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1. Institutional workers such as nurses and caregivers sometimes use Words like "dearie" and "sweetie" when talking to older people under their care. They may also speak in a higher register, or otherwise treat the older people like children. What term is used to describe this type of speech and behaviour? a. Elderspeak b. Ancientspeak c. Baby talk 4. c) the 85 year old lady who drives slowly - Behavioural, emotional True of false: 5. People feel lost in retirement they often get sick and die shortly after they retire - false because they are living longer 6. Sexual activity and interest in sex decline in later life - false 7. Older people face a lower risk of criminal victimization (robbery) than any other age group — true Critical thinking questions: Which of the following would be considered a stereotype of an older individual a) The 65 year old grandma who runs in a marathon b) The 65 year old grandpa who plays soccer league c) Frankis 64 years ..... - discrimination (we act based on our beliefs) d) The 95 year old man who sings in a choir Frank is 64 years old. He has gray hair, is stout, and walks hunched over due to a back injury. He still works as an accountant, but when people se him loading groceries into his aror trying to do his other working often ask him if they can be of assistance. Frank knows that he still capable to do these tasks, but he graciously accepts the help. What negative judgment about Frank is occurring? a. Discrimination b. Stereotyping c. Ageism d. Prejudice *stereotyping (beliefs not well supported by evidence) + prejudice (We decide based on our beliefs) + discrimination (we act based on our beliefs) = ageism (possibly) The Myth: Older adults expect to be left in quiet - Evidence against the myth:

- Frequency of participation in social activities appears equal for all adult age groups - Community centers for older people are quite popular How can the myth harm the older adults and also the society (use next slide figure) Myth: Most older people have similar needs, mainly access to hospital and nursing homes - Evidence: Huge variations based on sex, ethnicity, socioeconomic status - Main needs - Income, housing, access to social, cultural, and health services, strong social network - Determinants that affect all aspects of stages of life - How can the myth harm the older ____, also the society HOMEWORK: 1. Should people dye their hair to look younger? The choice to colour one's hair a different colour in order to appear younger is a subjective one. Some people may decide to dye their hair in order to express themselves more or to gain confidence. Some might feel comfortable with their aging naturally and not feel the need to change the colour of their hair. In the end, the decision to dye one's hair to appear younger is personal and is based on values and tastes. 2. Does hair colouring marginalize the poorer person who can't afford to pay for colouring ? The decision to colour one's hair can be a personal one, and it is impacted by a number of things such as cultural norms, personal preferences, and societal expectations. While some could contend that hair colouring is an unnecessary luxury and might even marginalize individuals who cannot afford it, it's important to understand that social conventions and beauty standards differ greatly. Individuals hold varying opinions regarding personal grooming, and cost is simply one of several variables that could impact these choices. 3. Does hair colouring reinforce societal ageism? As people dye their hair for a variety of reasons, such as personal style and artistic expression, hair colouring itself may not always support societal ageism. Nonetheless, ageism can be exacerbated by social standards of attractiveness and how aging is seen. Certain cultures may have an expectation that people, especially women, should always look young. Decisions regarding hair colouring may be indirectly influenced by this social pressure.

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Tutorial 2: 1. Older people with underlying conditions - such as diabetes or lung disease - put them at higher risk of death 2. Older people are less likely to wear masks or use other PPE (personal protective equipment) 3. Social distancing and isolation prove to be difficult in nursing homes 4. Older people are less likely to get vaccinated 1. 1+3 2. 3 demo: Increase in life expectancy, decrease in death, increase immigration a. smallest : immigration b. Largest: fertility 3. 3 important demographic trends: a. Increasing dependency load for 65+ b. Significant growth in older age cohorts c. Higher proportion of women cohorts move into older age d. Baby boomer increase ???? True or False 1. More developed countries show faster rates if population aging False 2. Decline in birth rate = primary case of population aging - true 3. Will be dramatic changes in canadian population structure in the next 50 years - false Immigrants uses all age ranges Canadian older adults are - From diverse ethnic background following patterns of migrations = MOBILE - 1st stage (after retirement) - Permanent vacationers - Snowbirds - 2nd stage = places w easier access to help -3rd stage = institutions Debate:

