Continence Across Continents To Upend Stigma and Dependency (CACTUS-D): study protocol for a cluster randomized controlled trial

Background: Urinary incontinence occurs in 40 % of women aged 65 years and over; however, only 15 % seek care and many delay healthcare seeking for years. Incontinence is associated with depression, social isolation, reduced quality of life, falls and other comorbidities. It is accompanied by an enormous cost to the individual and society. Despite the substantial implications of urinary incontinence on social, psychological and physical well-being of older women, the impact of continence promotion on urinary symptom improvement and subsequent effects on falls, quality of life, stigma, social participation and the cost of care remains unknown. Methods: This study is a mixed methods multi-national open-label 2-arm parallel cluster randomized controlled trial aiming to recruit 1000 community-dwelling incontinent women aged 65 years and older across Quebec, Western Canada, France and United Kingdom. Participants will be recruited through community organizations. Data will be collected at 6 time points: baseline and 1 week, 3 months, 6 months, 9 months and 12 months after baseline. One of the primary objectives is to evaluate whether the continence promotion intervention improves incontinence symptoms (measured with the Patient Global Impression of Improvement questionnaire, PGI-I) at 12 months post intervention compared to the control group. Other co-primary outcomes include changes in incontinence-related stigma, fall reduction, and incremental cost-effectiveness ratio and quality-adjusted life years. Data analysis will account for correlation of outcomes (clustering) within community organizations. A qualitative sub-study will explore stigma reduction. Discussion: Community-based continence promotion programs may be a cost-effective strategy to reduce urinary incontinence, stigma and falls among older women with untreated incontinence, and simultaneously improve quality of life and healthy active life expectancy.European Research Area on Ageing2 (ERA-AGE2) progra

Mobility and Cognition in Seniors. Report from the 2008 Institute of Aging (CIHR) Mobility and Cognition Workshop

Background The annual Scientific Meeting of the Canadian Association on Gerontology was held on October 24 and 25, 2008 in London, Ontario. Prior to the annual meeting, mobility and cognition experts met on October 23, 2008 to engage in a pre-conference workshop. Methods Discussions during the workshop addressed novel areas of research and knowledge and research gaps pertaining to the interaction between mobility and cognition in seniors. Results Workshop presenters moved from the neuromuscular, biomechanics, and neurology of gait impairments, and falls through the role of cognition and mood on mobility regulation to the whole person in the environment. Research gaps were identified. Conclusions Despite a consensus that mobility and cognition are increasingly correlated as people age, several gaps in our understanding of mechanisms and how to assess the interaction were recognized. The gaps originally identified in 2008 are still pertinent today. Common and standardized assessments for “mobility and cognition” are still not in place in current practice. Interventions that target mobility and cognitive decline as a single entity are still lacking

Psychopathy and semantic processing

The performance of psychopathic (n=16) and nonpsychopathic (n=ll) right-handed male criminals was compared on tasks requiring the verbal semantic processing of four-letter concrete nouns presented tachistoscopically to either the left or the right visual half-field. Subjects processed stimuli at a superficial level (Simple Recognition), and at deeper levels (Lower-order and Higher-order Categorization conditions). "Yes/No" responses were made manually by triggering microswitches. Responding hand (left or right) was counterbalanced across conditions. Dependent measures were reaction time (RT) and error rate (ER), and were analysed separately as a function of group, processing level, responding hand, and visual half-field of presentation. The groups did not differ with respect to the pattern of RT results. Statistically significant group differences did emerge in the ER results however, with psychopaths making fewer errors than nonpsychopaths in the categorization conditions. These findings are discussed in the context of current neuropsychological models of verbal semantic function and psychopathy.Arts, Faculty ofPsychology, Department ofGraduat

Event-related brain potentials recorded during performance of a perceptual-motor task

This thesis examined the event-related brain potentials recorded while subjects perform a continuous involvement perceptual-motor task. It was found that potentials associated with psychological processes of anticipation and selective attention could be reliably measured. A post-stimulus negative shift observed in response to attended stimuli was found to be composed of two types of electrocortical activity. The first and earliest to appear was sensitive to the difference between channels (i.e. ears) carrying relevant and irrelevant auditory information. The second was sensitive to the direction in which subjects oriented their attention during the task. Between 200 msec and 300 msec after stimulus onset, these two activities or processes interacted such that the electrocortical effect of selective attention became largest in the cerebral hemisphere contralateral to the direction of orientation. Predicted relationships between brain potentials and task performance on a trial-to-trial basis were not found. The results are discussed in terms of the current understanding of the electrophysiology of human attention.Arts, Faculty ofPsychology, Department ofGraduat

The Disability Experience: Living with a Birth Defect Resulting from Thalidomide Exposure

