Health professionals and care partners of persons living with dementia have expressed that learning needs related to dementia care are a priority. There are currently a variety of training programs available in Ontario (Canada) to address aspects of dementia care, but no commonly accepted description of the core knowledge, skills, and abilities, (i.e., competencies) that should underpin dementia-related training and education in the province. The aim of this study was to review current evidence to inform the later development of competency statements describing the knowledge, skills and actions required for dementia care among care providers ranging from laypersons to health professionals. We also sought to validate existing dementia care principles and align new concepts to provide a useful organizing framework for future competency development. We distinguished between micro-, meso- and macro-level concepts to clarify the competencies required by individuals situated in different locations across the healthcare system, linking competency development in dementia care to broader system transformation. This review precedes the co-development of a holistic competency framework to guide approaches to dementia care training in Ontario.

Objectives: This evaluation study was designed to examine the factors that contribute the promotion of social connectedness among people with dementia and their caregivers through social recreational programs; develop an understanding of volunteer's impact on program success; and identify the barriers and facilitators to improve the volunteer-based programs to promote social connectedness. Method: A qualitative descriptive research design was used to explore the study participants' lived experiences of social recreational programs from Alzheimer's Society of Durham Region (ASDR) in Ontario, Canada. A final sample of 31 participants was recruited including people with dementia, informal caregivers, and community volunteers. Qualitative data was collected through face-to-face semi-structured interviews. Emerging themes were derived from the qualitative descriptive data using thematic analysis. Results: The qualitative interviews highlighted the impact of social recreational programs on people with dementia, caregivers and volunteers in the promotion of social connectedness, as well as the examination of barriers and facilitators to identify opportunities for the future improvement of ASDR programs that would benefit the dementia populations. The study findings revealed that the project 'Living Well with Dementia' has been able to successfully foster social connectedness through its volunteer-led social recreational programs by promoting the physical and mental well-being of people with dementia and their caregivers. Conclusion: Our study findings underscored the critical roles of volunteers who contributed to the success of community-based programs. Future research is needed to identify the opportunities to address current gaps in services and to strengthen the social recreational programs using evidence-based practices and client-centered approaches. Supplemental data for this article can be accessed online at http://doi.org/10.1080/13607863.2021.1950614.

Background/aims Despite the proven benefits of vaccine prevention and the continuous development of this important public health measure, vaccine hesitancy is among the top ten threats to global health according to the World Health Organization in 2019. Those who contract the influenza virus will typically develop a mild illness. However, for populations at a higher risk, including those diagnosed with dementia, influenza is proven to be more detrimental. Persons with dementia (PWD) face a serious threat to influenza on an annual basis, and vaccine hesitancy may further potentiate this risk. The purpose of this paper is to explore and understand the barriers PWD face in receiving the influenza vaccine. Methods A literature review was conducted to examine the barriers that prevent PWD from seeking out the annual influenza vaccine. A thematic analysis provided an understanding of the overarching relationships found among the influences between the identified themes. Results Three main influences were identified: (1) intra-personal, (2) inter-personal, and (3) extra-personal, with each influence containing several subsequent sub-themes. Discussion/conclusion The literature review found that there is a lack of research involving this high-risk population and the barriers they face, especially within the extra-personal influences. Further research is required to understand how each barrier relates and connects with each other. Understanding this connection will aid public health organizations in decreasing the threat of vaccine hesitancy, thus decreasing the incidents of preventable deaths.