Define 1. 1) Is this index declining or increasing in Canada? a. Increasing 2. 2) Does the ratio really indicate dependency? a. No, you can still work at 65, subjective due to some retiring earlier or later 3. 3) Any policy, strategy to decrease dependency of older individuals to working age population a. No, you can still work at 65, subjective due to some retiring earlier or later Ageism Define: systematic discrimination of people of different age 1. Discuss the importance of the 3 main parts of the definition a. Reasononly becauseolder,b) _ 3)_ b. stereotypes (how we think), prejudice (how we feel) and discrimination (how we act) towards others or oneself based on age 2. How does ageism hurt all age groups not only older individuals a. Economic policy, increase age higher, add to pension plan Stereotypes - each student think of one stereotype about 1. Memory status of older individuals OR 2. Social life of older individuals Discuss how these - Might generate ageism - Can possibly hurt all age groups Harmless stereotypes - Give an example of a harmless stereotypes about older adults - Why is it a stereotype? - Why do you think it is harmless? - Canitalso become harmful? How? - Can the stereotype open doors for other (more harmful) stereotypes? Examples? *older folks being slower driver, older folks having bad memory, old people can not utilize stereotypes Older you get the more wise you are Harmless = positive

One harmless stereotype about older adults is the belief that "the older you get, the wiser you become." This stereotype suggests that with age comes a wealth of life experience and knowledge. While it may be rooted in some truth, it is a stereotype because it oversimplifies the complexities of aging and individual differences. It is often considered harmless because it portrays older adults in a positive light, highlighting their potential for wisdom and respect. However, it can become harmful if it leads to ageism or discrimination by assuming that all older individuals possess inherent wisdom, disregarding their individual capacities or contributions. Additionally, this stereotype can pave the way for more harmful stereotypes, such as assuming older adults are incapable of learning new things or being technologically savvy.

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1. Define life expectancy - avg # of years a person is expected to live from birth 2. What is epidemiological transition - changes that happen in trends in health/diseases over time, overall helps improve health promotion and health behaviors a. Definition b. Reasons 3. What is compression of morbidity - when people start to have chronic diseases or disabilities - Avg number of morbidity remain the same, just it happens later in time and shorter in period/time before death Compressic.x of Morbidity morbidity birth » age 60 85 S life extension «---- 13 o A Expansion of morbidity 60 95 ,,,,, compression of morbidity ----p Compression of morbidity isability free years ‘Same number of morbidity oI e s number of mor compressed in a shorter time Test you knowledge 1) What happens to an individual's sense thresholds as they age a) The threshold increases - eg. hearing — as one gets older, loss of hearing gets sensitive (higher threshold = lower sensitivity) 2) Which of the following has a strong positive association with obesity? d) watching television — slows metabolism , take into consideration of the positive aspects of the other options like sleeping, reading and wheelchair; since you need sleep to function, reading to increase knowledge, and some may need wheelchair to get from A toB 3) Older people (mostly) respond to changing physical problems by doing which of the following? b) adjusting their expectations about their activities - older ppl look at this commonly Big Questions:

e Are our perceptions from health decline in older age totally correct? Or is there misunderstanding and/or stereotyping? o Physical and mental health state e Are we responding to these changes correctly? o Atindividual (medical, personal care) levels o Society response o If yes, explain how o If not, what can we do? Notes from discussion: Keep an open mind, like forgetfulness and mental health (older vs younger, its stereotyped that older struggle with more mental health but in reality younger do more) eg. stereotypical term learned is geriatrics We're heading in the right direction in terms of educating, like Western U has a lot of aging courses within undergrad, masters, phd, doctorate Ex. older ppl get dementia and we are not exactly responding in the correct way, we shouldn’t be isolating them, putting them down, or not caring about them, etc. We need to create solutions and help vulnerable ppl Hw: write a paragraph about thoughts from today's discussion

