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Castellon-Lopez Y, Carson SL, Ward KT, Ramirez KD, Vo LP, Kuo T, Seeman T, Vassar SD, Trejo L, Eidem E, Aranda MP, Brown AF. Understanding the implementation and sustainability needs of evidence-based programs for racial and ethnic minoritized older adults in under-resourced communities with limited aging services. BMC Health Serv Res 2024; 24:466. [PMID: 38614988 PMCID: PMC11015605 DOI: 10.1186/s12913-024-10925-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 03/28/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Evidence-based programs (EBPs) for older adults effectively improve health outcomes. However, there is a limited understanding of the unique needs of service providers as they consider adopting, implementing, and maintaining programs for older minority adults in low-income communities with limited aging services. METHODS We conducted semi-structured interviews with key informants of community-based organizations (CBOs) to understand implementation and sustainability needs of CBOs within four racial and ethnically diverse Los Angeles County geographic areas. We performed thematic analysis of interview transcripts. RESULTS Interviews were conducted with representatives from 25 senior-serving agencies providing aging-related EBPs. CBO representatives reported implementing EBPs in 8 domains: Falls Prevention (68%), Mental Health (64%), Caregiver Health (48%), Chronic Disease Management (48%), Diabetes Management (36%), Arthritis Management (28%), Physical Activity (24%), and Multiple Conditions Management (8%). Themes are presented using the six domains of the Bass and Judge framework for factors impacting successful and sustained EBP implementation. CBOs in low-income and diverse communities described unique challenges with tailoring interventions based on local community context (literacy, language), cultural context, and locally available resources (technology, safe community spaces, transportation) and faced resource-intensive administrative burdens through staff turnover, data collection, sustainable funding, and networking. CONCLUSIONS Serving racial and ethnic communities has unique challenges that require tailored approaches and additional resources to ensure equitable access to EBPs for all communities. We describe suggestions for enhancing the effective adoption of EBPs among service agencies in under-resourced and diverse aging communities serving populations with aging-related health disparities.
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Affiliation(s)
- Yelba Castellon-Lopez
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Cancer Research Center for Health Equity, Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA, USA.
| | - Savanna L Carson
- Department of Medicine, Division of General Internal Medicine-Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Katherine T Ward
- Department of Medicine, Section of Geriatrics, LAC/Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Karina D Ramirez
- Department of Medicine, Division of Geriatrics, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Lynn Phan Vo
- Department of Medicine, Division of General Internal Medicine-Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Tony Kuo
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Teresa Seeman
- Department of Geriatrics, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Stefanie D Vassar
- Department of Medicine, Division of General Internal Medicine-Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Laura Trejo
- Los Angeles County Aging and Disabilities Department, Los Angeles, CA, USA
| | - Ellen Eidem
- Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - María P Aranda
- USC Edward R. Roybal Institute on Aging, USC Suzanne Dworak-Peck School of Social Work, Los Angeles, CA, USA
| | - Arleen F Brown
- Department of Medicine, Division of General Internal Medicine-Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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Windle A, Marshall A, de la Perrelle L, Champion S, Ross PD, Harvey G, Davy C. Factors that influence the implementation of innovation in aged care: a scoping review. JBI Evid Implement 2023; 22:02205615-990000000-00072. [PMID: 38153118 PMCID: PMC11163893 DOI: 10.1097/xeb.0000000000000407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
OBJECTIVE The objective of this scoping review is to identify factors that influence the implementation of innovation in aged care. INTRODUCTION Aged care is a dynamic sector experiencing rapid change. Implementation of innovations in aged care has received relatively little research attention compared to health care. INCLUSION CRITERIA This review included studies of any design, that examined the implementation of innovations in aged care settings. METHODS Searches were conducted in MEDLINE, CINAHL, AgeLine, and ProQuest Social Sciences Premium Collection for studies published between January 1, 2012 and December 31, 2022. The titles and abstracts of retrieved citations were screened by two independent reviewers. Full-text articles were screened by one reviewer to determine inclusion. Data were extracted in NVivo using a tool developed by the research team. Factors that influenced implementation were inductively coded, interpreted, and grouped into categories in a series of workshops. RESULTS Of the 2530 studies that were screened, 193 were included. Of the included papers, the majority (74%) related to residential aged care, 28% used an implementation theory or framework, and 15% involved consumers. Five key categories of factors influencing implementation were identified: organizational context including resourcing and culture; people's attitudes and capabilities; relationships between people; the intervention and its appropriateness; and implementation actions such as stakeholder engagement and implementation strategies. CONCLUSIONS Our findings can be used to develop practical resources to support implementation efforts, and highlight the importance of resourcing for successful implementation. Attention to community-based aged care, and greater engagement with theory and community is needed to promote research rigor, relevance and applicability.
