Paul Masotti

Healthy Naturally Occurring Retirement Communities: A Low-Cost Approach to Facilitating Healthy Aging

Naturally occurring retirement communities (NORCs) are broadly defined as communities where individuals either remain or move when they retire. Using the determinants of health model as a base, we hypothesize that some environmental determinants have a different impact on people at different ages. Health benefits to living within NORCs have been observed and likely vary depending upon where the specific NORC exists on the NORC to healthy-NORC spectrum. Some NORC environments are healthier than others for seniors, because the NORC environment has characteristics associated with better health for seniors. Health benefits within healthy NORCs are higher where physical and social environments facilitate greater activity and promote feelings of well-being. Compared to the provision of additional medical or social services, healthy NORCs are a low-cost community-level approach to facilitating healthy aging. Municipal governments should pursue policies that stimulate and support the development of healthy NORCs.

Adverse events experienced by homecare patients: a scoping review of the literature

PURPOSE The paper summarizes the results of a scoping review that focused on the occurrence of adverse events experienced by homecare patients. DATA SOURCES The literature search covered published and grey literature between 1998 and 2007. Databases searched included: MEDLINE, EMBASE, CINAHL and EBM REVIEWS including the Cochrane Library, AGELINE, the National Patient Safety Foundation Bibliography, Agency for Healthcare Research and Quality and the Patient Safety Net bibliography. STUDY SELECTION Papers included research studies, review articles, policy papers, opinion articles and legal briefs. Inclusion criteria were: (i) homecare directed services provided in the home by healthcare professionals or caregivers; (ii) addressed a characteristic relevant to patient experienced adverse events (e.g. occurrences, rates, definitions, prevention or outcomes); and (iii) were in English. Data extraction A pool of 1007 articles was reduced to 168 after analysis. Data were charted according to six categories: definitions, rates, causes, consequences, interventions and policy. RESULTS Eight categories emerged: adverse drug events, line-related, technology-related, infections and urinary catheters, wounds, falls, studies reporting multiple rates and other. Reported overall rates of adverse events ranged from 3.5 to 15.1% with higher rates for specific types. Few intervention studies were found. Adverse events were commonly associated with communication problems. Policy suggestions included the need to improve assessments, monitoring, education, coordination and communication. CONCLUSION A standardized definition of adverse events in the homecare setting is needed. Prospective cohort studies are needed to improve estimates and intervention studies should be undertaken to reduce the risk that homecare patients will experience adverse events.

Preventing Fetal Alcohol Spectrum Disorder in Aboriginal Communities: A Methods Development Project

The authors describe their three-year project working collaboratively with Aboriginal communities to prevent fetal alcohol spectrum disorder.

Healthy Naturally Occurring Retirement Communities: The Need for Increased Collaboration Between Local Public Health Agencies and Municipal Government

Naturally occurring retirement communities (NORCs) exist on a “health promoting” continuum in the extent to which they facilitate healthy aging. Some NORCs are healthier than others for seniors because their physical and social environments encourage activity and promote feelings of well-being. Municipal governments and public health agencies have different potential roles in developing healthy-NORCs. Municipal government responsibilities affect housing, transportation, green space, and zoning policies, which in turn affect the physical and built environment, a key senior-sensitive determinant of health. Public health agency responsibilities include population-based approaches to health promotion and chronic disease and injuries prevention through the encouragement of behaviors such as healthy eating and physical activity. Public health recognizes the importance of supportive environments, to which the built environment contributes. The gap between the responsibilities of public health and those of municipal government hinders the development of healthy-NORCs. Public health, although responsible for health promotion, has limited ability to influence the built environment. The municipal government is responsible for policy affecting the built environment, but health promotion is rarely considered in this exercise. Public policy aimed at facilitating healthy aging would be supported by increased collaboration between public health and municipal government.