Definition of Mental Disorders e Any of a broad range of medical conditions (such as major depression, schizophrenia, obsessive compulsive disorder, or panic disorder) that are marked primarily by sufficient disorganization of personality, mind, or emotions to impair normal psychological functioning and caused marked distress or disability and that are typically associated with a disruption in normal thinking, feeling, mood, behavior, interpersonal interactions, or daily functioning o Any problems with this definition? People have lots of opinions on mental disorder and judge it more than a physical disability. o When something is referred to as a medical condition, it means it is a disease, not normal, ways to prevent, and interventions. o When an issue passes a threshold and causes disorganization and effects behavior, then it might be a mental disorder that causes disability or distress. It is not as easy as measuring blood sugar. Opinions about Mental Disorders e Historically, mental disorders were considered different from 'physical’ diseases e Etiology: no organic/physiological cause (there is a reason, we just cannot find it yet) e High risk groups: people with some 'fixed' traits (people often ignore risk factors for mental disorders, personality can be a risk factor but you cannot fight against personality) e Treatment: ineffective (people think treatment won't work or some do not work because we do not know the physiological cause) e Prognosis: usually no mortality (people think that except suicide and anorexia, there is no risk for mortality) Society reaction: isolation No tangible support for these opinions by scientific evidence Opinions become more extreme for older populations, intersects with ageism Dementia: e Asof Jan 1, 2024 733,000 people in Canada are living with dementia (61.8% women) o New cases (incidence) daily: 350 e The projected number people in Canada to be living with dementia in 2030: 999,600 e 1in 5 caregivers have experience caring for someone living with dementia o Caregiver burden Individuals living with dementia e We need to plan for near future Linear increase with age, more women with dementia Can start as early as age of 40 Age is a clear risk factor, and we cannot do anything to change that. Our population is aging which is why we have more cases. Out of 100 people, 65% are female, 35% are male

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o This is misleading because there are just more older women than older men. We need to take into age distribution and stratification into consideration e s sex arisk factor? o If distribution is the exact same then results could be interpreted to determine if sex is infant a risk factor Are women twice likely to acquire dementia? e About 2/3 of people diagnosed with dementia are women e The lifetime risk (also the frequency, or count) of dementia is greater for women, similar to other aging-related diseases e When we stratify by age, we remove the effect of age, and still women are more likely to get dementia by it is not that pronounced (see 2nd graph) e So women are more likely to get dementia at any age group in comparison to men but not at a high degree like depicted in 1st graph. e The life expectancy for women is longer than for me, and age is the greatest risk factor o The differences in incidence (new cases) is not that pronounced, more realistic picture. e In conclusion, sex is a risk factor (not a strong factor) Dementia e Is adisease, there are several different types e Early symptoms of Alzheimer's disease: memory deficits, confusion, irritability, aggression, mood swings, and behavioral changes e There are etiologies (i.e., vascular changes in brain) o Risk factors for vascular diseases: risk factors for heart disease, are the same for vascular dementia. Alzheimer's Disease e Etiology not confirmed yet e Suggested risk factors: o About half of all prevalent cases of dementia are attributable to these 7 modifiable risk factors (many intersect with sex) o There are sex differences due to sexism, which is why some risk factors are more common in women and why dementia is more common in women. o Obesity, diabetes, hypertension, depression, inactivity, smoking, low education e Preventive measures: don't smoke, stay active, control depression, higher education Depression in Old Age e Depression rates are generally lower in older adults. It does not mean it does not exist in older people. This has not changed from 2009-2017. Earlier diagnosis, more awareness? Symptoms of depression in older adults are often underrecognized, underreported, and undertreated.