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Affiliation(s)
- Alice Windle
- Aged Care Research and Industry Innovation Australia (ARIIA), Adelaide, SA, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Amy Marshall
- Aged Care Research and Industry Innovation Australia (ARIIA), Adelaide, SA, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Lenore de la Perrelle
- Aged Care Research and Industry Innovation Australia (ARIIA), Adelaide, SA, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Stephanie Champion
- Aged Care Research and Industry Innovation Australia (ARIIA), Adelaide, SA, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Paul D.S. Ross
- Aged Care Research and Industry Innovation Australia (ARIIA), Adelaide, SA, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Gillian Harvey
- Aged Care Research and Industry Innovation Australia (ARIIA), Adelaide, SA, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Carol Davy
- Aged Care Research and Industry Innovation Australia (ARIIA), Adelaide, SA, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
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van der Laag PJ, Dorhout BG, Heeren AA, Veenhof C, Barten DJJA, Schoonhoven L. Barriers and facilitators for implementation of a combined lifestyle intervention in community-dwelling older adults: a scoping review. Front Public Health 2023; 11:1253267. [PMID: 37900029 PMCID: PMC10602891 DOI: 10.3389/fpubh.2023.1253267] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/08/2023] [Indexed: 10/31/2023] Open
Abstract
Background Lifestyle interventions, combining nutrition and exercise, are effective in improving the physical functioning of community-dwelling older adults and preventing healthcare risks due to loss in muscle mass. However, the potential of these types of interventions is not being fully exploited due to insufficient implementation. Having insight into the determinants that could hinder or facilitate the implementation of a combined lifestyle intervention could improve the development of matching implementation strategies and enhance the implementation of such lifestyle interventions. The aim of this study was to identify barriers and facilitators for the successful implementation of a combined lifestyle intervention for community-dwelling older adults. Method A scoping review was conducted. A literature search was conducted in four electronic databases, and references were checked for additional inclusion. Studies were screened if they met the inclusion criteria. Barriers and facilitators were extracted from the included studies. To validate the results of the literature search, healthcare professionals and community-dwelling older adults were interviewed. Barriers and facilitators were categorized by two researchers according to the constructs of the Consolidated Framework for Implementation Research (CFIR). Results The search identified 12,364 studies, and 23 were found eligible for inclusion in the review. Barriers and facilitators for 26 of the 39 constructs of the CFIR were extracted. The interviews with healthcare professionals and older adults yielded six extra barriers and facilitators for implementation, resulting in determinants for 32 of the 39 CFIR constructs. According to literature and healthcare professionals, cosmopolitanism (network with external organizations), patient needs and resources, readiness for implementation, costs, knowledge and beliefs about the intervention, network and communication, and engaging were found to be the most important determinants for implementation of a combined lifestyle intervention. Conclusion A broad range of barriers and facilitators across all domains of the CFIR framework emerged in this study. The results of this review reflect on determinants that should be taken into account when planning for the implementation of a combined lifestyle intervention. A further step in the implementation process is the development of implementation strategies aiming at the identified determinants to enhance the implementation of a combined lifestyle intervention in community care.
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Affiliation(s)
- Patricia J. van der Laag
- Julius Center for Health Sciences and Primary Care, Nursing Science, University Medical Center Utrecht, University Utrecht, Utrecht, Netherlands
| | - Berber G. Dorhout
- Research Group Innovation of Human Movement Care, Research Centre for Healthy and Sustainable Living, Utrecht University of Applied Sciences, Utrecht, Netherlands
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
| | - Aaron A. Heeren
- Research Group Innovation of Human Movement Care, Research Centre for Healthy and Sustainable Living, Utrecht University of Applied Sciences, Utrecht, Netherlands
| | - Cindy Veenhof
- Research Group Innovation of Human Movement Care, Research Centre for Healthy and Sustainable Living, Utrecht University of Applied Sciences, Utrecht, Netherlands
- Department of Rehabilitation, Physical Therapy Science & Sports, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, Netherlands
| | - Di-Janne J. A. Barten
- Research Group Innovation of Human Movement Care, Research Centre for Healthy and Sustainable Living, Utrecht University of Applied Sciences, Utrecht, Netherlands
- Department of Rehabilitation, Physical Therapy Science & Sports, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Lisette Schoonhoven
- Julius Center for Health Sciences and Primary Care, Nursing Science, University Medical Center Utrecht, University Utrecht, Utrecht, Netherlands
- Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
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Sheppard CL, Myers AM, Hesjedahl S. Using Travel Diaries to Examine the Extent to Which Older Adult Centres Are a Focal Point for Recreation and Social Activities. Can J Aging 2023; 42:495-505. [PMID: 37439086 DOI: 10.1017/s0714980823000120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023] Open
Abstract
This study aimed to better understand the extent to which older adult centres are a focal point for recreation and social activities for their members. Travel diaries completed by 261 members of 12 older adult centres across Ontario provided comprehensive and real-time (24-hour) data over two consecutive weeks concerning time away from home, trip purposes, and modes of travel. The data showed that nearly one-third of their trips included a stop at their older adult centre. Three-quarters also went to other community venues over the study period, possibly to access amenities (e.g., pools) not available at their centre. Notwithstanding, their local older adult centre was still a focal point in out-of-home travel, particularly for potentially more vulnerable older adults, including those who were non-drivers, had less education, and felt lonelier. The diaries also substantiated the importance of time spent socializing with peers and staff at the centre, apart from formal program participation.
