Associations between perceived proximity to neighborhood resources, disability, and social participation among community-dwelling older adults: results from the VoisiNuAge study

Participation needs of older adults having disabilities and receiving home care: met needs mainly concern daily activities, while unmet needs mostly involve social activities

BACKGROUND

Participation is a key determinant of successful aging and enables older adults to stay in their homes and be integrated into the community. Assessing participation needs involves identifying restrictions in the accomplishment of daily and social activities. Although meeting participation needs involves older adults, their caregivers and healthcare providers, little is known about their respective viewpoints. This study thus explored the participation needs of older adults having disabilities as perceived by the older adults themselves, their caregivers and healthcare providers.

METHODS

A qualitative multiple case study consisted of conducting 33 semi-structured interviews in eleven triads, each composed of an older adult, his/her caregiver and a healthcare provider recruited in a Health and Social Services Centre (HSSC) in Québec, Canada. Interview transcripts and reviews of clinical records were analyzed using content analysis and descriptive statistics based on thematic saliency analysis methods.

RESULTS

Aged 66 to 88 years, five older adults had physical disabilities, five had mild cognitive impairment and one had psychological problems, leading to moderate to severe functional decline. Caregivers and healthcare providers were mainly women, respectively retired spouses and various professionals with four to 32 years of clinical experience. Participation needs reported by each triad included all domains of participation. Needs related to daily activities, such as personal care, nutrition, and housing, were generally met. Regarding social activities, few needs were met by various resources in the community and were generally limited to personal responsibilities, including making decisions and managing budgets, and some community life activities, such as going shopping. Unmet needs were mainly related to social activities, involving leisure, other community life activities and interpersonal relationships, and some daily activities, including fitness and mobility.

CONCLUSIONS

This study highlights the complexity of older adults' participation needs, involving daily as well as social activities. Properly assessing and addressing these needs is thus necessary to improve older adults' health and well-being. Discrepancies in the various actors' perceptions of participation needs must be further explored. Additional research would help better understand how to optimize the contribution of community organizations and caregivers.

Importance of proximity to resources, social support, transportation and neighborhood security for mobility and social participation in older adults: results from a scoping study

BACKGROUND

Since mobility and social participation are key determinants of health and quality of life, it is important to identify factors associated with them. Although several investigations have been conducted on the neighborhood environment, mobility and social participation, there is no clear integration of the results. This study aimed to provide a comprehensive understanding regarding how the neighborhood environment is associated with mobility and social participation in older adults.

METHODS

A rigorous methodological scoping study framework was used to search nine databases from different fields with fifty-one keywords. Data were exhaustively analyzed, organized and synthesized according to the International Classification of Functioning, Disability and Health (ICF) by two research assistants following PRISMA guidelines, and results were validated with knowledge users.

RESULTS

The majority of the 50 selected articles report results of cross-sectional studies (29; 58%), mainly conducted in the US (24; 48%) or Canada (15; 30%). Studies mostly focused on neighborhood environment associations with mobility (39; 78%), social participation (19; 38%), and occasionally both (11; 22%). Neighborhood attributes considered were mainly 'Pro ducts and technology' (43; 86) and 'Services, systems and policies' (37; 74%), but also 'Natural and human-made changes' (27; 54%) and 'Support and relationships' (21; 42%). Mobility and social participation were both positively associated with Proximity to resources and recreational facilities, Social support, Having a car or driver's license, Public transportation and Neighborhood security, and negatively associated with Poor user-friendliness of the walking environment and Neighborhood insecurity. Attributes of the neighborhood environment not covered by previous research on mobility and social participation mainly concerned 'Attitudes', and 'Services, systems and policies'.

CONCLUSION

Results from this comprehensive synthesis of empirical studies on associations of the neighborhood environment with mobility and social participation will ultimately support best practices, decisions and the development of innovative inclusive public health interventions including clear guidelines for the creation of age-supportive environments. To foster mobility and social participation, these interventions must consider Proximity to resources and to recreational facilities, Social support, Transportation, Neighborhood security and User-friendliness of the walking environment. Future studies should include both mobility and social participation, and investigate how they are associated with 'Attitudes', and 'Services, systems and policies' in older adults, including disadvantaged older adults.

Conceptual and operational considerations in identifying socioenvironmental factors associated with disability among community-dwelling adults

Disability is conceived as a person–context interaction. Physical and social environments are identified as intervention targets for improving social participation and independence. In comparison to the body of research on place and health, relatively few reports have been published on residential environments and disability in the health sciences literature. We reviewed studies evaluating the socioenvironmental correlates of disability. Searches were conducted in Medline, Embase and CINAHL databases for peer-reviewed articles published between 1997 and 2014. We found many environmental factors to be associated with disability, particularly area-level socioeconomic status and rurality. However, diversity in conceptual and methodological approaches to such research yields a limited basis for comparing studies. Conceptual inconsistencies in operational measures of disability and conceptual disagreement between studies potentially affect understanding of socioenvironmental influences. Similarly, greater precision in socioenvironmental measures and in study designs are likely to improve inference. Consistent and generalisable support for socioenvironmental influences on disability in the general adult population is scarce.

