income countries, people experiencing socioeconomic disadvantages often struggle to access healthcare services not covered by public health insurance. This study explores the factors contributing to financial barriers to healthcare access (FBHA) among socioeconomically disadvantaged individuals in Edmonton, Canada.Design/methodology/approach Employing a convergent parallel mixed-method cross-sectional design, the study collected both quantitative and qualitative data through an interviewer-administered questionnaire. Logistic regression was used to examine associations between socioeconomic indicators and FBHA, while qualitative data were analyzed using inductive qualitative content analysis.Findings Among the 392 participants, 62.50% were women, 39.03% experienced housing instability, 49.49% reported health conditions, and 38.78% encountered FBHA for services not covered by public health insurance. Having additional health insurance (OR = 0.40, 95% CI: 0.24-0.65) and housing stability (OR = 0.46, 95% CI: 0.27-0.78) were associated with lower odds of FBHA; however, experiencing food insecurity was associated with greater odds (OR = 3.85, 95% CI: 1.66-8.93). Participants reported numerous health needs remaining unaddressed due to prohibitive costs, including dental and vision care, mental health services, prescription medications, and other essential services.Originality/value This study offers original contributions by focussing on individuals excluded from healthcare due to financial barriers, an often-overlooked group in healthcare access research, and by clarifying where such barriers may persist despite UHC. To substantiate this focus, the study integrates quantitative estimates with community-informed evidence and specifies how food insecurity, housing instability, and limited additional insurance converge to sustain unmet needs. The findings suggest that more inclusive policies and targeted interventions might be warranted.

BACKGROUNDS:Urinary incontinence (UI) is increasingly prevalent, particularly in older adults. UI management is frequently under-resourced and is associated with the development of potentially avoidable complications, placing a significant burden on the patient and on the healthcare system. This study aimed to estimate the cost of UI-related complications in Canada. METHODS:We conducted a comprehensive literature review using PubMed, Canadian Institute for Health Information (CIHI) data and citation mining to identify the prevalence of UI, UI-related complications, and associated treatment costs across each of acute care, long-term care (LTC), homecare and self/family care. UI-related complications quantified included: urinary tract infections (UTI), catheter-associated UTI, incontinence-associated dermatitis (IAD), UI-related pressure ulcers (PU), slips and falls, and fall-related injuries. The total economic burden to the Canadian healthcare system was estimated using UI prevalence, complication rates, and costs of treating complications in each setting. RESULTS:The estimated number of older Canadians with UI totaled 2,338,503 with an annual economic burden of UI-related complications up to $1,654,875,326. Acute care had the highest cost (up to $1,190,494,315), driven by skin-related complications (up to $525,692,182 for PU and $471,461,636 for IAD). Fall-related injuries, followed by UTIs, imposed the highest cost in LTC, homecare and self/family care, totaling up to $309,141,175 and $126,305,519, respectively. LTC had the lowest overall complication burden (up to $49,408,153), roughly one-third the cost in homecare, and one-fifth the cost in self/family care. CONCLUSIONS:UI and its associated complications represent a substantial economic burden to the Canadian healthcare system. This underscores the need for improved UI management strategies to contain associated costs.