Program Abstracts

Program Abstracts

November 21st-23rd, 2012

Delta Halifax

Halifax, Nova Scotia, Canada

Table of Contents

Wednesday, November 21st………………………………………………………………………pg2

Keynote Speaker: Andre Picard…………………………………………………………………pg2

Thursday, November 22nd…………………………………………………………………………pg2

Keynote Speaker: Ann Martin-Matthews……………………………………………………pg2

Oral Presentations Session A………………………….….……………………………………..pg2

Poster Presentations Session A……………………..………………………………………….pg8

Workshops Session B……………………….…………………………………………………….pg13

Oral Presentations Session C………………………………………………………………….pg16

Kathryn Allen Weldon Public Lecture: Dr. Kenneth Rockwood……….………….pg25

Friday, November 23rd……………………………………………………………………………pg25

Panel: Multi-perspective Look at Dementia……….…………………………………….pg25

Oral Presentations Session D………………………….….…………………………………..pg26

Poster Presentations Session D…………………………..………………………………….pg32

Keynote Speaker: Susan Kirkland…………………..………………………………………pg38

Wednesday, November 21st, 2012

7:00-8:30 pm

Keynote Speaker: Andre Picard, The Globe and Mail

The Greying of Medicare: Can Canada’s Aging Health System Be Revitalized?

Much is written about the aging of the population and its impact on health costs. But what about the health system itself – is the 1950s model of healthcare able to deliver 21st century care? A veteran healthcare journalist examines how Medicare should adjust to the needs of the population – and not vice-versa.______

Thursday, November 22nd, 2012

9:00-10:00 am

Keynote Speaker: Anne Martin-Matthews, University of British Columbia

The Future of Aging: Interdisciplinary Research, Practice and Policy Partnerships

There is tremendous diversity and variability in the aged population, which is not always reflected in the current language of research, policy and practice. This presentation situates the aging of Canada’s population within an international context to expand awareness of the complexity of research on aging, and with it, the possibilities and challenges of developing and implementing interdisciplinary evidence-based research partnerships and collaborations. Implications of the heterogeneity of aging populations for health services and systems will be considered, along with multidisciplinary paradigms for thinking about aging. Reflections on the importance of recognizing the diversity and complexity of aging; the need for interdisciplinary research platforms, and practice and policy partnerships; and the benefits of creating linkages across existing projects and data systems conclude the presentation.

10:30 am -12:00 pmOral Presentations Session A

Supporting Care

Aging at Home: Identifying safety markers for home care recipients

Marilyn Macdonald, Dalhousie University; Ariela Lang, VON Canada; Janet Storch, University of Victoria; Lynn Stevenson, Vancouver Island Health Authority

Canada’s aging population is advancing; by 2036, 25% of the Canadian population will be over the age of 65. As individuals are living longer, their likelihood of developing one or more chronic illnesses increases. Those who suffer from Chronic Obstructive Pulmonary Disease (COPD) and Congestive Heart Failure (CHF) require a great deal of intricate care. The majority of this care is provided in the client’s home by family caregivers. Although patient safety is a clear and pressing issue in institutional settings, client safety is a new frontier within the home care context. To address this gap, a CIHR funded scoping review was conducted on home care literature to identify meaningful safety markers for recipients of home care. Results generated seven safety markers attending to the experiences of home care clients and their caregivers: a sense of being left ‘home alone’ to deal with their illness, receiving a ‘fixed’ set of information in a ‘foreign’ clinical language; dealing with numerous health professionals or ‘strangers’ in the home; fulfilling multiple roles; managing medication regimes; being left ‘out of pocket’ due to the costs of required resources in receiving and providing care at home; and risking caregivers ‘own health through increased responsibilities of caring for a loved one at home. Identifying these safety markers will help to inform safety related knowledge and policies within home care practices. The knowledge gained may also help mitigate risks, improve quality of life for clients and caregivers, and assist in supporting a more sustainable health care system. ______

Understanding Alzheimer’s Disease and Other Related Dementia

Linda Lane, We Care Home Health Services; Rosanna Dolinki, We Care Home Health Services