o Depression can sometimes be misdiagnosed as dementia which is concerning since depression is treatable versus dementia is not. e A disease with risk factors, effective prevention and treatment. o Men with physical diseases = strong risk factor e If we practice healthy aging, these rates could decrease even further. Self-Perception of Good Mental e Two important points about mental health of older adults: o Improved with age o resilience e Asks people "how do you think your mental health is?" o We can see that older individuals perceive to have better mental health than younger age groups e COVID affected younger people's mental health more, this did not happen in older individuals. e Huge drop in mental health in younger people, less than 5% for older people and these older individuals bounced back after a couple months. But for the young population, they did not bounce back. e Older people have significant resilience, so COVID did not impact their mental health. Resilience: e Disability-adjusted life years (DALY) is a measure of the burden a disease imposes on person and society e Inolder age, no additional depression or anxiety in comparison to younger ages. e Older people learn little by little on how to cope, whereas younger people do not as much Change in the Brain: e Our brain changes based on behavior. When we treat people well (socially, physically, mentally) the brain learns how to develop. e Plasticity: long-lasting alterations in the brain's chemistry, gray matter, and structural connectivity in support of behavior o Which helps the brain get better and stronger e Mental reserve capacity (not exclusive to cognition) o Not fixed and nor determined solely by genes e You can enhance peoples mental health by education, social status, stimulating lifestyle (exercise, social network, occupation) Brain Development in Later Life: 1. Reorganizing in response to new info and experience 2. Brain cells growth in later life 3. The brain's emotional centers become more balanced with age 4. Compared with younger people, older people use both halves of the brain more equally

In older age, senses become weaker (sight, hearing, etc.) but the brain becomes stronger, in terms of understanding emotions/behaviors at a higher degree than younger individuals Key: providing positive experiences throughout the life course for this brain development STUDY: Talked to older people in long-term care. They found that older people say they did not consider COVID pandemic to be a tragedy. By ‘othering' them, we made their resilience invisible. This resilience is coming from a brain that has been developed Key notes: e Brain plasticity is not automated, it does not happen to everyone, it only happens to those who are exposed to healthy behaviors e Those under lots of stress or isolation will not develop resilience « Healthy aging is something you cannot achieve, you need to work on it throughout your entire life. Brain Changes in Later Life e Encoding: linking new information with already stored information e Inolder age, encoding becomes slower. The information is still there, but accessing it becomes slower. So older individuals need to use more context and clues. Let the person develop the clues, do not tell them. With age, brain becomes smaller due to loss of brain mass. Those with Alzheimer's have an even smaller brain. e Memory like other cognitive and sensory functions, should be evaluated in the context (physical and social environment) e In lab studies, particularly for memory performance, people perform worse in comparison to everyday life (natural environment) o This is because in lab studies, you do not have sufficient opportunities to develop clues o Therefore, these findings cannot be generalized and are misleading Intervention is Possible e If brain function becomes slower, intervention can help e Brain responds to stimulation and challenge as a person ages.These stimulations/challenges can delay or even compensate for mental decline o Memory training o An enriched environment o Physical fitness training Key: we need the correct amount of challenge for normal aging Lawton's Ecological Model e This model is adaptable to most age-related health issues e Each and everyone person has a capacity, as we get older, we get huge variations of performance.

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Environmental demands or pressures (physical or social) can be weak or very strong. We need to find the mean level or balance = the correct amount of pressure based on someone's capacity o This is why research for aging is so vast o We need many different interventions for different levels of older individuals e Example: a person who is sensory deprived, means they cannot go out and receive stimulation despite being capable to, so this individual begins to decline. They need pressure from the environment (i.e., socialization, encouragement, etc.) e Example: a person who is very vulnerable and under too much pressure (i.e., homelessness in the winter, they cannot survive), we need to decrease this pressure and balance! e We need balance between pressures/demands from the physical and social environment and the capability of a person for healthy aging Abnormal Aging of Brain e Functional disorders in some people as they age e Paranoia, anxiety, neuroses, schizophrenia e Some organic disorders (disease of the brain) o Alzheimer's or Parkinson's disease m Confusion, forgetfulness m Behaviors not socially accepted, especially from an old person o Do not confuse forgetfulness (inability to remember) with encoding (slow encoding, using clues/contexts is a normal part of aging) e We tend to jump quickly and automatically assume that an older individual has a problem due to behaviors that are not accepted socially (i.e., inappropriate jokes in younger people are tolerated vs. in older people it is not, they are seen as having abnormal behavior) Challenges of Mental Health Issues in Old Age Stigma: e Receiving a label, facing stereotyping o Experiencing discrimination o Losing status o Limiting access to social and healthcare services Legal/ethical Issues e The loss of competence o People with a cognitive impairment may lose the ability to understand their situation and consequences of their decisions e Do not confuse competency (a legal term) with capacity (a clinical term that refers to a person's ability to function)