Background Many Americans with metastasised colon cancer do not receive indicated palliative chemotherapy. We examined the effects of health insurance and physician supplies on such chemotherapy in California. Methods We analysed registry data for 1199 people with metastasised colon cancer diagnosed between 1996 and 2000 and followed for 1 year. We obtained data on health insurance, census tract-based socioeconomic status and county-level physician supplies. Poor neighbourhoods were oversampled and the criterion was receipt of chemotherapy. Effects were described with rate ratios (RR) and tested with logistic regression models. Results Palliative chemotherapy was received by less than half of the participants (45%). Facilitating effects of primary care (RR=1.23) and health insurance (RR=1.14) as well as an impeding effect of specialised care (RR=0.86) were observed. Primary care physician (PCP) supply took precedence. Adjusting for poverty, PCP supply was the only significant and strong predictor of chemotherapy (OR=1.62, 95% CI 1.02 to 2.56). The threshold for this primary care advantage was realised in communities with 8.5 or more PCPs per 10 000 inhabitants. Only 10% of participants lived in such well-supplied communities. Conclusions This study's observations of facilitating effects of primary care and health insurance on palliative chemotherapy for metastasised colon cancer clearly suggested a way to maximise Affordable Care Act (ACA) protections. Strengthening America's system of primary care will probably be the best way to ensure that the ACA's full benefits are realised. Such would go a long way towards facilitating access to palliative care.

Sleep disturbances are common in persons with dementia (PWD). While pharmacotherapy is widely used, non-pharmacological interventions are beginning to surface as first-line management strategies. This study sought to investigate if physical activity was associated with more favourable sleep patterns in PWD, and to compare the sleep quantity and quality between active and inactive PWD. We conducted an exploratory study to tackle these research questions. Self-reported telephone questionnaires were administered to 40 caregivers of PWD, who answered questions as proxies on behalf of their care recipient. Just over half (55%) of our participants met the criteria for being active. Walking was the most popular form of physical activity for both active and inactive PWD. Active PWD also preferred exercise classes and gardening, whereas inactive PWD favoured chair exercises. Compared to their inactive counterparts, active PWD were more likely to experience appropriate sleep quantity (p = 0.00). The active group also reported significantly better overall sleep quality (p = 0.003). Together, our findings suggest that physical activity may be associated with improved sleep in PWD. Future studies are warranted to investigate whether physical activity can be promoted as a safe and effective means to improve quality-of-life in this population.

Background: Despite the impending shortage of nurses in Canada and globally, the recruitment and retention of males to the profession has been a challenge in the new millennium due to a variety of social barriers and negative stereotypes propagated by the mass and social media, and in part by schools of nursing themselves. Purpose: To examine the lived experiences of male nursing students in Ontario, Canada and their perceptions of reported educational and practice barriers, and social stereotypes. Design: A phenomenological approach was employed to examine the lived experiences of 37 male nursing students. Methods: Purposive and snowball sampling techniques were employed to recruit male students from a mid-sized university school of nursing. In depth, face-to-face interviews were conducted and guided by semi-structured open-end questions. Interviews were transcribed verbatim, coded and thematically categorized to make sense of the essential meanings. Results: Barriers to recruitment and retention of males in schools of nursing included the feminization of nursing curriculums; reverse discrimination by female nursing students, faculty and nursing clinical staff; a lack of positive male role models in academia, and negative social stereotypes including that men in nursing are effeminate, gay or are labeled as inappropriate caregivers Conclusion: The active recruitment and retention of males into schools of nursing may help to address, in part, the predicted global shortages facing the profession, while also helping to promote gender diversity and social equity in this critical health care profession.

