Mei Lan Fang

Ambient Assisted Living Technologies for Aging Well: A Scoping Review

Abstract Ambient assisted living (AAL) technology is of considerable interest in supporting the independence and quality of life of older adults. As such, it is a core focus of the emerging field of gerontechnology, which considers how technological innovation can aid health and well-being in older age. For this scoping review, a comprehensive search of databases and key journals was conducted from January to April of 2013 in order to identify AAL technologies that have the potential to help deal with some of the challenges associated with aging. In particular, we focused on technologies that could potentially be used by people living with some degree of cognitive impairment, ranging from normal cognitive aging to mild cognitive impairment up to earlier stages of dementia. Options currently available and those still under development were both included in our search. Fifty-nine technologies were identified and are outlined here, along with a discussion of history of AAL from a gerontological perspective and related theoretical considerations.

A knowledge synthesis of culturally- and spiritually-sensitive end-of-life care: findings from a scoping review.

BackgroundMultiple factors influence the end-of-life (EoL) care and experience of poor quality services by culturally- and spiritually-diverse groups. Access to EoL services e.g. health and social supports at home or in hospices is difficult for ethnic minorities compared to white European groups. A tool is required to empower patients and families to access culturally-safe care. This review was undertaken by the Canadian Virtual Hospice as a foundation for this tool.MethodsTo explore attitudes, behaviours and patterns to utilization of EoL care by culturally and spiritually diverse groups and identify gaps in EoL care practice and delivery methods, a scoping review and thematic analysis of article content was conducted. Fourteen electronic databases and websites were searched between June–August 2014 to identify English-language peer-reviewed publications and grey literature (including reports and other online resources) published between 2004–2014.ResultsThe search identified barriers and enablers at the systems, community and personal/family levels. Primary barriers include: cultural differences between healthcare providers; persons approaching EoL and family members; under-utilization of culturally-sensitive models designed to improve EoL care; language barriers; lack of awareness of cultural and religious diversity issues; exclusion of families in the decision-making process; personal racial and religious discrimination; and lack of culturally-tailored EoL information to facilitate decision-making.ConclusionsThis review highlights that most research has focused on decision-making. There were fewer studies exploring different cultural and spiritual experiences at the EoL and interventions to improve EoL care. Interventions evaluated were largely educational in nature rather than service oriented.

Experiencing ‘pathologized presence and normalized absence’; understanding health related experiences and access to health care among Iraqi and Somali asylum seekers, refugees and persons without legal status

BackgroundAsylum seekers, refugees and persons without legal status have been reported to experience a range of difficulties when accessing public services and supports in the UK. While research has identified health care barriers to equitable access such as language difficulties, it has not considered the broader social contexts of marginalization experienced through the dynamics of ‘othering’. The current study explores health and health care experiences of Somali and Iraqi asylum seekers, refugees and persons without legal status, highlighting ‘minoritization’ processes and the ‘pathologization’ of difference as analytical lenses to understand the multiple layers of oppression that contribute to health inequities.MethodsFor the study, qualitative methods were used to document the lived experiences of asylum seekers, refugees and persons without legal status. Thirty-five in-depth interviews and five focus groups were used to explore personal accounts, reveal shared understandings and enable social, cognitive and emotional understandings of on-going health problems and challenges when seeking treatment and care. A participatory framework was undertaken which inspired collaborative workings with local organizations that worked directly with asylum seekers, refugees and persons without legal status.ResultsThe analysis revealed four key themes: 1) pre-departure histories and post-arrival challenges; 2) legal status; 3) health knowledges and procedural barriers as well as 4) language and cultural competence. Confidentiality, trust, wait times and short doctor-patient consultations were emphasized as being insufficient for culturally specific communications and often translating into inadequate treatment and care. Barriers to accessing health care was associated with social disadvantage and restrictions of the broader welfare system suggesting that a re-evaluation of the asylum seeking process is required to improve the situation.DiscussionsMacro- and micro-level intersections of accustomed societal beliefs, practices and norms, broad-levellegislation and policy decisions, and health care and social services delivery methods have affected the health and health care experiences of forced migrants that reside in the UK. Research highlights how ‘minoritization processes,’ influencing the intersections between social identities, can hinder access to and delivery of health and social services to vulnerable groups. Similar findings were reported here; and the most influential mechanism directly impacting health and access to health and social services was legal status.ConclusionsEquitable health care provision requires systemic change that incorporate understandings of marginalization, ‘othering’ processes and the intersections between the past histories and everyday realities of asylum seekers, refugees and persons without legal status.