Tutorial Week of March 4 to 8, 2023 - Covering week 7 Social Health in Old(er) Age True or False: 1. People spend less time sleeping in old age: False 2. As people age, they naturally want to disengage and do not have an interest in new social networks and active leisure activities: False 3. Compared to younger generations, older generations spend more time on passive leisure activities: True Older people are less engaged because .... e Limitations in physical abilities e Absence of a connection to work e Loss of throughout life course established social networks de to death of family members and friends Group activity: How can we increase social engagement in each of these situations: Group 1 Limitations in physical activities: e Limitations does not always mean unable to (eg. bingo night is just sitting down and playing games) e Generate a physical activity, utilize activities that can be done within the house, to also bring it outside and complete it with a bigger group Volunteering Intergenerational mixes — long term homes had day care children which is another way to engage e Buddy program Group 2: Absence of a connection to network: Group 3: Loss of social interactions: e Be around people that are going through similar things and discuss Review the goals and purposes of education in old age *this was not really discussed just to mainly talk about in reflection submission for today How can more equitable educational opportunities be provided in old age? Do we need totally different institutions? Or is it better to use existing facilities and modify them for older populations? What are the potential impacts of education in old age on the social health of older adult

Week 8 Content: Domains (Dimensions) of Healthy Aging 1) Refer to table 1 of Lu 2019 and select one domain of healthy aging 2) Select 2-3 indicators (a variable that can be measured) representing the selected domain in 1 a) You may use table 2 of Lu 2007 as a guide (page 301) Mexico — social wellbeing & security Cognitive health -> short term memory, long term memory Psychological wellbeing -> depressive symptoms, life satisfactions Group Work: The quality of intervention Refer to Table 14-1 of your reading (Chapter 14 if Satariano & Maus) or the Week 8 slides 23 to 25. Please discuss whether these 3 interventions listed below satisfy the 4 criteria for a ‘good’ intervention. Discuss each criterion separately 1. A matter of Balance (AMOB) 2. Otago Exercise Program 3. Tai Chi: Moving for a Better Balance (TCMBB) Audience Active Living Fuery 12-week sessions. Irained facilitators wwwACtiveLving. ey LEDS y D @aricast 1 per oo Brysical sttty 1o sessiond Ther aaiy Tves AMater ofoance Reduce s riskand | Adls sge 60 an . o e ciTalingrimorove | Gdsratoare - | ek orice ] 2lenedlnvlesders Humaineresiin falls efficacy and ambulatory and able weekly), 2 hours per Tk management promors 10 prosier soe Semsion Jie-rhievis Crveniconesse Adutswthchionc 6 sessons,about2 2 wained layloaders hixpys 2 pansaemare hours per session patienteducation. Sanford edu Programasteism, P it &stronat Manage ower s Sedentary oider Buweeks 3 tmesper Traine exremiy osteoarthrite aduliswithlower: | ek 00 mimirer | oned focltator westandstrong ‘extremity joint per session e pain and stffness; participants must be cleared by a physician to, participate in exercise