Background Our research group advanced a health insurance theory to explain Canada’s cancer care advantages over America. The late Barbara Starfield theorized that Canada’s greater primary care-orientation also plays a critically protective role. We tested the resultant Starfield-Gorey theory by examining the effects of poverty, health insurance and physician supplies, primary care and specialists, on colon cancer care in Ontario and California. Methods We analyzed registry data for people with non-metastasized colon cancer from Ontario ( n = 2,060) and California ( n = 4,574) diagnosed between 1996 and 2000 and followed to 2010. We obtained census tract-based socioeconomic data from population censuses and data on county-level physician supplies from national repositories: primary care physicians, gastroenterologists and other specialists. High poverty neighborhoods were oversampled and the criterion was 10 year survival. Hypotheses were explored with standardized rate ratios (RR) and tested with logistic regression models. Results Significant inverse associations of poverty (RR = 0.79) and inadequate health insurance (RR = 0.80) with survival were observed in the California, while they were non-significant or non-existent in Ontario. The direct associations of primary care physician (RRs of 1.32 versus 1.11) and gastroenterologist (RRs of 1.56 versus 1.15) supplies with survival were both stronger in Ontario than California. The supply of primary care physicians took precedence. Probably mediated through the initial course of treatment, it largely explained the Canadian advantage. Conclusions Poverty and health insurance were more predictive in the USA, community physician supplies more so in Canada. Canada’s primary care protections were greatest among the most socioeconomically vulnerable. The protective effects of Canadian health care prior to enactment of the Affordable Care Act (ACA) clearly suggested the following. Notwithstanding the importance of insuring all, strengthening America’s system of primary care will probably be the best way to ensure that the ACA’s full benefits are realized. Finally, Canada’s strong primary care system ought to be maintained.

Objective: Home care (HC) has been promoted as an efficient alternative to residential care (RC). However, little is known about the individuals who receive HC. This study compared the cognitive and functional statuses of persons with dementia receiving HC or RC at the time of diagnosis with dementia. It was hypothesized that persons with dementia receiving RC would have declined further, both cognitively and functionally.Study design: Population-based secondary data analysis.Methods: Data from the Canadian Institute for Health Information's Continuing Care Reporting System and the Home Care Reporting System, 2009-2011, were used. Respective populations of 39,604 and 21,153 persons with dementia who received either RC or HC were included. Cognitive and functional statuses were measured using a cognitive performance scale (CPS) and an activities of daily living (ADL) scale, respectively.Results: The mean CPS score was higher for the RC group (3.2 vs 2.5). The proportion of individuals diagnosed when impairment was moderate to very severe (CPS >= 4) was higher in the RC group (32.0% vs 13.3%). The mean ADL score was also higher for the RC group (3.5 vs 1.6). The proportion of individuals diagnosed when they required extensive assistance or were totally dependent (ADL > 3) was markedly higher in the RC group (72.3% vs 27.3%). All findings were statistically significant (P < 0.0001). Multivariable analysis suggested that RC clients were nearly four times more likely than HC clients to be diagnosed at a later stage (odds ratio = 3.74, 95% confidence interval 3.54-3.95).Conclusions: Persons with dementia in RC facilities in Ontario are diagnosed when their cognitive and functional statuses have declined more than those of their HC counterparts. (C) 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Many Americans diagnosed with colon cancer do not receive indicated chemotherapy. Certain unmarried women may be particularly disadvantaged. A 3-way interaction of the multiplicative disadvantages of being an unmarried and inadequately insured woman living in poverty was explored.

This paper explores the gender differences with respect to potential negative physical effects associated with prolonged Video Display Terminal (VDT) use. In this cross-sectional survey, we distributed self- reported health questionnaire along with the Nordic Musculoskeletal Questionnaire (NMQ) to 278 University of Ontario students (95 males and 183 females, aged between 17-32 years) in Oshawa, Ontario, Canada. Results showed that female students suffered more pain/discomfort in the neck/shoulder/hand and wrist (64.1%) in comparison to males (45.7%). Location of pain was also different in female students when compared to male students. This study provides preliminary evidence to suggest that female UOIT students experienced increased negative health effects on exposure to VDTs in comparison to male students. This study will help facilitate more targeted interventions towards millennials and assist them in reducing pain/discomfort they may experience when using devices with VDTs.