Informing Understandings of Mild Cognitive Impairment for Older Adults: Implications From a Scoping Review.

The development of effective interventions for mild cognitive impairment (MCI) in older adults has been limited by extensive variability in the conceptualization and definition of MCI, its subtypes, and relevant diagnostic criteria within the neurocultural, pharmaceutical, and gerontological communities. A scoping review was conducted to explore the conceptual development of MCI and identify the resulting ethical, political, and technological implications for the care of older adults with MCI. A comprehensive search was conducted between January and April 2013 to identify English-language peer-reviewed articles published between 1999 and 2013. Our analysis revealed that the MCI conceptual debate remains unresolved, the response to ethical issues is contentious, the policy response is limited, and one-dimensional and technological interventions are scarce. Reflections on the conceptual, ethical, and policy responses in conjunction with the identification of the needs of older adults diagnosed with MCI highlight significant opportunities for technological interventions to effectively reposition MCI in the aging care discourse.

Exploring traditional end-of-life beliefs, values, expectations, and practices among Chinese women living in England: Informing culturally safe care.

OBJECTIVE This study explores the end-of-life (EoL) beliefs, values, practices, and expectations of a select group of harder-to-reach Chinese women living in England. METHOD A cultural safety approach was undertaken to interpret 11 in-depth, semistructured interviews. Interviews were conducted in Mandarin and Cantonese. Transcripts were translated and back-translated by two researchers. Findings were analyzed using the technical analytical principles of grounded theory. RESULTS The key themes generated from our analysis include: acculturation; differential beliefs and norms in providing care: family versus health services; language and communication; Eastern versus Western spiritual practices and beliefs; and dying, death, and the hereafter. SIGNIFICANCE OF RESULTS End-of-life discussions can be part of an arduous, painful, and uncomfortable process, particularly for migrants living on the margins of society in a new cultural setting. For some Chinese people living in the United Kingdom, end-of-life care requires attention to acculturation, particularly Western versus Eastern beliefs on religion, spirituality, burial practices, and provision of care, and the availability of culturally specific care, all of which encompass issues related to gender. Stories of a purposive sample of Chinese women were viewed through a cultural safety lens to gain a deeper understanding of how social and cultural norms and expectations, in addition to the pressures of acculturation, impact gendered roles and responsibilities. The analysis revealed variations between/within Eastern and Western culture that resulted in pronounced, and oftentimes gendered, differences in EoL care expectations.

Ageing well in the right place: partnership working with older people

Purpose: The provision of home and community supports can enable people to successfully age-in-place by improving physical and mental health, supporting social participation and enhancing independence, autonomy and choice. One challenge concerns the integration of place-based supports available as older people transition into affordable housing. Sustainable solutions need to be developed and implemented with the full involvement of communities, service organisations and older people themselves. Partnership building is an important component of this process. This article details the intricacies of developing partnerships with low-income older people, local service providers and nonprofit housing associations in the context of a Canadian housing development. Design/methodology/approach: A community based participatory approach was used to inform the data collection and partnership building process. The partnership building process progressed through a series of democratized committee meetings based on the principles of appreciative inquiry, four collaboration cafes with nonprofit housing providers, and four community mapping workshops with low-income older people. Data collection also involved 25 interviews and 15 photovoice sessions with the housing tenants. The common aims of partnership and data collection were to: (i) understand the challenges and opportunities experienced by older people, service providers and nonprofit housing providers; (ii) identify the perspectives of service providers and nonprofit housing providers for the provision and delivery of senior-friendly services and resources; and (iii) determine actions that can be undertaken to better meet the needs of service providers and nonprofit housing providers in order to help them better serve older people. Findings: The partnership prioritised the generation of a shared vision together with shared values, interests and the goal of co-creating meaningful housing solutions for older people transitioning into affordable housing. Input from interviews and photovoice sessions with older people provided material to inform decision making in support of ageing well in the right place. Attention to issues of power dynamics and knowledge generation and feedback mechanisms enable all fields of expertise to be taken into account, including the experiential expertise of older residents. This resulted in functional, physical, psychological and social aspects of ageing in place to inform the new build housing complex. Research limitations/implications: The time and effort required to conduct democratized partnerships slowed the decision making process. Research limitations/implications: The time and effort required to conduct democratized partnerships slowed the decision making process. Originality/value: The findings confirm that the drive toward community partnerships is a necessary process in supporting older people to age well in the right place. This requires sound mechanisms to include the voice of older people themselves alongside other relevant stakeholders. Ageing well in a housing complex requires meaningful placemaking to include the functional, physical, psychological and social aspects of older people’s everyday life in respect to both home and community.

