Naturally Occurring Retirement Communities: Scoping Review

BackgroundAs Canada’s population ages, there is a need to explore community-based solutions to support older adults. Naturally occurring retirement communities (NORCs), defined in 1986 as buildings or areas not specifically designed for, but which attract, older adults and associated NORC supportive service programs (NORC-SSPs) have been described as potential resources to support aging in place. Though the body of literature on NORCs has been growing since the 1980s, no synthesis of this work has been conducted to date. ObjectiveThe goal of this scoping review is to highlight the current state of NORC literature to inform future research and offer a summarized description of NORCs and how they have supported, and can support, older adults to age in place. MethodsUsing a published framework, a scoping review was conducted by searching 13 databases from earliest date of coverage to January 2022. We included English peer- and non–peer-reviewed scholarly journal publications that described, critiqued, reflected on, or researched NORCs. Aging-in-place literature with little to no mention of NORCs was excluded, as were studies that recruited participants from NORCs but did not connect findings to the setting. A qualitative content analysis of the literature was conducted, guided by a conceptual framework, to examine the promise of NORC programs to promote aging in place. ResultsFrom 787 publications, we included 64 (8.1%) articles. All publications were North American, and nearly half used a descriptive research approach (31/64, 48%). A little more than half provided a specific definition of a NORC (33/64, 52%); of these, 13 (39%) used the 1986 definition; yet, there were discrepancies in the defined proportions of older adults that constitute a NORC (eg, 40% or 50%). Of the 64 articles, 6 (9%) described processes for identifying NORCs and 39 (61%) specifically described NORC-SSPs and included both external partnerships with organizations for service delivery (33/39, 85%) and internal resources such as staff, volunteers, or neighbors. Identified key components of a NORC-SSP included activities fostering social relationships (25/64, 39%) and access to resources and services (26/64, 41%). Sustainability and funding of NORC-SSPs were described (27/64, 42%), particularly as challenges to success. Initial outcomes, including self-efficacy (6/64, 9%) and increased access to social and health supports (14/64, 22%) were cited; however, long-term outcomes were lacking. ConclusionsThis review synthesizes the NORC literature to date and demonstrates that NORC-SSPs have potential as an alternative model of supporting aging in place. Longitudinal research exploring the impacts of both NORCs and NORC-SSPs on older adult health and well-being is recommended. Future research should also explore ways to improve the sustainability of NORC-SSPs

Varied overground walking-task practice versus body-weight-supported treadmill training in ambulatory adults within one year of stroke: a randomized controlled trial protocol

<p>Abstract</p> <p>Background</p> <p>Although task-oriented training has been shown to improve walking outcomes after stroke, it is not yet clear whether one task-oriented approach is superior to another. The purpose of this study is to compare the effectiveness of the Motor Learning Walking Program (MLWP), a varied overground walking task program consistent with key motor learning principles, to body-weight-supported treadmill training (BWSTT) in community-dwelling, ambulatory, adults within 1 year of stroke.</p> <p>Methods/Design</p> <p>A parallel, randomized controlled trial with stratification by baseline gait speed will be conducted. Allocation will be controlled by a central randomization service and participants will be allocated to the two active intervention groups (1:1) using a permuted block randomization process. Seventy participants will be assigned to one of two 15-session training programs. In MLWP, one physiotherapist will supervise practice of various overground walking tasks. Instructions, feedback, and guidance will be provided in a manner that facilitates self-evaluation and problem solving. In BWSTT, training will emphasize repetition of the normal gait cycle while supported over a treadmill, assisted by up to three physiotherapists. Outcomes will be assessed by a blinded assessor at baseline, post-intervention and at 2-month follow-up. The primary outcome will be post-intervention comfortable gait speed. Secondary outcomes include fast gait speed, walking endurance, balance self-efficacy, participation in community mobility, health-related quality of life, and goal attainment. Groups will be compared using analysis of covariance with baseline gait speed strata as the single covariate. Intention-to-treat analysis will be used.</p> <p>Discussion</p> <p>In order to direct clinicians, patients, and other health decision-makers, there is a need for a head-to-head comparison of different approaches to active, task-related walking training after stroke. We hypothesize that outcomes will be optimized through the application of a task-related training program that is consistent with key motor learning principles related to practice, guidance and feedback.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov # <a href="http://www.clinicaltrials.gov/ct2/show/NCT00561405">NCT00561405</a></p

Perturbation training to promote safe independent mobility post-stroke: study protocol for a randomized controlled trial

Abstract Background Falls are one of the most common medical complications post-stroke. Physical exercise, particularly exercise that challenges balance, reduces the risk of falls among healthy and frail older adults. However, exercise has not proven effective for preventing falls post-stroke. Falls ultimately occur when an individual fails to recover from a loss of balance. Thus, training to specifically improve reactive balance control could prevent falls. Perturbation training aims to improve reactive balance control by repeatedly exposing participants to postural perturbations. There is emerging evidence that perturbation training reduces fall rates among individuals with neurological conditions, such as Parkinson disease. The primary aim of this work is to determine if perturbation-based balance training can reduce occurrence of falls in daily life among individuals with chronic stroke. Secondary objectives are to determine the effect of perturbation training on balance confidence and activity restriction, and functional balance and mobility. Methods/design Individuals with chronic stroke will be recruited. Participants will be randomly assigned to one of two groups: 1) perturbation training, or 2) ‘traditional’ balance training. Perturbation training will involve both manual perturbations (e.g., a push or pull from a physiotherapist), and rapid voluntary movements to cause a loss of balance. Training will occur twice per week for 6 weeks. Participants will record falls and activity for 12 months following completion of the training program. Standardized clinical tools will be used to assess functional balance and mobility, and balance confidence before and after training. Discussion Falls are a significant problem for those with stroke. Despite the large body of work demonstrating effective interventions, such as exercise, for preventing falls in other populations, there is little evidence for interventions that prevent falls post-stroke. The proposed study will investigate a novel and promising intervention: perturbation training. If effective, this training has the potential to not only prevent falls, but to also improve safe independent mobility and engagement in daily activities for those with stroke. Trial registration Current Controlled Trials: ISRCTN05434601

Subjective status and perceived legitimacy across countries

The relationships between subjective status and perceived legitimacy are important for understanding the extent to which people with low status are complicit in their oppression. We use novel data from 66 samples and 30 countries (N = 12,788) and find that people with higher status see the social system as more legitimate than those with lower status, but there is variation across people and countries. The association between subjective status and perceived legitimacy was never negative at any levels of eight moderator variables, although the positive association was sometimes reduced. Although not always consistent with hypotheses, group identification, self-esteem, and beliefs in social mobility were all associated with perceived legitimacy among people who have low subjective status. These findings enrich our understanding of the relationship between social status and legitimacy

Subjective status and perceived legitimacy across countries

The relationships between subjective status and perceived legitimacy are important for understanding the extent to which people with low status are complicit in their oppression. We use novel data from 66 samples and 30 countries (N = 12,788) and find that people with higher status see the social system as more legitimate than those with lower status, but there is variation across people and countries. The association between subjective status and perceived legitimacy was never negative at any levels of eight moderator variables, although the positive association was sometimes reduced. Although not always consistent with hypotheses, group identification, self-esteem, and beliefs in social mobility were all associated with perceived legitimacy among people who have low subjective status. These findings enrich our understanding of the relationship between social status and legitimacy