The drug, Thalidomide, is a classic example of how medicine has the potential to cause us harm. The market flooding of this drug in the 1950’s resulted in the birth of 8 to 10 thousand children with birth defects. Today in Canada this tragedy still affects the lives of approximately 125 individuals. How do these individuals live their lives and what has been the overall impact of their impairment? This article explores the lived experience of a woman born with upper limb phocomelia as a result of Thalidomide exposure. A one-hour unstructured face-to-face interview was conducted. Permission was received from the interviewee to make a voice recording of the interview allowing for a more concrete data review. The interview uncovered 6\ud primary themes indicating that a physical impairment resulting from thalidomide can have a minimal impact on an individual’s overall quality of life, as long as sufficient support and a positive self identity is present. The interviewee’s accounts suggest that living with disability is a unique experience that can lead to positive outcomes. The ultimate conclusion of this paper is that more extensive research is needed to further represent the voices of the disability community

Older adults’ use of an on-line decision support system : usability and stability of assistive technology recommendations

Online decision support systems (DSS) may help older adults self-select assistive technology (AT) by offering recommendations. User interactions with DSSs may change the recommendations they receive. Objective: We evaluated recommendations stability and usability of an online DSS. Methods: Middle-aged and older adults (n = 43) were observed while using the DSS. The stability of DSS recommendations (ATs and advice) was compared between two time points, using a three-point scale: no, partial, or full agreement. Usability was coded, referencing ISO standards. Results: Half (51%) of participants received AT recommendations from the DSS in both sessions, with full (14%) or partial (12%) agreement. All but one participant received advice, and almost all of them had full (40%) or partial (56%) agreement between sessions. Many of the usability issues appear to be the result of the users inaccurately measuring their environment, challenges in understanding the questions being asked, and improperly making selections from the system. Discussion: Strict AT matching rules versus generic advice, and usability issues, likely reduced the matching rate and stability of AT recommendations. Conclusion: It appears that some users may require assistance with the system, and we suggest changes to the DSS format and content to improve stability and usability

Psychosocial Impact of Assistive Technologies for Mobility and Their Implications for Active Ageing

Purpose: Active ageing is defined as the process of optimizing opportunities for physical, social and mental health to enable older people to actively take part in society without discrimination and to enjoy independence and good quality of life. The World Health Organization assumed this to be a process for increasing and maintaining an individual’s participation in activities to enhance his/her quality of life. In this survey, the authors addressed the following question: is assistive technology (AT) for mobility contributing to enhancement of lifelong capacity and performance? Method: From June 2015 until February 2016, 96 community dwelling adults, AT users for mobility (powered wheelchairs, manual wheelchairs, lower limb prostheses, walkers, crutches and canes), aged 45–97, mean 67.02 ± 14.24 years old, 56.3% female, were interviewed using the Psychosocial Impact of Assistive Devices Scale (P-PIADS), the Activities and Participation Profile related to Mobility (APPM) and demographics, clinical and questions about AT use and training. Results and Discussion: The participants’ profiles revealed moderate limitation and restrictions in participation, measured by the APPM (2.03). Most participants displayed a positive impact from AT; average scores obtained from the P-PIADS subscales were: Self-esteem 0.62, Competency 1.11 and Adaptability 1.10. The P-PIADS total was 0.96, with the powered wheelchair users scoring the highest (1.53) and the walker users scoring the lowest (0.73). All subscales and the P-PIADS total were positively correlated with the activities and participation profile. There was no relation between age and the psychosocial impact of AT or activities and participation profile. These results encourage the authors to follow up with these participants for a lifelong intervention. To accomplish that aim, currently, the protocol is implemented at the AT prescribing centers in Coimbra, Portugal in order to assess the impact of AT on participation in society, one of the domains of the Active Ageing Index, a new analytical tool to help policy makers in developing policies for active and healthy ageing

Framework for policymaking on self-management of health by older adults using technologies

Abstract Background During the coronavirus disease 2019 (COVID-19) pandemic, the use of information and communication technologies (ICTs) to support care management exponentially increased. Governments around the world adapted existing programs to meet the needs of patients. The reactivity of governments, however, led to changes that were inequitable, undermining groups such as older adults living with chronic diseases and disability. Policies that align with recent developments in ICTs can promote better health outcomes and innovation in care management. A framework for policymaking presents potential for overcoming barriers and gaps that exist in current policies. Objective The goal of this study was to examine how well a provisional framework for policymaking represented the interactions between various components of government policymaking on older adults’ self-management of chronic disease and disability using ICTs. Methods Through an online survey, the study engaged policymakers from various ministries of the government of Ontario in the evaluation and revision of the framework. The data were analyzed using simple statistics and by interpreting written comments. Results Nine participants from three ministries in the government of Ontario responded to the questionnaire. Overall, participants described the framework as useful and identified areas for improvement and further clarification. A revised version of the framework is presented. Conclusions Through the revision exercise, our study confirmed the relevance and usefulness for a policymaking framework on the self-management of disease and disability of older adults’ using ICTs. Further inquiries should examine the application of the framework to jurisdictions other than Ontario considering the dissociated nature of Canadian provincial healthcare systems