From Familiar Faces to Family: Staff and Resident Relationships in Long-Term Care.

Objective: Long-term care (LTC) facilities are increasingly intent on creating a “homelike” atmosphere for residents. Although residential staff are integral to the construction of a home within LTC settings, their perceptions have been relatively absent from the literature. Method: Thirty-two LTC staff participants were interviewed about their experiences and perceptions of the physical environment and conceptualizations of home, and thematic analyses were conducted. Results: An overarching category—interpersonal relationships—emerged from our analyses emphasizing the importance of relationships in creating a homelike environment within institutional settings. Sub-themes that inform our understanding include the following: (a) Staff members’ perceptions of home; (b) “Their second home”: Adjustment to and familiarity in LTC; and (c) “We become family”: Relationality makes a home. Discussion: The study provides evidence to inform current policies and practices in LTC. Specifically, enough time and space should be given to residents and staff to create and maintain personal relationships to make residential care homelike.

Co-creation Methods: Informing Technology Solutions for Older Adults

With the demographic shift towards an aging population, there is an increasing need for and interest in technologies that address challenges associated with aging. The AGE-WELL Network of Centres of Excellence is developing and building capacity in researchers and partners affiliated with the network and beyond to co-create solutions with older adults and other stakeholders. In this paper three projects using different approaches to co-creation are explored: community-based participatory research, integrated knowledge translation, and transdisciplinary working. The projects span different focus areas and disciplines: (1) a seniors’ affordable housing redevelopment evaluation; (2) a realist review of middle-aged and older adults and the digital divide; and (3) development of rehabilitation software for older adults’ cognitive health. Based on these projects, opportunities for enriching the research process through co-creation methods are highlighted. In addition, factors to consider when choosing and implementing co-creation methods, such as the type of research project, level of project development, ethical issues, and resources available will be discussed. We conclude the paper with a call for researchers using co-creation in technology development to evaluate the impact of such approaches.

Understanding the functionality of housing-related support services through mapping methods and dialogue

This article describes the experience and process of using community mapping as a tool for collecting data on the functioning of housing-related support services in Metro Vancouver. We outline our mapping methods and discuss strengths and challenges encountered during workshops aimed at understandings how the system of housing-related supports function. Strengths were that workshops provided a forum for social participation and engagement. In addition, mapping is a research tool that enables local knowledge of service functioning and service gaps to be accessed and exchanged. Challenges include ensuring diverse representation; reducing power imbalances; and having adequate space to accommodate interested participants.

Co-creating Home and Community: Building Partnerships to Support Older Adults to Age-Well-in-Place

The provision of home and community supports can enable people to successfully age-in-place by improving physical and mental health, supporting social participation, and enhancing independence, autonomy, and choice. One challenge to ageing in place concerns the integration of place-based supports available as older people transition into affordable housing. Sustainable solutions need to be developed and implemented with the full involvement of communities, service organisations, and older people themselves. Partnership building is an important component of this process. This chapter details the intricacies of developing partnerships with low-income older people, local service providers, and non-profit housing associations in the context of a Canadian housing development. The findings confirm that the drive towards community partnerships is a necessary process in supporting seniors to live independently and age well within their homes and communities.