Previous research suggested that missed and delayed dementia diagnosis were substantial among residential care facility (RCF) clients. In recent decades, many countries around the world, including Canada, experienced a major shift in health care restructuring where home care (HC) was heavily promoted as a cost-efficient alternative to traditional institutional-style care. However, little has been explored to compare the welfares of individuals who received these services. The purpose of this study was to compare the levels of cognitive function and their ability to perform day-to-day activities at the time of diagnosis of dementia, between RCF and HC clients. We hypothesized that RCF clients were more likely to have a diagnosis at later stages of decline in both cognitive function and ability to perform activities of daily living than HC clients. We utilized a population-based secondary data analysis approach, using data from the Canadian Institute for Health Information's Continuing Care Reporting System and Home Care Reporting System from 2009-2011. Main variables of interest were cognitive function (CF) and activity of daily living (ADL) at the time of diagnosis. CF within 30 days of diagnosis was measured by a 7-point cognitive performance scale (CPS) - 0 (intact) to 6 (very severe impairment). ADL score was measure by a 7-point scale - 0 (independent) to 6 (total dependence). Data were extracted from 24,574 RCF clients and 11,746 HC clients, all with a diagnosis of dementia. Average CPS score was higher for the RCF group (3.1 vs. 2.3, p=0.0001). Proportion of diagnosis at CPS≥4 (moderately severe to very severe impairment) was also higher in the RCF group (29.4% vs. 9.7%, p=0.0001). Average ADL score was 3.4 for RCF clients and 1.1 for HC clients (p=0.0001). Proportion of diagnosis at ADL≥3 (required extensive assistance to total dependence) was 71.2% for RCF clients and 14.7% for HC clients (p=0.0001). Proportion of diagnosis made at CPS≥4 and ADL≥3 were significantly higher in the RCF group than in the HC group (26.9% vs. 4.9%, p=0.0001). Our findings suggest that RCF clients are more likely to experience diagnoses at poorer stages of CF and ADL than HC clients.

Little research has been conducted on examining the relationship between caring interventions such as adult day programs (ADPs) and the quality of life (QOL) of individuals with Alzheimer's disease.Our study objective was to investigate the merits of attending ADPs on the QOL of these individuals.We hypothesized that individuals with Alzheimer's disease who attended ADP had higher QOL than those who did not.We also hypothesized that individuals with Alzheimer's disease who attended ADP enjoyed comparable QOL as their non-diseased counterparts.To explore these issues, we piloted a cross-sectional study in Durham, Ontario, Canada.We recruited 130 participants at five ADPs and at six caregiver support groups in the region.Among them, there were 73 disease-free ADP clients, 28 ADP clients with Alzheimer's disease and 29 individuals with Alzheimer's disease who did not attend ADPs.Study procedures involved primary data collection using assisted self-report questionnaires and a 13-item quality-of-life scale.This current paper provided a detailed description of the study process.We also provided results that showed overall QOL scores for individuals with Alzheimer's disease who attended ADP were comparable to those without the disease (2.7 vs. 2.9, p=0.1), whereas the scores were much lower for individuals with Alzheimer's disease who did not attend ADP than those who attended ADP (1.9 vs. 2.7, p=0.0001).Individuals who attended ADP consistently provided higher ratings than those who did not attend ADP.Based on our findings, we concluded that attending ADPs may be partially responsible for the observed differences in QOL.

Approximately half of the Canadian adults have sedentary lifestyles that increase their risk of developing cardiovascular disease (CVD). Women are 10 times more likely to die from CVD than from any other disease. Their risk almost doubles with the onset of menopause, which may result in increased body iron burden and oxidative stress in sedentary women. Body iron burden may catalyze the production of cytotoxic oxygen species in vivo. We hypothesized that postmenopausal women who engage in moderate forms of aerobic exercise for at least 30 min three or more times per week would have significantly (i) lower levels of body iron burden, (ii) increased glutathione peroxidase (GPx) activity, and (iii) decreased oxidative stress in comparison to sedentary controls. An age-matched, case-control study was employed to examine the effects of active (N = 25) versus sedentary (N = 25) lifestyles in women aged 55-65 years on measures of body iron burden as quantified by total serum iron, transferrin saturation, and serum ferritin levels; GPx activity; and oxidative stress as quantified by 4-hydroxynonenal, malondialdehyde, and hexanal. Measures of body iron burden were significantly elevated in sedentary women in comparison to active women (p < .001). Red cell GPx activity was higher in active women compared to sedentary women (p < .001). Measures of oxidative stress were significantly higher in sedentary versus active women (p < .001). These findings suggest that aerobic forms of exercise may mitigate the risk of developing CVD in postmenopausal women by improving antioxidant capacity and decreasing body iron burden.