Dementia will affect 1.1 million Canadians in less than 25 years. With between 2% and 10% of all cases of dementia starting before the age of 65, the impact will be seen across the aging population. In conducting staff surveys, client surveys, central intake requests and a national educational needs assessment, we uncovered that clients with Alzheimer’s and other related dementia needed a better care experience in the community. In response to this, we moved ahead on 2 fronts - the development of focused education for our staff and development of an education guide for informal caregivers. Understanding Alzheimer’s Disease is a program for unregulated staff that guides through the basics of caring for clients with Alzheimer’s disease and other related dementia. The focus of the program is to provide staff the skills and knowledge to help clients and their families better cope with the disease as it progresses. We are reviewing the effectiveness of the program – launched in January 2012 - through client and staff surveys and focus groups, to assess the impact of the program on enhancing the client experience. The 2nd step in our journey to enhance client experience was the creation of a Caregiver’s Guide for families looking after loved ones with Alzheimer’s. This guide offers tips on physical and emotional care for the client and for the caregiver. It has been developed using the knowledge of our clinical leaders and through consultation with experts in the field of Alzheimer/Dementia care.

1

“Doing what comes natural”: The direct caregivers’ experience of caring for residents with dementia

Sandee Hicks-Moore, University of New Brunswick

Objectives/Perspectives: Direct caregivers, namely personal support workers (PSWs) and licensed practical nurses (LPNs) caring for persons with dementia living in long-term care (LTC) encounter multiple challenges in their work, yet a clear understanding from their unique perspective of their experiences are missing from the literature. This research identifies their understandings of dementia care and the realities they experience daily at work. Method: This research is informed by hermeneutic phenomenology. Two questions guided the study: 1) What meanings do direct caregivers –PSWs and LPNs – in long term care develop about their experiences of caring for persons with dementia? 2) How may these meanings change, if at all? Fifteen direct caregivers from five different LTC facilities located in rural and urban settings in southern New Brunswick explained their experiences in dementia care. Results: Three themes emerged from the analysis of the data: 1) Adaptation which refers to the caregivers’ abilities to adjust to the unpredictable and often psychological and physically overwhelming situations they experience in caring for residents with dementia. 2) Inclusion which refers to how the caregivers seek ways to stabilize themselves and gain acceptance in the workplace. 3) Denied professionalism indicates the lack of credit given to their knowledge and skills by co-workers, supervisors and administrators of higher status. Conclusion: The findings of this research will be explained in an effort to broaden our understanding of the experiences of the direct caregivers and may be useful in enhancing educational and support programs for PSWs and LPNs.

Aging in Place

Building Age-Friendly Communities From the Community Up: The Nova Scotia Experience

Pamela Fancey, Mount Saint Vincent University; Jacqueline Campbell, Nova Scotia Department of Seniors; Brenda Hattie, Mount Saint Vincent University; Janice Keefe, Mount Saint Vincent University

Making our communities age-friendly is one of the most effective approaches for responding to our aging demographic. Age-Friendly Communities (AFC) addresses the environmental and social factors that hinder active and healthy aging. Informed by the original research conducted by the World Health Organization (2005) and within Canada by the Public Health Agency of Canada (2007), the Nova Scotia Department of Seniors and the Nova Scotia Centre on Aging have been supporting more than 10 municipalities in Nova Scotia with a strategic planning process aimed at helping them become more age friendly. This work has involved developing broad based advisory committees, community consultation, communications and promotion, and planning for implementation. Support is provided to each municipality individually through the process, as well as support is provided to build a community of practice around age-friendly communities across municipalities. Each municipality has its own strengths and capacities and the Nova Scotia AFC initiative builds upon these in different ways. Results from this inter-sectoral partnership are beginning to emerge demonstrating that the approach being taken is important in helping communities become more age friendly. This presentation will highlight the dialogical approach to this community-based collaborative initiative, and some of the key learnings that have emerged. The messages from this presentation will be beneficial for other jurisdictions interested in age-friendly community at the community, practice or policy levels.