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Program Name Otago Exercise Program Program to Encourage Active, Rewarding Lives for Seniors (PEARLS) Stepping On Tai Chi: Moving for Better Balarice balance, and endurance Reduce symptor of depression and improve health-related Qquality of life Increase seif confidence in making decisions and changing behavior (4. exercise) o reduce falls Improve balance, strength, and physical Community- dwelling frail older adults Adults age 60 and older with minor depression or Comimunity-residing, coanitively intact, older adults at risk for falling Adults age 65 and older TABLE 14-1 Selected Examples of the Highest-Level Disease Prevention Evidence-Based Programs for Seniors Increase strength, 45 home visits over 8 weeks; monthly phone calls for a year; optional follow-up visits (6,9, and 12 months) 8 sessions, 50 (occurs over 19 weeks) Trained social services worker per session 1 trained leader; 1 peer leader 7 week program, 2 hours per session: home or telephone visit; booster session after 3 months 24- 10 26-week Qualified instructors program, 3 cl per week, 1 nour per Physical therapist http/ /. meduncedu/ aging/cgecs exercise-program g wihealthyaging. org/stepping-on www tiambb.org performance to (TCmes) prevent falls To evaluate whether the interventions A Matter of Balance (AMOB), Otago Exercise Program, and Tai Chi: Moving for a Better Balance (TCMBB) satisfy the four criteria for a 'good’ intervention, let's discuss each criterion separately: Effectiveness/Efficacy: A Matter of Balance (AMOB): AMOB has been designed to reduce the fear of falling and increase activity levels among older adults. Several studies have shown its effectiveness in reducing falls and fear of falling, improving balance and mobility, and enhancing self-efficacy. Therefore, it meets the criterion of effectiveness. Otago Exercise Program: This program consists of a series of strength and balance exercises tailored to individual needs. Numerous studies have demonstrated its effectiveness in reducing falls among older adults, particularly those at high risk. Thus, it satisfies the criterion of effectiveness. Tai Chi: Moving for a Better Balance (TCMBB): TCMBB integrates Tai Chi movements specifically aimed at improving balance and reducing the risk of falls among older adults. Research has shown its effectiveness in improving balance control, reducing falls, and enhancing overall physical function. Hence, it meets the criterion of effectiveness. Safety: A Matter of Balance (AMOB): AMOB primarily involves group-based exercises and education sessions, which are generally safe for older adults. However, safety concerns may arise if participants have underlying health conditions or if exercises are not performed correctly. Nonetheless, the program is typically structured to minimize risks and ensure participant safety. Otago Exercise Program: The exercises in the Otago program are designed to be safe for older adults. However, individualized assessment and supervision are crucial to ensure that exercises are performed correctly and safely, especially for participants with pre-existing health issues. Tai Chi: Moving for a Better Balance (TCMBB): Tai Chi is generally considered a safe form of exercise for older adults. However, participants should be monitored for any adverse effects, particularly those with musculoskeletal or balance impairments. Proper instruction and supervision are essential to minimize the risk of injury. Feasil ity:

A Matter of Balance (AMOB): AMOB is a structured program that requires trained facilitators to deliver the sessions. It may require resources for training facilitators, organizing sessions, and ensuring participant engagement. However, it has been implemented in various community settings, indicating its feasibility with appropriate planning and support. Otago Exercise Program: The Otago program involves a series of exercises that can be adapted to different settings, including home-based or group sessions. While it requires trained instructors and adherence to a structured protocol, it has been successfully implemented in various healthcare and community settings. Tai Chi: Moving for a Better Balance (TCMBB): TCMBB involves teaching Tai Chi movements tailored specifically for balance improvement. Like other exercise programs, it requires trained instructors and appropriate space for conducting sessions. With adequate resources and support, it can be implemented feasibly in community or healthcare settings. Acceptabil A Matter of Balance (AMOB): Participant feedback and research studies suggest that AMOB is generally well-received among older adults. The group-based format provides social support and encouragement, contributing to its acceptability. Otago Exercise Program: The Otago program has received positive feedback from participants due to its personalized approach and focus on improving strength and balance. However, individual preferences and adherence may vary based on factors such as program duration and intensity. Tai Chi: Moving for a Better Balance (TCMBB): TCMBB offers a holistic approach to fall prevention through the practice of Tai Chi, which is often perceived favorably by older adults. The gentle movements and meditative aspects make it appealing to a wide range of participants, contributing to its acceptability.