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Affiliation(s)
| | - Anita M Myers
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Sue Hesjedahl
- Older Adult Centres' Association of Ontario, Caledon, ON, Canada
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Scher CJ, Somerville C, Greenfield EA, Coyle C. Organizational Characteristics of Senior Centers and Engagement in Dementia-Friendly Communities. Innov Aging 2023; 7:igad050. [PMID: 37520857 PMCID: PMC10374275 DOI: 10.1093/geroni/igad050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Indexed: 08/01/2023] Open
Abstract
Background and Objectives Dementia-friendly communities (DFCs) are systematic and collaborative efforts to make local communities more supportive and inclusive of persons living with dementia and their care partners. This study explores how the organizational characteristics of senior centers influence their engagement in DFCs. Research Design and Methods We used a partially mixed, concurrent, equal status design, drawing on qualitative interviews with staff from 13 senior centers leading DFC initiatives as part of a statewide dementia-friendly network in Massachusetts, as well as quantitative data from 342 senior centers collected as part of a statewide survey. Results The qualitative results demonstrated ways in which human, social, tangible, and programmatic capital facilitate senior centers' DFC engagement. In particular, the results illuminated the importance of social capital with organizations and groups outside of the senior center, spanning the municipal, regional, and state levels. Findings from multivariate analyses further indicated robust and strong associations between higher levels of social capital, as well as more dementia-focused programming and greater variety of funding sources, with greater likelihood of engagement in DFC work. Discussion and Implications Results indicate the importance of policy and practice to foster both organizational capacity and multilevel systems conditions to enable and motivate senior centers' involvement in DFC initiatives.
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Affiliation(s)
- Clara J Scher
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Ceara Somerville
- Center for Social & Demographic Research on Aging, Gerontology Institute, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Emily A Greenfield
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Caitlin Coyle
- Center for Social & Demographic Research on Aging, Gerontology Institute, University of Massachusetts Boston, Boston, Massachusetts, USA
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Martin M, Saltzman LY, Henry V, Broussard C, Hansel TC. Mental health and well-being for aging adults during the COVID-19 pandemic. Aging Ment Health 2022; 26:1889-1898. [PMID: 34380358 DOI: 10.1080/13607863.2021.1963950] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The COVID-19 pandemic remains a significant mental health crisis. Although empirical research works to better understand the impact of COVID-19 on the mental health of the general population, some groups remain at greater risk for adverse mental health consequences. The purpose of this study is to better understand how COVID-19 experiences, food insecurities, and social support are associated with mental health and well-being for aging populations. METHODS Data collection began April 1, 2020 and continued through May 22, 2020. Study participants were recruited via website and media promotion and completed an anonymous survey. A sample of adults age 50 years and older (N = 136) were selected for the current analysis. Measures included scales of anxiety, depression, resilience, quality of life, COVID-19 experiences, interdependence, and insecurities. Three stepwise linear regression models were conducted using forward selection were estimated. RESULTS The first model found food insecurity, community closeness, and COVID-19 experiences predicted 23% of the variance in mental health. The second model found having enough money to meet needs, COVID-19 interdependence, and age predicted 20% of the variance in resilience. The final model found having enough money to meet needs, COVID-19 experiences, community closeness, and information access predicted 45% of the variance in quality of life. DISCUSSION Our discussion highlights the role of COVID-19 experiences, tangible resource losses, and community connection in mental health outcomes for aging populations during COVID-19. We suggest areas of future research and highlight the important role of technology in both scholarship and practice.