The challenges of aging-in-place as a long term care option

Suzanne Dupuis Blanchard, Université de Moncton

Seniors want to stay in their homes for as long as possible. While only 7% of seniors currently live in a long term care facilities, over half of seniors living at home wonder how long they will be able to do so. Along with the aging of our population, many questions about the Canadian health care system, and especially our long term care options, have been asked. The goal of this presentation is to present a culmination of qualitative health research on aging-in-place in New Brunswick. Interviews have been conducted with a variety of participants: seniors who have their names on wait lists for relocation in a senior designated apartment building, others who have relocated from their homes, seniors who are currently aging-in-place, and various community agencies who provide services to seniors. Results reflect current challenges for seniors, their families and all levels of governments for aging-in-place as a long term care option. The presentation will highlight the various reasons seniors struggle to age in their homes while also providing a number of solutions. In conclusion, today’s tendency to build nursing homes creates an unbalanced approach to long term care. The results indicate the need the revise existing services and emphasize the importance of developing public policy for aging-in-place.

Developing Evidence-Based Housing for Older Adults

Lori Weeks, University of Prince Edward Island; Donald Shiner, Mount Saint Vincent University; Robin Stadnyk, Dalhousie University; Dany J. MacDonald, University of Prince Edward Island

To provide evidence about the amount and type of housing that will be needed by older adults, we explored the housing preferences of older adults, the variables that predict housing preferences, and how these results can inform the development of future housing. Our sample included 1,670 Atlantic Canadian older adults who completed a mailed survey as part of the Atlantic Seniors Housing Research Alliance research program. We used hierarchical logistic regression to determine the characteristics of respondents who preferred various types of housing. We also analyzed data from an open-ended question on ideal living arrangements. While a large number of older adults prefer to remain living where they are now, the majority do desire a different housing option in the future. Health and wealth variables yielded some interesting predictors of housing preferences, along with other socio-demographic variables. It is clear that there is no one particular form of housing that will meet the needs of all older adults. However, future forms of housing that ensured an independent living unit such as an apartment, options geared specifically to older adults, and provide access to assistance were most highly preferred by the participants. The results of this study are useful in informing decisions about housing options to develop supports for older adults who prefer to remain living in their homes and their communities and to create forms of housing that best meet the needs of our diverse older population.

Sciences and Dementia

Butyrylcholinesterase Imaging Agents to Visualize Pathology in Alzheimer’s Disease

Ian Macdonald, Dalhousie University; Ian Pottie, Mount Saint Vincent University; Earl Martin, Mount Saint Vincent University; Sultan Darvesh, Dalhousie University

Background: Butyrylcholinesterase (BuChE) is an enzyme that, among other functions, catalyzes the hydrolysis of the neurotransmitter acetylcholine. Increased levels of BuChE are associated with the pathology of Alzheimer’s disease (AD). This association makes BuChE a suitable target for disease-specific imaging of this neurological disease. We propose that BuChE-specific radiopharmaceuticals can be used for brain scanning to detect this enzyme in vivo, and thus the pathology associated with AD. As a preliminary step towards this goal, imaging agents have been synthesized and evaluated in rodent and human brain tissues. Methods: BuChE-specific radioligands were administered to wild type and transgenic AD rodents as well as incubated with post-mortem normal and AD human brain tissues. The distribution of radioactivity was determined via autoradiography. BuChE inhibitors were used to confirm specificity of the radioligand binding to this enzyme. Results: Autoradiographic analysis of rodent and human brain tissues indicated accumulation of radioactivity in areas known to contain BuChE as determined by histochemical analysis. Furthermore, presence of a BuChE inhibitor attenuated accumulation of radioactivity. Preliminary results indicate that AD tissues can be distinguished from normal human brain. Conclusions: BuChE has previously been implicated in the pathology of neurological diseases. We have synthesized several BuChE imaging agents. Autoradiography, in experimental animal and human brain tissue indicates that these agents have the potential to provide a non-invasive means for early diagnosis and treatment monitoring of AD using brain scanning.