Barriers to social participation among lonely older adults: the influence of social fears and identity

INTRODUCTION

Loneliness among older adults is a major public health problem that may be associated with processes of social participation and identity. This study therefore sought to examine the relationship between social participation and identity in a sample of lonely older adults living independently in London, England.

METHOD

An inductive qualitative approach, based on semi-structured interviews and thematic analysis, was employed.

RESULTS

Participants commonly spoke of barriers to social participation that have been reported elsewhere, including illness/disability, loss of contact with friends/relatives, lack of a supportive community, and lack of acceptable social opportunities. However, novel findings were also derived. In particular, participants commonly minimised the difficulties they faced alone, and described attempts to avoid social opportunities. These behaviours were linked to fears about engaging in social participation opportunities, including fears of social rejection and/or exploitation, and fears of losing valued aspects of identity.

DISCUSSION

It is concluded that social participation amongst lonely older people will not improve through the removal of previously reported barriers alone; instead, older peoples' beliefs, fears and identities must be addressed. Suggestions for implementing these findings within community organisations are provided.

Environmental Factors Associated With Social Participation of Older Adults Living in Metropolitan, Urban, and Rural Areas: The NuAge Study

OBJECTIVES

We compared the social participation of older adults living in metropolitan, urban, and rural areas, and identified associated environmental factors.

METHODS

From 2004 to 2006, we conducted a cross-sectional study using an age-, gender-, and area-stratified random sample of 1198 adults (aged 67-82 years). We collected data via interviewer-administered questionnaires and derived from Canadian censuses.

RESULTS

Social participation did not differ across living areas (P = .09), but after controlling for potential confounding variables, we identified associated area-specific environmental variables. In metropolitan areas, higher social participation was associated with greater proximity to neighborhood resources, having a driver's license, transit use, and better quality social network (R(2) = 0.18). In urban areas, higher social participation was associated with greater proximity to neighborhood resources and having a driver's license (R(2) = 0.11). Finally, in rural areas, higher social participation was associated with greater accessibility to key resources, having a driver's license, children living in the neighborhood, and more years lived in the current dwelling (R(2) = 0.18).

CONCLUSIONS

To enhance social participation of older adults, public health interventions need to address different environmental factors according to living areas.

[Health and social services used by the rural elderly]

OBJECTIVES

To describe the use of health and social services, and to analyze the influence of functional capacity for Instrumental Activities of Daily Living (IADL) and other factors in their use.

METHOD

Cross-sectional study in a non-institutionalized population older than 64 years old in a basic rural health area of Zaragoza.

DEPENDENT VARIABLES

use of different health and social services. Main independent variable: functional capacity for IADL according to the Lawton-Brody. Confounding variables: sociodemographic, physical exercise, comorbidity, self-perceived health, walking aids, social resources and economic resources (OARS-MAFQ). The relationship between the use of services and functional capacity for IADL was assessed using crude OR (ORC) and adjusted (adjusted OR) with CI95% by means of multivariate logistic regression models.

RESULTS

The use of social and health services increased with age and worse functional capacity for IADL. The increased use of health services was related with bad stage of health, limited social and economic resources, physical inactivity and female. The increased use of home help services was related with limited social resources, low education level and male. Regular physical activity and using walking aids were associated with greater participation in recreational activities.

CONCLUSIONS

The probability of using social and health services increased in older people with impaired functional capacity for IADL. The specific use of them changed according to differences in health, demographic and contextual features.

Social isolation in older adults who are frequent users of primary care services

OBJECTIVE

To describe older adults who are frequent users of primary care services and to explore associations between the number of primary care visits per year and multiple dimensions that define social isolation.

DESIGN

Mailed, cross-sectional survey.

SETTING

An urban academic primary care practice in Kingston, Ont.

PARTICIPANTS

Forty patients aged 70 years and older who attended 12 or more appointments in the previous year with residents, physicians, nurses, nurse practitioners, or registered practical nurses.

MAIN OUTCOME MEASURES

Social isolation (size of close social network, loneliness, satisfaction with social participation, frequency of social participation), past and future need for health services related to social issues, and health and functional variables.

RESULTS

The participants reported relatively low levels of loneliness, with a mean (SD) score of 4.1 (1.3) out of 9. Overall, 18.9% of participants reported having a small close social network, 45.9% of participants wanted to do more social activities, and 57.5% of participants were isolated according to at least 1 indicator. Some participants (23.1%) had received primary care services related to social issues, and most participants (54.5%) wanted these services in the future, including receiving information about other health services or community resources, or having discussions about loneliness, relationships, or social activities. Number of primary care visits was not associated with any of the 4 indicators of social isolation.

CONCLUSION

Social isolation in older, frequent users of primary care services might be more common than previously thought, particularly the aspect of dissatisfaction with social participation. Expanded primary care services and referrals to other services might help to address this population's desires for services related to social issues. Future research could examine the social needs of older primary care attenders and the feasibility of providing related interventions in primary care settings.