Community care programs: home care, geriatric day hospitals, adult daycare Home care: subpopulations to revive this healthcare - ppl w chronic conditions, mobility issues, mainly older populations Benefit: ppl just enough support to prevent going to a long term health care, more covers in care and so the specific needs are met and you are home surrounded in a house with family. Provides psychological care Cons: cost with the equipment in the house will cost a lot. Does not have access to everything like a hospital and specialists. Financial barriers, language barriers Adult day care: need to pay out of own pocket Ppl have access to transportation except those in rural area, should be in mobile condition, those adults that don’t have many companiships benefit Pros: social relations improved, they can go home and daycare not needed to go to care services. Structured activities - ppl may not like the w it cities that are offered Cons: lower class can't access, barriers of transportation (ex. Red Cross), some not comfortable to go and language barriers may be hesitant to go to adult day care Geriatric day hospitals (GDHs) are specialized outpatient facilities that offer comprehensive multidisciplinary health services to elderly patients. These services often include medical treatment, rehabilitation, and social support, tailored to the individual needs of older adults to improve their functionality, independence, and quality of life. Different subpopulations of elderly individuals may benefit from GDHs, and there are various pros and cons associated with these programs. You have to be referred to get to these types of places so the indivual may not meet expectations ### Subpopulations Benefiting More from GDHs (usually 65 and up, but also dis sim itt and chronic issues) - dieticans, psychotherapists, social aspect of meeting alike individuals 1. **Post-hospitalization patients:** Older adults who have been recently discharged from the hospital but still require structured medical care and monitoring can significantly benefit from GDHs. These facilities provide an intermediate level of care, helping patients transition safely back to their homes.

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2. **Those with multiple chronic conditions:** Elderly patients with multiple comorbidities often need ongoing, coordinated care that GDHs are well-equipped to provide, helping manage complex health needs and reduce hospital readmissions. 3. **Patients with mobility issues and physical disabilities:** GDHs offer physical therapy and rehabilitation services, which are crucial for seniors facing mobility challenges, helping them maintain or improve their physical function. 4. **Individuals with mild to moderate cognitive impairments:** GDHs can offer cognitive therapies and activities that support individuals with dementia or mild cognitive impairments, potentially slowing the progression of their conditions. 5. **Socially isolated seniors:** GDHs provide a social environment and structured activities, which can be beneficial for elderly individuals who are isolated or lonely, improving their social well-being and mental health. ### Pros of Geriatric Day Hospitals 1. **Comprehensive care:** GDHs provide a holistic approach to care, addressing medical, rehabilitation, and social needs in one location. 2. **Prevention of hospitalization:** By offering ongoing, proactive care, GDHs can prevent the need for hospital admissions and reduce emergency room visits. 3. **Support for caregivers:** They provide respite for caregivers, reducing their burden and stress levels. 4. **Enhanced quality of life:** Through various therapies and social activities, GDHs can improve the overall well-being and quality of life for elderly patients. 5. **Cost-effectiveness:** GDHs can be more cost-effective than inpatient care, especially for long-term management of chronic conditions. ### Cons of Geriatric Day Hospitals 1. **Accessibility:** Transportation to and from the facility can be a challenge for some seniors, especially those living in remote areas.geriatric isn't as common 2. **Not suitable for all:** GDHs might not provide the level of care required for seniors with severe medical conditions or those needing round-the-clock supervision. 3. **Resource-intensive:** Setting up and maintaining a GDH requires significant resources and a multidisciplinary team, which can be a barrier in some regions.

4. **Adaptation period:** Some seniors might find it challenging to adjust to the routine of attending a day hospital, feeling overwhelmed by the new environment and schedule. 5. **Limited availability:** There may be limited availability of GDHs in certain areas, restricting access for some elderly individuals who would benefit from such services. Overall, GDHs represent a valuable model of care for elderly populations, offering tailored, comprehensive services that can significantly enhance their health and quality of life. However, the effectiveness and suitability of GDHs can vary depending on individual circumstances and local healthcare infrastructure.