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Affiliation(s)
- Maya Martin
- School of Social Work, Tulane University, New Orleans, LA, USA
| | - Leia Y Saltzman
- School of Social Work, Tulane University, New Orleans, LA, USA
| | - Veronica Henry
- School of Social Work, Tulane University, New Orleans, LA, USA
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Piedra LM, Howe MJK, Ridings J, Gutwein M. Do Latino Older Adults and Service Providers Agree on Positive Aging? Using Concept Mapping to Compare Perspectives. THE GERONTOLOGIST 2022; 63:169-181. [PMID: 35639984 PMCID: PMC9872760 DOI: 10.1093/geront/gnac074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES In the United States, Latino adults are a growing segment of the aging population who will need research-informed interventions to help them age successfully. Arguably, how Latino older adults and service providers understand "positive aging" serves as an important precursor for the cultivation of such interventions. This investigation explored whether Latino older adults' conceptualizations of positive aging aligned with those of service providers. RESEARCH DESIGN AND METHODS We compared how Latino older adults (n = 93) and service providers (n = 45) rated 85 positive aging statements produced by Latino older adults. These 85 items were used to generate a concept map, which displays those items thematically by clusters and overarching regions of meaning. RESULTS We found divergences at each level of the map-statements, clusters, and regions-which illuminate differences between how service providers and Latino older adults think about Latino positive aging. For example, whereas Latino older adults prioritized the cluster containing items related to internal well-being, service providers rated it seventh of 11 clusters. The region comprising clusters related to relationships garnered the highest agreement between groups, but also a notable departure; compared to Latino older adults, service providers rated community and social involvement as less important. DISCUSSION AND IMPLICATIONS Understanding such differences can help providers tailor services consistent with the interests of Latino older adults. Future studies should examine the extent to which stakeholders believe various aspects of positive aging are modifiable.
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Affiliation(s)
- Lissette M Piedra
- Address correspondence to: Lissette M. Piedra, PhD, MSW, School of Social Work, University of Illinois at Urbana-Champaign, 1010 West Nevada St., Urbana, IL 61801, USA. E-mail:
| | | | - John Ridings
- Institute for Clinical Social Work, Chicago, Illinois, USA
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Eaton J. Let us progress! Implementing professionally led arts-based programming in senior centers. EDUCATIONAL GERONTOLOGY 2022; 48:415-428. [PMID: 35965886 PMCID: PMC9367169 DOI: 10.1080/03601277.2022.2045536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The arts offer a cost effective and appealing approach to healthy aging. The purpose of this study is to evaluate the development and implementation of three creative aging pilot programs led by professional teaching artists in multipurpose senior centers. The process of recruitment focused on professional teaching artists, senior center directors, and program participants. Data collection documented attendance, field note observations, participant demographics, self-reported health, and satisfaction. Open-ended interviews detailed individual experience, learning opportunities, dislikes, and both program and instructor feedback. Analysis involved descriptive statistics and apriori pattern coding. Outcomes are reported specific to each program developed, including: 1) readers theatre, 2) choir, and an 3) Improvisation/Movement class. A total of 35 older adults participated in all three programs. The choir had the highest average of regular attendance, while the improvisation/movement class struggled with recruitment. Overall satisfaction was high across all programs, with participants expressing enjoyment with courses that offer a challenge and desired that courses continue. This study emphasizes the importance in collaborating with centers to develop high quality programming and recommends strategies to facilitate program sustainability. Future program development and instruction may be improved through application of lessons learned.
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Guest MA, Stalzer B, Patton M. From Need to Policy: Community Supported Development and Implementation of the South Carolina Vulnerable Adult Guardian Ad Litem (SC VAGAL) Program. J Appl Gerontol 2020; 41:46-53. [PMID: 33331200 DOI: 10.1177/0733464820978801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Adult guardian ad litem programs are a necessary public service to protect adults from abuse and neglect. This article describes the development and implementation of an adult guardian ad litem program. We discuss the program's impetus, pilot testing, evaluation, and implementation of the program. Our experience highlights the vital role of diverse inter-sectoral stakeholders. Furthermore, the development process highlights the need for flexibility in program development, tension negotiation among stakeholders, and engagement of aging stakeholders in nontraditional arenas.
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Affiliation(s)
| | | | - Maria Patton
- South Carolina Department on Aging, Columbia, USA
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Abstract
RÉSUMÉLes centres pour personnes âgées ont été identifiés comme des points focaux pour la prestation de services pour la population vieillissante, qui est en forte croissance au Canada et aux États-Unis. Malgré ce rôle important des centres pour personnes âgées, peu de recherches leur ont été consacrées. Cet examen de portée a ciblé les études empiriques en langue anglaise portant sur les centres pour personnes âgées qui ont été publiées dans des revues scientifiques depuis 2000. Un total de 58 études ont été repérées (n = 51 pour les études américaines, n = 7 pour les études canadiennes). La majorité de ces articles était centrée sur des thèmes liés à la participation d’individus dans les centres pour personnes âgées, et quelques études seulement traitaient du milieu associé aux centres pour personnes âgées. Ces résultats suggèrent que les recherches futures devraient cibler les avantages de la programmation des centres pour personnes âgées, avec une attention particulière sur les besoins des baby-boomers, sur les facteurs clés liés au financement, aux espaces et au personnel, ainsi que sur les caractéristiques et les rôles des centres pour personnes âgées dans le contexte canadien.
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