Despite evidence of chemotherapy’s ability to cure or comfort those with colon cancer, nearly half of such Americans do not receive it. African Americans (AA) seem particularly disadvantaged. An ethnicity by poverty by health insurance interaction was hypothesized such that the multiplicative disadvantage of being extremely poor and inadequately insured is worse for AAs than for non-Hispanic white Americans (NHWA).

AimTo compare the levels of cognitive function at the time of diagnosis among institutional care facility residents with dementia, who were diagnosed either before or after admission to a facility in Ontario, Canada.MethodsThe study utilized a population-based secondary data analysis approach, using data from the Canadian Institute for Health Information's Continuing Care Reporting System from 2009 to 2011. Cognitive function within 30 days of diagnosis was measured by a seven-point cognitive performance scale (CPS) - 0 (intact) to 6 (very severe impairment).ResultsData were extracted from 39633 institutional care facility residents who had a diagnosis of dementia on record. The average CPS score was higher for residents whose diagnosis was made after admission to a facility than for residents whose diagnosis was made before admission (3.1 vs 2.9, P=0.009). The proportion of diagnosis at CPS4 (moderately severe to very severe impairment) was also higher in the diagnosis after admission group (29.7% vs 24.6%, P=0.001). Multivariable analysis showed that diagnoses made after admission were more likely to be at a severe stage of cognitive decline (CPS4) than diagnoses made before admission (adjusted odds ratio 1.49, P=0.001). A similar result was also noted when comparison was made between mild and moderate-to-severe stages of cognitive decline. After admission diagnoses were more likely to be at moderate-to-severe stages of cognitive decline (CPS 3) than before admission diagnoses (adjusted odds ratio 1.70, P=0.001).ConclusionOur findings suggest that dementia diagnoses after admission to institutional care facilities are more likely to be made at poorer stages of cognitive function decline. Geriatr Gerontol Int 2014; 14: 918-925.

Objectives This study aims to determine the prevalence of potentially undetected dementia among institutional care facility residents in Ontario, Canada, and to identify factors associated with undetection. Methods We utilized a population-based secondary data analysis approach, pertaining to data from the Canadian Institute for Health Information's Continuing Care Reporting System, 2009-2011. Potentially undetected dementia was defined as having severely impaired cognitive function and requiring extensive assistance on activity of daily living (ADL) but no records of dementia diagnoses. Cognitive function was measured by the Cognitive Performance Scale (CPS), 0 (intact) to 6 (very severe impairment), and ADL by a hierarchy scale, 0 (independent) to 6 (total dependence). Results Of the 242,957 residents who had no records of dementia diagnoses, 11.6% (n=28,078) had a CPS score 4 (severe impairment or higher) and ADL score 3 (required extensive assistance or more). Data from 11,614 demented residents with corresponding CPS and ADL scores were used for comparison. Residents without dementia diagnosis were younger (77 vs. 84years), more likely to have never married (20% vs. 6%), and have longer admission (4 vs. 2.8years). The most significant factors for no diagnoses were never married (adjusted odds ratio=2.1, 95% confidence interval [CI]=1.91-2.29), admitted to hospital-based facilities (adjusted odds ratio=1.58, 95% CI=1.48-1.69), presence of schizophrenia (adjusted odds ratio=1.43, 95% CI=1.22-1.69), depression (adjusted odds ratio=1.23, 95% CI=1.16-1.29), and diabetes mellitus (adjusted odds ratio=1.32, 95% CI=1.26-1.40). Conclusions A large number of residents who had poor cognitive function and inadequate ADL ability did not have dementia diagnoses on record. Social and comorbid conditions were contributing factors to potentially undetected dementia. Copyright (c) 2013 John Wiley & Sons, Ltd.