1) Formal care versus informal care 2) Major differences ‘how do models of healthcare approach care? - model (promo-care) 3) How can the Canadian system be modified to address issues related to informal care better? - Schedule easier to accommodate for care - More resources can be produced (transportation as an example Risk Factors for social isolation - Read the case-study 13.1.1 (2-3 mins) 1. What individual factors contributed to Hilda's social isolation? e Losing her vision e She has arthritis in her knee, mobility issues e She could not afford to get a taxi, financial situation worsen transportation problems How did she make gradual modifications e Can go to a senior care centre which she could get to by bus How the healthcare system could have done better e Make transportation free or more accessible for her 2. What changes in her social network contributed to Hilda's social isolation? e Her health problems impacted her connection with friends; sister lives in diff province so she is isolated e Her neighborhood - she felt unsafe and safety issues arised like snow no shovel 3. What contextual factors contribute to Hilda’s social isolation? L] COVID -19 and Institutionalization of Death e Following discussion from class about institutionalization of death what additional issues were possibly created by COVID-19 in the landscape of bereavement for those who lost an older person due to COVID - 19 in an institution (read case study 14.2.2) o There is a loss of contact, so cant see family face to face and so once they go to hospital cant see them to say final goodbyes due to restrictions of covid o Might feel bad socially isolating, contributing to loneliness and guilt since they can't be there for the loved ones o Ignoring the person’s wishes related to death o Overmedicalization of the process e Long term effects of losing someone? o Haven't seen them for a while, wont have that closure which can involve destruction in grieving process o Dealing with grieving without the support of others and loved ones around you due to covid o Push away from entering the hospital in fear of losing loved ones in a place where they cant see them

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e How overcome the grief - o there can be time put towards hobbies and activities and surround by loved ones to distract from the grief and Do you think there may remain long term effects on the grieving process of those who have lost an older loved one? The risk of maladaptive grief: there is a risk as it can negatively affect a person’s health engaging in unhealthy behavior (eating) TUTORIAL SUBMISSION:

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tutorial 5 - feb 28 sex discrepancies in depression Turube et al (among others) showed that older Canadian women are 2 to 3 times more likely to suffer from depression than men. How do you explain these findings using your knowledge? 1. There are more older women than men and (probably) depression is more common in older age. How to explore there are 2-3 times more older women in Canada? 2. Currently (roughly) there are 3.5 million >65 men and 4.4 million older women in Canada 3. Many determinants that affect girls and younger women remain detrimental for women through lifecourse o they suffer from more chronic diseases causing stress ¢ women have more beauty standards o there is generally more older women ¢ women have more familial stress o an aftereffect of toxic masculinity ¢ men tend not to complain about stress e review population pyramid tragedy or ordeal? intersecting perspectives on life and death of older adults in long-term care during the COVID-19 pandemic Data: personal accounts of 15 older persons who resided in LTC homes in Montreal and Toronto during the COVID-19 pandemic . "Finding: Our analysis shows that the media which repeatedly highlighted shocking numerical accounts of human deaths and devastating conditions of life and death constructed COVID 19 as a tragedy impacting an objective and passive 'other'. Yet older residents who lived through COVID 19 in LTC viewed it as one of many ordeals of life which they managed with strong social relationships.

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The issue: By objectifying death and generating a tragedy narrative not only was human resilience rendered invisible, but opportunities for action were hampered. Intervention: We hope that infusing the voices of older persons into the COVID 19 conversation will invite opportunities for transformation and renewal in LTC.” discuss: 1. what are the sources of considering older adults ‘others’? * media not considering older populations * studies constantly making older populations “vulnerable” and ignoring their actual views based on assumptions o erasing their narrative e stereotypes o physical separation with long-term care centres 2. how can this harm all age groups? * we're all going to grow older; affects our views and perceptions on the older populations as well o we will internalize it o further spreading ageism « making people fear aging 3. resilience grew even when it was invisible. any suggestions to empower older adults more? * more social interaction and connection o bring discussions to other regions other than Toronto — analyze the disparities since it’s not representative of the entire population * more interactive games and activities that they would want to do * paying attention to social wellbeing rather than just physical wellbeing * giving them back autonomy

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