What do mouse models teach us about aging?

Richard Brown, Dalhousie University; Rhian Gunn, Dalhousie University; Timothy O’Leary, Dalhousie University; Kurt Stover, Dalhousie University

Our lab studies the neurobehavioural changes in genetically modified mice as they age. There are three purposes for these studies. First, to understand the basic behavioural changes associated with aging. Second, to understand the neural and genetic mechanisms underlying these changes, and third, to use these mouse models to develop new treatments for age-related disorders. We have examined mouse models for glaucoma and Alzheimer's disease. The DBA/2J mouse develops age-related glaucoma and is functionally blind by 12 months of age. We examined the effects of blindness on learning and memory in these mice and showed that treatment of glaucoma with Timoptic XE improved visual ability and performance on visuo-spatial tests of learning and memory. We are testing a number of mouse models of Alzheimer's disease and are finding that these mice have age-related visual and motor control problems as well as cognitive decline. For example, the double transgenic APPswe/PS1de9 mouse shows deficits in visual acuity but not in olfaction. One of our goals is to dissociate the sensory and motor deficits from deficits in cognitive function. Another goal is to examine sex and strain differences in the development of age-related disorders. Data will be presented on age-related behavioural deficits in the 3X-Tg and 5x FAD mouse models of Alzheimer's disease. The development of new drugs depends on a complete knowledge of the neurobiological mechanisms underlying diseases of aging and the goal of our research is to uncover these mechanisms. Supported by NSERC of Canada.

Retirement Opportunities and Challenges

Comprehensive Risk Management in the Third Age: Women’s Special Challenges

Brigitte Neumann, Retired; Leroy Stone, Université du Montreal

Comprehensive risk management involves a network of strategies designed to address an array of possible losses so as to achieve the best available, or the optimum, allocation of one’s limited coping resources. This is important for individuals and families in the Third Age, especially women due to their greater chances of reaching advanced age. Women’s special challenges occur in a variety of domains, including the following: (a) the risks of outliving one’s financial resources, particularly in light of the likelihood of becoming widowed; (b) women’s greater chances of experiencing years with serious disability in later life; (c) social risks including the loss of family, friends and social networks as one’s age cohort dies off; and (d) risks of experiencing years with caregiving responsibility in later life. Such issues faced particularly by women give rise to the question of whether they are better prepared than men to address retirement’s challenges. Our research, based on the 2007 General Social Survey, shows that generally they are not as well prepared as men, and that there are key population segments in which the lesser preparedness of women is marked. These population segments with relatively low retirement preparedness include married immigrant women; women who are single, widowed or divorced; and women at the highest and lowest level of education and income. The presentation concludes with some recommendations for specialists who work on behalf of senior women.

Aging and Mobility: International Migration as a Retirement Strategy

Liesl Gambold, Dalhousie University

There are 10.1 million baby boomers in Canada, which is a proportion of the population far greater than other countries. Thus, understanding the lifestyle choices of retirees and the government policies within which they make these choices has never been so crucial. These individuals’ decisions will have far-reaching implications culturally, politically and economically. Since larger numbers of seniors are living their retirement years in economically challenging situations, this paper examines the mobility of elderly men and women in the form of international retirement migration as an increasingly popular strategy to ameliorate levels of economic and general well-being. This paper examines retirement as a process reflecting individual histories and preferences as well as shifting global, cultural, and ideological values. Employing standpoint theory, used by many feminist scholars, this paper begins by taking “everyday life as problematic” and the understanding that the aged are socially and culturally marginalized. With a growing aging population, however, this marginalization will surely be altered. International retirement migrants face the same challenges as the aging population at large such as health changes and concerns, mobility issues, financial questions and their over-all sense of well-being. However, they face the complex aging process in a foreign country and have the added difficult task of manoeuvering cross-culturally. Based on empirical, anthropological research done in Mexico, Spain, and southern France, this paper highlights the efforts of retirees to forge a new path, choose a new homeland and, perhaps, reinventing themselves a bit along the way.